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Pneumococcal antimicrobial resistance: the problem in Hungary
1Heim Pál Children's Hospital, Budapest, Hungary.
Abstract:
An epidemiological survey of penicillin resistance as determined by minimum inhibitory concentrations (MICs) in Streptococcus pneumoniae strains collected from several Hungarian laboratories in 1988-1989 indicated a prevalence of 58% among a total of 135 isolates. A significantly higher resistance rate (69.2%) was found for isolates from pediatric patients than from adult patients (44.0%). Penicillin-resistant strains were more frequently resistant to non-beta-lactam antibiotics (tetracycline, erythromycin, co-trimoxazole, and chloramphenicol) than were penicillin-sensitive strains. On the basis of the MIC50 and MIC90 values of ampicillin and five cephalosporins for penicillin-resistant strains, it was established that ampicillin and cephalexin were not superior to penicillin. The low MIC90 of ceftriaxone and cefotaxime for these organisms reflects promising therapeutic potential, even in septicemia and meningitis caused by penicillin-resistant strains. The therapeutic alternative to penicillin in the treatment of respiratory tract infection may be second-generation cephalosporins such as cefuroxime or cefamandole.
Insights
Penicillin resistance in Streptococcus pneumoniae reached 58% in Hungary (1988-1989), with higher rates in children. Penicillin-resistant strains showed cross-resistance to other antibiotics, but ceftriaxone and cefotaxime offer therapeutic promise.
Area of Science:
- Microbiology
- Epidemiology
- Infectious Diseases
Background:
- Penicillin resistance in Streptococcus pneumoniae is a growing public health concern.
- Understanding resistance patterns is crucial for effective antibiotic therapy.
Purpose of the Study:
- To determine the prevalence of penicillin resistance in Streptococcus pneumoniae in Hungary.
- To assess the susceptibility of resistant strains to other antibiotics.
- To evaluate the potential of alternative antibiotics for treating infections caused by resistant strains.
Main Methods:
- Epidemiological survey of Streptococcus pneumoniae isolates from Hungarian laboratories (1988-1989).
- Determination of minimum inhibitory concentrations (MICs) for penicillin and other antibiotics.
- Comparison of resistance rates between pediatric and adult patient isolates.
Main Results:
- A 58% prevalence of penicillin resistance was observed in 135 Streptococcus pneumoniae isolates.
- Pediatric isolates exhibited a significantly higher resistance rate (69.2%) compared to adult isolates (44.0%).
- Penicillin-resistant strains demonstrated higher co-resistance to tetracycline, erythromycin, co-trimoxazole, and chloramphenicol.
Conclusions:
- Ampicillin and cephalexin showed no superiority over penicillin against resistant strains.
- Ceftriaxone and cefotaxime demonstrated low MIC90 values, indicating potential therapeutic value for severe infections.
- Second-generation cephalosporins like cefuroxime or cefamandole may serve as alternatives for respiratory tract infections.