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Capsular Serotyping of Streptococcus pneumoniae Using the Quellung Reaction
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Penicillin susceptibility breakpoints for Streptococcus pneumoniae and their effect on susceptibility categorisation

M Imöhl1, R R Reinert, P M Tulkens

  • 1Institute of Medical Microbiology, National Reference Center for Streptococci, University Hospital (RWTH) Aachen, Pauwelsstr. 30, Aachen, Germany, matthias.imoehl@rwth-aachen.de.

European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology
|June 16, 2014
PubMed

Insights

Invasive pneumococcal disease (IPD) surveillance in Germany showed a slight decline in penicillin susceptibility over 16 years. Emerging high-level penicillin resistance in Streptococcus pneumoniae was observed, highlighting the impact of differing interpretation guidelines.

Area of Science:

  • Microbiology
  • Epidemiology
  • Infectious Diseases

Background:

  • Continuous nationwide surveillance of invasive pneumococcal disease (IPD) in Germany tracked penicillin susceptibility from 1997 to 2013.
  • Data included 20,437 Streptococcus pneumoniae isolates, with 13.7% from meningitis cases and 86.3% from non-meningitis cases.

Purpose of the Study:

  • To analyze trends in penicillin susceptibility of invasive pneumococcal isolates in Germany over a 16-year period.
  • To evaluate the impact of different interpretation guidelines (CLSI and EUCAST) on categorizing penicillin resistance.

Main Methods:

  • Analysis of nationwide IPD surveillance data from July 1, 1997, to June 30, 2013.
  • Determination of penicillin minimum inhibitory concentrations (MICs) for 20,437 Streptococcus pneumoniae isolates.
  • Comparison of susceptibility categorisation using pre-2008 CLSI, 2008-2014 CLSI, and 2009-2014 EUCAST breakpoints.

Main Results:

  • A slight decline in penicillin susceptibility was observed over the study period.
  • The first isolates of Streptococcus pneumoniae with high-level penicillin resistance (MICs of 8 μg/ml) were detected in 2012/2013.
  • Different guidelines resulted in varying percentages of intermediate and resistant isolates, particularly for meningitis cases.

Conclusions:

  • Penicillin resistance in invasive pneumococcal isolates in Germany shows a concerning trend, with emerging high-level resistance.
  • The choice of interpretation guideline significantly impacts the reported rates of penicillin resistance, necessitating careful consideration when comparing surveillance data.
  • Continued monitoring of antimicrobial susceptibility is crucial for effective management of IPD.

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