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We investigated children aged 2-5, who had gone adenoidectomy for recurrent and/or persistent symptoms of upper respiratory tract infections for prevalence of pneumococci in adenoid tissue. Serotypes and antibiotic resistance patterns of the isolated pneumococci were determined and also risk factors of pneumococcal colonization were defined. S. pneumoniae colonization in adenoids was found in 62 (60.2%) children. Serotypes belonged to 10-valent and 13-valent pneumococcal conjugated vaccines (PCVs) constituted 56.1% and 68.2% of the isolates, respectively. Decreased susceptibility to penicillin was found in 45.5% of isolates; pneumococci were resistant to co-trimoxazole (62.1%), tetracycline (43.9%), erythromycin (54.5%), clindamycin (54.5%) and chloramphenicol (31.8%). Multidrug resistant S. pneumoniae comprised 57.6% of the isolates. Antibiotic resistant pneumococci were mostly distributed among serotypes belonged to 10-valent and 13-valent PCVs. Good vaccine coverage among the isolated pneumococci confirmed that the introduction of PCVs in the national immunization programme may reduce the pool of resistant and multidrug resistant pneumococci in a community.
In this study we present an analysis of prescription numbers of various antibiotic classes to Bavarian (Southern Gennany) outpatients between 2000 and 2006 compared to fluctuating resistance patterns in representative respiratory pathogens. Prescriptions of "narrow-spectrum" antibiotics (e.g. penicillins, macrolides) decreased by 39% while prescriptions of "broad-spectrum" antibiotics increased by 38%. The most prominent increase was for quinolones and cephalosporines class II. Prescriptions of these antibiotics exhibited prominent seasonal alterations suggesting that these drugs had been used for treatment of respiratory infections. In contrast, the numbers of S. pneumoniae and H. influenzae detected in respiratory specimen decreased. Almost constant resistance rates of S. pneumoniae for first line antibiotics do not justify an increased use of cephalosporins class II and quinolones. Compared to Europe and Gennany in general, consumption of antibiotics is low in Bavaria. Even at this low level we propose an education of physicians treating outpatients in a way to avoid an excessive use of antimicrobials.
An abrupt antimicrobial resistance increase among Streptococcus pneumoniae strains has become a serious therapeutic problem in the recent years. The aim of this study was to describe the resistance increase of S. pneumoniae strains isolated in the West Pomerania Province over three years (2001-2003). Using E-tests method and NCCLS criteria for 80 pneumococal resistant strains the resistance degrees and patterns have been determined and analyzed in connection with their clinical origin. The majority of specimens of resistant strains isolated came from nasopharynx (80% strains) of infected ambulatory patients (81.3%), from children at nursery school age (65.7%), suffering from chronic upper respiratory tracts infection (86.7%). However, strains originated from older patients, hospitalized, in serious health condition showed higher resistance degrees. The greatest number of isolates (27.5%) showed resistance to 3 out of 9 tested drugs and over a half (53.8%) of the tested strains belonged to MDR strains, with increasing percentage over time: from 62.5% in 2001 to 69.8% in 2003. Resistance to 8 out of 9 determined antibiotics (except vancomycin) has occurred and domination of 4 resistance patterns: ELTS, S, TSH, PSI, present in 50.1% of the tested strains was observed. The phenomena observed in the study: growing resistance degree, increasing amount of MDR strains, emergence of new resistance patterns, testify to gradual pneumococcal resistance increase and give a picture of local trends in antibiotic therapy. Also the epidemiological data concerning patients, from whom the tested strains were isolated are adequate to risk factors of infection with resistant pneumococci.
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