GlaxoSmithKline, 980 Great West Road, Brentford, Middlesex TW8 9GS, UK.
Dnipropetrovsk State Medical Academy Diagnostic Center, Soborna Square, 4, 49027 Dnipro, Ukraine.
J Antimicrob Chemother. 2020 Apr 1;75(Suppl 1):i100-i111. doi: 10.1093/jac/dkaa087.
To determine antibiotic susceptibility of Streptococcus pneumoniae and Haemophilus influenzae isolates from community-acquired respiratory tract infections (CA-RTIs) collected in 2016-17 from Ukraine.
MICs were determined by CLSI broth microdilution and susceptibility was assessed using CLSI, EUCAST (dose-specific) and pharmacokinetic/pharmacodynamic (PK/PD) breakpoints.
A total of 177 viable clinical isolates, including 78 S. pneumoniae and 99 H. influenzae, were collected. Overall, ∼98% of S. pneumoniae isolates were susceptible to penicillin by CLSI IV or EUCAST high-dose breakpoints and 73.1% were susceptible by CLSI oral or EUCAST low-dose IV breakpoints. Susceptibility rates of 76.9%-100% were observed for most antibiotics by all breakpoints except trimethoprim/sulfamethoxazole (41%-69.2%) and cefaclor, which showed the greatest difference between breakpoints: 0% by EUCAST, 28.2% by PK/PD and 73.1% by CLSI. All S. pneumoniae isolates were susceptible to amoxicillin/clavulanic acid by CLSI and PK/PD breakpoints. H. influenzae isolates were almost all β-lactamase negative (90.9%). One isolate was β-lactamase negative and ampicillin resistant (BLNAR) by CLSI and four isolates were BLNAR by EUCAST criteria. Susceptibility of isolates was high (≥90.9%) by CLSI breakpoints for all antibiotics tested except trimethoprim/sulfamethoxazole (61.6%). Susceptibility using EUCAST breakpoints was similar for ampicillin (90.9%) and amoxicillin/clavulanic acid (95%) but was low for cefuroxime (oral), where only 10.1% of isolates were susceptible. All S. pneumoniae and H. influenzae isolates were susceptible to the fluoroquinolones by all breakpoints. Susceptibility to ceftriaxone was also 100% for H. influenzae and ≥91% for S. pneumoniae isolates by all breakpoints. The application of different EUCAST breakpoints for low and higher doses for some of the antibiotics (amoxicillin, amoxicillin/clavulanic acid, ampicillin, penicillin, ceftriaxone, clarithromycin, erythromycin, levofloxacin and trimethoprim/sulfamethoxazole) allowed, for the first time in a SOAR study, the effect of raising the dosage on susceptibility to be quantified.
Antibiotic susceptibility in these respiratory tract pathogens was generally high in Ukraine. These data are important for empirical therapy choices in the treatment of CA-RTIs.
确定 2016-17 年乌克兰社区获得性呼吸道感染（CA-RTI）分离的肺炎链球菌和流感嗜血杆菌的抗生素敏感性。
采用 CLSI 肉汤微量稀释法测定 MIC，采用 CLSI、EUCAST（剂量特异性）和药代动力学/药效学（PK/PD）折点评估敏感性。
共收集了 177 株有活性的临床分离株，包括 78 株肺炎链球菌和 99 株流感嗜血杆菌。总体而言，CLSI IV 或 EUCAST 高剂量折点下约 98%的肺炎链球菌分离株对青霉素敏感，CLSI 口服或 EUCAST 低剂量 IV 折点下 73.1%的分离株对青霉素敏感。除甲氧苄啶/磺胺甲恶唑（41%-69.2%）和头孢克洛外，所有分离株对大多数抗生素的敏感性率均为 76.9%-100%，而这些抗生素的折点之间存在最大差异：EUCAST 为 0%，PK/PD 为 28.2%，CLSI 为 73.1%。所有肺炎链球菌分离株对 CLSI 和 PK/PD 折点的阿莫西林/克拉维酸均敏感。90.9%的流感嗜血杆菌分离株均为β-内酰胺酶阴性。1 株 CLSI 分离株为β-内酰胺酶阴性和氨苄西林耐药（BLNAR），4 株 EUCAST 分离株为 BLNAR。除甲氧苄啶/磺胺甲恶唑（61.6%）外，所有分离株对 CLSI 折点的抗生素均具有较高的敏感性（≥90.9%）。氨苄西林（90.9%）和阿莫西林/克拉维酸（95%）的 EUCAST 折点敏感性相似，但头孢呋辛（口服）的敏感性较低，只有 10.1%的分离株敏感。所有肺炎链球菌和流感嗜血杆菌分离株对所有折点的氟喹诺酮类药物均敏感。CLSI 折点也可使所有流感嗜血杆菌分离株的头孢曲松敏感性达到 100%，使所有肺炎链球菌分离株的敏感性≥91%。EUCAST 为某些抗生素（阿莫西林、阿莫西林/克拉维酸、氨苄西林、青霉素、头孢曲松、克拉霉素、红霉素、左氧氟沙星和甲氧苄啶/磺胺甲恶唑）设定了低剂量和高剂量的不同折点，这首次使定量评估提高剂量对敏感性的影响成为可能。
乌克兰呼吸道病原体的抗生素敏感性普遍较高。这些数据对于治疗 CA-RTI 的经验性治疗选择非常重要。
