Prevalence of Antimicrobial Resistances in Streptococcus pneumoniae Isolates in
Australia, 2005: Report from the Australian Group on Antimicrobial Resistance (AGAR)
South Metropolitan Area
Thomas Gottlieb1, Peter Collignon2, Jennifer Robson3, Julie Pearson4, Jan Bell5, and the Australian Group on Antimicrobial Resistance
1Department of Microbiology and Infectious Diseases, Concord Hospital, New South Wales, 2Infectious Diseases Unit and Microbiology Department, The Canberra Hospital, Woden, ACT, 3Microbiology Department, Sullivan Nicolaides Pathology, Taringa, Queensland,
4Department of Microbiology and Infectious Diseases, Royal Perth Hospital, PathWest Laboratory Medicine, Western Australia, 5Department of Microbiology and Infectious Diseases, Women’s and Children’s Hospital, South Australia.
is a common cause of
meningitis and bacteraemia as well as community-
Table 1 CLSI (2009) interpretive standards for penicillin
pneumonia, sinusitis, and otitis media. Rates of
antimicrobials have increased over the past two
decades, compromising treatment efficacy particularly
The Australian Group on Antimicrobial Resistance
antimicrobial resistance. Resistance rates from this
Figure 4 Trends in erythromycin resistance 1994-2005
current study were compared to those from previous
AGAR surveys conducted in 1989 (where only
penicillin was tested), 1994, 1999 and 2002.
Twenty institutions from the 5 mainland states and the
Australian Capital Territory (ACT) participated in the S.
AGAR survey. Starting 1st January 2005, each
laboratory collected up to 100 consecutive significant clinical
Figure 1 Penicillin MIC distribution 2005 (%S, I and R refer to
Alpha-haemolytic, optochin sensitive, and/or
bile-soluble, Gram-positive cocci were identified as S.
. Any strain with an optochin zone of inhibition of
Figure 5 Trends in tetracycline resistance 1994-2005
between 6 and 14mm in CO was tested for bile solubility.
Participating laboratories performed
Overall penicillin I+R
laboratory’s routine standardised methodology (CDS, CLSI or
BSAC disc diffusion, Vitek2®, agar dilution or MIC testing).
Clindamycin and erythromycin discs were placed side by side
to look for clindamycin inducibility. Penicillin and moxifloxacin
MICs were determined for all isolates using Etest® strips.
Four hundred and seventy one (95%) of the 497 isolates that
were penicillin intermediate or resistant (MIC >0.064 mg/L)
were also tested with either a ceftriaxone or cefotaxime
Figure 2 Trends in penicillin for non-invasive isolates 1989-2005
Figure 6 Trends in co-trimoxazole resistance 1994-2005
A total of 1,776 S. pneumoniae
isolates were included
Table 2 Multi-resistance in S. pneumoniae
in the study. 20% of isolates were from invasive
Overall penicillin I+R
The new penicillin CLSI breakpoints
(Table 1) were employed for this survey. Overall
497/1,776 (28%) isolates were non-susceptible to oralpenicillin. All of the blood culture isolates were
breakpoints. One CSF isolate (MIC 0.25mg/L) was
resistant by the parenteral (meningitis) breakpoint.
Figure 3 Trends in penicillin for invasive isolates 1989-2005
Trend data shows that overall penicillin resistance
levofloxacin was detected in another four isolates.
continues to increase for invasive and non-invasive
326/1,775 (18.4%) isolates were
Moxifloxacin resistance was present in two isolates
strains however since 2005 high-level resistant
tetracycline resistant. There was a significant
difference (P<0.001) in tetracycline resistance
intermediate strains have declined (Figures 2 and 3).
17.3% of isolates were multi-
among non-invasive (21.3%) and invasive (6.3%)
resistant (acquired resistance to >2 drug classes)
Cefotaxime or ceftriaxone
strains. Trend data shows that after an increase in
(Table 2). Multi-resistance was significantly higher
MICs were determined on 95% of penicillin non-
resistance in non-invasive isolates from 1994 to
susceptible strains. Fourteen isolates (3.0%) were
1999, overall resistance has remained relatively
compared with invasive strains (6.0%).
resistant to either cefotaxime or ceftriaxone.
steady from 1999 to 2005 (Figure 5).
Erythromycin and clindamycin:
550/1,775 (31.0%) isolates were
isolates were erythromycin resistant. Resistance was
significantly higher (P<0.001) in non-invasive (24.6%)
mainly due to the increase of high-level resistant
compared with invasive strains (15.1%). 228/1,462
strains in invasive and non-invasive infections.
(32.2%) compared with invasive (25.6%) strains.
(15.6%) isolates were clindamycin resistant. Of 364
Macrolide resistance continues to increase with
Trend data shows decreasing rates of resistance in
erythromycin resistant isolates, 222 (61%) had a
current rates at 23%. Of concern is the high
invasive isolates from 1994 to 2005 and a
MLS constitutive resistant phenotype and 6 (1.6%)
proportion of multi-resistant strains with almost one
decrease for non-invasive strains from 2002 to
had inducible resistance. Trend data shows that
erythromycin resistance for all strains is increasing
albeit slowly. A decline in resistance from 19.2% to
resistance was detected in only four of 1,775
15.1% over the last two surveys was evident for
(0.2%) isolates tested. Intermediate resistance to
AGAR has been supported by the Department of Health and Ageing
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