Increasing prevalence of antimicrobial resistance in Streptococcus pneumoniae in Kuwait: implications for therapy

From 2001 to 2004, 824 consecutive Streptococcus pneumoniae isolates obtained from all the teaching hospitals and primary-care centers serving all of Kuwait were studied for their susceptibility to a number of antibiotics. Of these, 514 (63%) were resistant to penicillin, 55% of which were of intermediate resistance, with a minimum inhibitory concentration (MIC) of 0.16-1 microg/ml, and 8% were of full resistance (MIC > or =2 microg/ml). The prevalence of penicillin resistance was significantly higher among the eye isolates than the rest of the isolates combined. Resistance across all classes of antibiotics was more common with the isolates from blood and cerebrospinal fluid (CSF). Decreased susceptibility to ceftriaxone, cefotaxime, imipenem, meropenem, erythromycin, and cotrimoxazole was observed in 15%, 12.8%, 10.2%, 8.6%, 42%, and 69% of isolates, respectively. Multidrug-resistant S. pneumoniae was isolated mostly from invasive diseases. There has been a remarkable increase in the prevalence of drug-resistant S. pneumoniae isolates in Kuwait over the past 20 years, and Kuwait has thus joined the league of hyperendemic countries for penicillin-resistant S. pneumoniae (PRSP). It is also conceivable that Kuwait, with a large expatriate population of workers, may serve as a focal point for further dissemination of resistant clones to the rest of the world. These data are unique because they are representative of the whole Kuwaiti population.