Antimicrobial susceptibility profiles among common respiratory tract pathogens: a GLOBAL perspective

Antimicrobial resistance by common respiratory tract pathogens remains a global concern, but surveillance programs allow us to recognize trends in susceptibility that may help guide empiric antimicrobial selection. During 2003 to 2004, the Global Landscape On the Bactericidal Activity of Levofloxacin (GLOBAL) surveillance program collected 9323 isolates of Streptococcus pneumoniae, 5828 isolates of Haemophilus influenzae, and 1878 isolates of Moraxella catarrhalis from 15 countries worldwide, and tested them for susceptibility to commonly used antimicrobial agents at a central laboratory. For S pneumoniae, penicillin (oral) susceptibility ranged from 41.5% (Asia) to 75.3% (Europe), while susceptibility to erythromycin ranged from 23.7% (Asia) to 87.0% (Central and South America). Susceptibility to levofloxacin was > or = 98.0% for each region studied, with the minimum inhibitory concentration (90%) (MIC(90)) = 1 microg/mL. Susceptibility to ciprofloxacin was > or = 81% for each region studied, with the MIC(90) = 2 microg/mL. For H influenzae, resistance to ampicillin ranged from 8.7% (South Africa) to 29.6% (Asia), while resistance to trimethoprimsulfamethoxazole ranged from 15.3% (United States) to 40.3% (Asia). Moraxella catarrhalis isolates from each region were > 95.0% susceptible to all antimicrobials tested. Susceptibility of H influenzae and M catarrhalis to levofloxacin was > 99.0% in each country. In general, S pneumoniae resistance to penicillin and macrolides remains a concern. Although the prevalence of ss-lactamase production by H influenzae and M catarrhalis can be high, these organisms continue to be susceptible to several commonly used antimicrobials. Respiratory fluoroquinolones continue to show high activity against these 3 organisms. There has been no change in the levofloxacin MIC(90) values for S pneumoniae and only rarely have resistant isolates of H influenzae and M catarrhalis been identified worldwide.