GlaxoSmithKline, 980 Great West Road, Brentford, Middlesex TW8 9GS, UK.
Ege University Medical Faculty, Department of Medical Microbiology, Bornova, Izmir, Turkey.
J Antimicrob Chemother. 2020 Apr 1;75(Suppl 1):i88-i99. doi: 10.1093/jac/dkaa086.
To determine antibiotic susceptibility of Streptococcus pneumoniae and Haemophilus influenzae isolates from community-acquired respiratory tract infections (CA-RTIs) collected in 2015-17 from Turkey.
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 179 S. pneumoniae and 239 H. influenzae isolates were collected. Few (27.9%) pneumococci were penicillin susceptible by CLSI oral or EUCAST low-dose breakpoints, but by EUCAST high-dose or CLSI IV breakpoints 84.4% were susceptible. The most active antibiotics (excluding penicillin IV) by CLSI breakpoints were fluoroquinolones (98.9% of isolates susceptible), ceftriaxone (83.2%), amoxicillin (78.8%) and amoxicillin/clavulanic acid (78.8%). Pneumococcal susceptibility to amoxicillin and amoxicillin/clavulanic acid was lower using EUCAST low-dose breakpoints (49.7%), although susceptibility increased when using EUCAST high-dose (57.0%-58.1%) and PK/PD (78.8%-87.7%) breakpoints. Twenty-three H. influenzae isolates were β-lactamase positive, with 11 characterized as β-lactamase negative and ampicillin resistant following EUCAST criteria and 5 by CLSI criteria. Generally antibiotic susceptibility was high using CLSI breakpoints: ≥92.9% for all antibiotics except ampicillin (87% by CLSI and EUCAST breakpoints) and trimethoprim/sulfamethoxazole (67.4% and 72% by CLSI and EUCAST breakpoints, respectively). Susceptibility using EUCAST breakpoints (where these are published) was similar, except for cefuroxime (oral) with 3.8% of isolates susceptible. PK/PD breakpoints indicated low susceptibility to macrolides (5.9%-10%) and cefaclor (13%). 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 of S. pneumoniae was generally low, which is in keeping with evidence of inappropriate and high antibiotic use in Turkey. H. influenzae susceptibility was high. These data are important for empirical therapy of CA-RTIs.
确定 2015-2017 年从土耳其收集的社区获得性呼吸道感染（CA-RTI）中肺炎链球菌和流感嗜血杆菌分离株的抗生素敏感性。
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 179 株肺炎链球菌和 239 株流感嗜血杆菌分离株。少数（27.9%）肺炎球菌对 CLSI 口服或 EUCAST 低剂量折点的青霉素敏感，但对 EUCAST 高剂量或 CLSI IV 折点的青霉素敏感率为 84.4%。根据 CLSI 折点，最有效的抗生素（不包括青霉素 IV）为氟喹诺酮类（98.9%的分离株敏感）、头孢曲松（83.2%）、阿莫西林（78.8%）和阿莫西林/克拉维酸（78.8%）。肺炎链球菌对阿莫西林和阿莫西林/克拉维酸的敏感性较低，使用 EUCAST 低剂量折点（49.7%），但使用 EUCAST 高剂量（57.0%-58.1%）和 PK/PD（78.8%-87.7%）折点时，敏感性增加。23 株流感嗜血杆菌分离株β-内酰胺酶阳性，其中 11 株经 EUCAST 标准鉴定为β-内酰胺酶阴性和氨苄西林耐药，5 株经 CLSI 标准鉴定为β-内酰胺酶阴性和氨苄西林耐药。一般来说，根据 CLSI 折点，抗生素的敏感性较高：除氨苄西林（CLSI 和 EUCAST 折点的 87%）和甲氧苄啶/磺胺甲恶唑（CLSI 和 EUCAST 折点的分别为 67.4%和 72%）外，所有抗生素的敏感性均≥92.9%。使用 EUCAST 折点（如果已公布）时，除头孢呋辛（口服）的分离株有 3.8%敏感外，其他抗生素的敏感性相似。PK/PD 折点表明大环内酯类（5.9%-10%）和头孢克洛（13%）的敏感性较低。一些抗生素（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）的不同 EUCAST 低剂量和高剂量折点的应用首次允许定量评估提高剂量对敏感性的影响。
肺炎链球菌的抗生素敏感性普遍较低，这与土耳其不合理和过度使用抗生素的证据一致。流感嗜血杆菌的敏感性较高。这些数据对 CA-RTI 的经验性治疗很重要。
