Antimicrobial resistance in clinical isolates of Streptococcus pneumoniae in a tertiary hospital in Kuwait, 1997–2007: Implications for empiric therapy

Abstract

Summary: Objective: This study evaluated antibiotic resistance trends in Streptococcus pneumoniae isolated in a tertiary hospital in Kuwait and its implications for empiric therapy. Materials and methods: Antimicrobial susceptibility of 1353 strains of S. pneumoniae isolated from clinical specimens during 1997–2007 was performed by disc diffusion method. MIC was determined by E test. The results were compared for 1997–2001, 2002–2005 and 2006–2007. Results: The prevalence of resistance for the respective periods were as follows: penicillin, 51.3%, 61.3% and 54.5%; erythromycin, 31.2%, 36.7% and 37.7%; tetracycline, 30.8%, 45.3% and 41.3%; co-trimoxazole, 49.5%, 58.5% and 62.8%; clindamycin, 20.4%, 20.6% and 24.5% and chloramphenicol, 8.1%, 8.9% and 3.7%. All were susceptible to vancomycin and rifampicin. For oxacillin-resistant isolates, penicillin resistance was rare (0.8%) with the new non-meningeal breakpoint. However, using the meningeal breakpoints, resistance increased for penicillin from 0.6%, to 28.7%, for cefotaxime from none to 16.5%, and for ceftriaxone from none to 7%. Intermediate resistance to meropenem increased from 1.7% to 22.4%. Multiple drug resistance increased from 22.4% to 37.8%. Conclusion: The study demonstrated that antimicrobial resistance of S. pneumoniae is increasing in Kuwait. However, the results of MIC determinations indicated that penicillin can still be used for therapy of non-meningeal infections. High prevalence of erythromycin resistance suggests that therapy of pneumonia with a macrolide alone may result in failure and should be based on results of susceptibility testing. Keywords: Streptococcus pneumoniae, Antibiotic resistance, E test, Penicillin resistance, Cefotaxime resistance, Erythromycin resistance