Increased bacterial resistance: PROTEKT US--an update

Community-acquired respiratory tract infections (CARTIs), including community-acquired pneumonia, acute exacerbations of chronic bronchitis, and acute bacterial sinusitis, remain substantial sources of morbidity and mortality in the US. The increasing prevalence of antimicrobial-resistant strains among the common respiratory pathogens, particularly Streptococcus pneumoniae, has complicated the choice of antimicrobials and threatens the efficacy of treatment for CARTIs. This highlights the need both for ongoing surveillance efforts to track current resistance patterns and for the development of new antimicrobial agents effective against resistant organisms. To provide current and ongoing antimicrobial resistance surveillance data, including comparisons of telithromycin (the first ketolide to undergo clinical development and be approved by the Food and Drug Administration) with other agents, a longitudinal global surveillance study--Prospective Resistant Organism Tracking and Epidemiology for the Ketolide Telithromycin (PROTEKT)--was launched in 1999. A US component of this study was initiated in 2000, and results from the first respiratory infection tracking season (2000-2001) are discussed in this article. Providing resistance data on the national, regional, and local levels, PROTEKT US has thus far confirmed the increasing prevalence of resistant S. pneumoniae isolates to beta-lactams and macrolides, as well as the emergence of fluoroquinolone resistance in the US. Importantly, telithromycin was highly active against S. pneumoniae, including resistant isolates.