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Changes in Streptococcus pneumoniae Susceptibility in Wisconsin: Implications for Clinical Treatment Decisions for
Erik Munson1,2, Stephen C Lavey3, Megan R Lasure4,5
1Department of Medical Laboratory Science, Marquette University, Milwaukee, Wisconsin erik.munson@marquette.edu.
Abstract:
Objective: In 2019, the American Thoracic Society and Infectious Diseases Society of America updated clinical practice guidelines for community-acquired pneumonia (CAP). In contrast to guidelines published in 2007, macrolide monotherapy for outpatients was made a conditional recommendation based on resistance levels. Local knowledge of current antimicrobial susceptibility is needed to guide management of CAP and other bacterial respiratory pathogens. The purpose of this study was to investigate antimicrobial susceptibility profiles and trending for Wisconsin Streptococcus pneumoniae isolates.Design: Multi-center laboratory surveillance, with testing at a central location utilizing standardized susceptibility testing protocols.Methods: Data published by the Wisconsin Department of Health Services (DHS) were augmented with data from the Surveillance of Wisconsin Organisms for Trends in Antimicrobial Resistance and Epidemiology (SWOTARE) program. Data were stratified by invasive or non-invasive sources, as well as DHS region and compared to data compiled from 2006-2010.Results: Susceptibility rates for ≥ 916 invasive S. pneumoniae assessed from 2016-2020 were greater than 91% for ceftriaxone, tetracycline, and fluoroquinolone agents and were generally higher than those from 354 non-invasive isolates. Low susceptibility rates were observed for invasive isolates of penicillin (78.7%) and erythromycin (64.8%) and were even lower for non-invasive isolates (73.8% and 59.9%, respectively). This erythromycin susceptibility rate was a significant reduction from that observed in 2006-2010 (80.4; P < 0.0002). 24.8% of isolates generated an erythromycin MIC ≥ 8 μg/mL. Statewide geographic variability was noted.Conclusions: Rates of S. pneumoniae susceptibility to parenteral penicillins and cephems, and oral tetracycline and fluoroquinolone agents, remain high throughout Wisconsin. However, low oral penicillin susceptibility rates, taken together with declining macrolide susceptibility rates, should cause clinicians to consider alternative treatment options for respiratory tract infections, especially with macrolides.
Insights
Antimicrobial resistance in Wisconsin Streptococcus pneumoniae is increasing, particularly for macrolides like erythromycin. Clinicians should consider alternative treatments for respiratory infections due to declining susceptibility rates.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Public Health Surveillance
Background:
- Updated clinical guidelines for community-acquired pneumonia (CAP) emphasize antimicrobial resistance.
- Macrolide monotherapy for outpatients is now a conditional recommendation.
- Local antimicrobial susceptibility data are crucial for guiding CAP treatment.
Purpose of the Study:
- To investigate antimicrobial susceptibility profiles and trends for Streptococcus pneumoniae isolates in Wisconsin.
- To inform clinical management of respiratory tract infections based on local resistance patterns.
Main Methods:
- Multi-center laboratory surveillance data from Wisconsin Department of Health Services (DHS) and the SWOTARE program were analyzed.
- Data were stratified by invasive/non-invasive sources and DHS region.
- Susceptibility testing utilized standardized protocols and compared current data (2016-2020) with historical data (2006-2010).
Main Results:
- High susceptibility (>91%) for invasive S. pneumoniae to ceftriaxone, tetracycline, and fluoroquinolones.
- Low susceptibility for invasive isolates to penicillin (78.7%) and erythromycin (64.8%).
- Erythromycin susceptibility significantly decreased from 80.4% (2006-2010) to 64.8% (2016-2020), with 24.8% showing high MICs.
Conclusions:
- S. pneumoniae susceptibility to parenteral penicillins, cephems, oral tetracyclines, and fluoroquinolones remains high in Wisconsin.
- Declining macrolide (erythromycin) and low oral penicillin susceptibility necessitate consideration of alternative treatments.
- Geographic variability in susceptibility was observed statewide.
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