1 Service d'Hygiène Hospitalière, Centre Hospitalier de Versailles André Mignot, 177 rue de Versailles, 78150 Le Chesnay; 2 Equipe Opérationnelle d'Hygiène, Laboratoire de Biologie, Centre Hospitalier de Dourdan, 2 rue du Potelet, 91415 Dourdan; 3 Service de Médecine B, Hôpital de Plaisir Grignon, 220 rue Mansart, 78375 Plaisir, France
Keywords: carbapenems , Streptococcus pneumoniae , France , bacteraemia
Sir,
Streptococcus pneumoniae is the most common cause of infections of the lower respiratory tract in adults and children. In Europe, France has the highest rates of penicillin and erythromycin resistance in pneumococci: in 2002, 53% and 58% of the strains were found to be non-susceptible to these antibiotics, respectively.1 In American guidelines (but not in French guidelines), ertapenem, a newly licensed parenteral carbapenem, constitutes an alternative to the usual parenteral ß-lactams for inpatients with pneumococcal infection.2 The purpose of this national multicentre study was to report the in vitro susceptibility to ertapenem and comparator compounds of S. pneumoniae isolated from French adults suffering from bacteraemic pneumonia.
Between 2000 and 2003, 339 strains of S. pneumoniae were collected by The ColBVH Study Group, a network of 105 non-teaching hospitals representative of general hospitals in France. These non-duplicated isolates were from blood cultures from hospitalized adults with pneumonia and were sent to a central laboratory (Service d'Hygiène, Centre Hospitalier de Versailles). The MICs of ertapenem, and penicillin G, amoxicillin, cefuroxime, cefotaxime, ceftriaxone, imipenem, erythromycin, quinupristin/dalfopristin, linezolid, levofloxacin, gatifloxacin and moxifloxacin, were determined using the agar dilution method in ambient air and interpreted according to NCCLS guidelines.3 S. pneumoniae ATCC 49619 was used as a control strain.
Among the 339 pneumococci tested, 92 (27.1%) and 55 (16.3%) were penicillin-intermediate and -resistant, respectively (Table 1). Ceftriaxone, ertapenem, imipenem, linezolid and quinupristin/dalfopristin were constantly active, although the MIC90 of the first three compounds increased with penicillin resistance: 1, 0.25 and 0.125 mg/L for penicillin-resistant strain versus 0.016, 0.016 and 0.008 mg/L for penicillin-susceptible strains, respectively. In terms of percentage of full susceptible strains, ranking of ß-lactams was: ertapenem = imipenem = ceftriaxone > amoxicillin > cefotaxime > cefuroxime > penicillin. Unlike cefuroxime, the in vitro activity of amoxicillin or cefotaxime remained high even amongst high-level penicillin-resistant strains. The percentage of erythromycin-susceptible strains decreased dramatically amongst penicillin non-susceptible isolates (88.5%, 17.4% and 3.6% of penicillin-susceptible, penicillin-intermediate and high-level penicillin-resistant pneumococci, respectively). Fluoroquinolones with enhanced activity against S. pneumoniae showed high in vitro activity (99.4% of susceptible strains).
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Footnotes
The Collège de Bactériologie-Virologie Hygiène des Hôpitaux (ColBVH) Study Group participants are listed in the Acknowledgements.
Acknowledgements
We received no funding from any pharmaceutical manufacturers.
We thank the microbiologists who participated in The ColBHV Study Group: J. Akli (Blois), C. Alba-Sauviat (Chaumont), G. Aubert (Saint Etienne), Amirault (Vierzon), J. Assens (St Afrique), J. P. Aubry (Quimperle), P. Aucher (Saint Jean D'angely), C. Auvray (Charleville Mezieres), A. Bailly (Albi), A. Barrans (Sete), D. Barraud (Gonesse), C. Benoit (Fontainebleau), E. Bichier (Saumur), H. Biessy (La Rochelle), M. Bietrix (Martigues), P. Bineau (Saint Dizier), V. Blanc (Antibes), S. Bland (Annecy), A. Boisivon (St Germain en Laye), Y. Boucaud-Maitre (Lyon), C. Bouguigny-Saison (Soissons), P. Brisou (Toulon Naval), S. Brovedani (Rambouillet), M. Caillaux (Tourcoing), B. Cancet (Villeneuve sur Lot), J. Carre-Cavelier (Bayeux), G. L. Cartolano (St Germain En Laye), J. Cartron (Dreux), G. Chambreuil (La Roche sur Yon), P. Chantelat (Vesoul), A. Chapelle (Aubenas), C. Chaplain (Saint Denis), H. Chardon (Aix En Provence), B. Chaurang (Neuilly Sur Seine), A. Clarac (Foix), P. Clergeau (Sallanches), E. Collot (Bar Le Duc), P. Courrier (Metz Armees), M. F. Danjoux (Tarbes), J. P. Darchis (Compiegne), H. De Montclos (Bourg En Bresse), A. Decoster (Lomme Les Lille), C. Delamare (Thionville), J. M. Delarbre (Mulhouse), P. Deligne (Remiremont), F. Delubac (Annonay), M. C. Demachy (Meaux), H. Demontclos (Bourg en Bresse), J. Deregnaucourt (Paris), M. A. Desailly-Chanson (La Roche Sur Yon), J. Didion (Metz), F. Doucet-Populaire (Versailles), A. Dublanchet (Villeneuve St Georges), B. Dubourdieu (Rodez), S. Dubourdieu (Gisors), Dupond (Laon), C. Durand (Provins), C. Eloy (Troyes), P. Emerique (Remiremont), F. Evreux (Le Havre), D. Fevre (Vienne), J. Flipo (Wissembourg), N. Fonsale (St Etienne), A. Fremaux (Creteil), C. Fuhrmann (Lyon), S. Gabriel (Monaco), M. Galanti (Coulommiers), G. Gallou (Falaise), F. Gandhilhon-Crepet (Monbrison), I. Ganivala (Montauban), E. Gardien (Morlaix), Garnotel (Marseille-Armees), M. Gavignet (Bourges), F. Geffroy (Quimper), C. Grasmick (Cahors), B. Gravagna (Lyon), G. Grise (Elbeuf), C. Guier (St Valler), P. Guiet (Nemours), A. Heidt (Hagueneau), M. Helfre (Firminy), J. Heurte (Beauvais), E. Heusse (Bayeux), M. C. Jaffar Bandjee (Saint Denis Reunion), D. Jan (Laval), E. Jaouen (Sable Sur Sarthe), G. Khatib (Bagnols Sur Ceze), J. P. Lafargue (Dax), R. Lamarca (Narbonne), V. Larroque (Carcassonne), E. Laurens (Cholet), A. Le Coustumier (Cahors), F. Le Turdu (Argenteuil), J. Y. Leberre (Saint Nazaire), E. Lecaillon Thibon (Perpignan), H. Lefrand-Crepin (Avignon), P. Lemaitre (Creil), C. Lemble (Selestat), M. Leneveu (Meulan), Lepilleur (St Dizier), A. Mandjee (Romans), A. Mangeol (Montfermeil), M. F. Marchal (Annemasse), M. Marcolin (Arras), A. Marmonier (Le Mans), T. Masseron (Lyon Cedex 03), R. Meley (Saint Etienne), O. Menouni (Montceau les Mines), M. Menouar (Rang Du Flier), A. Michel (Marseille), M. Mora (Frejus), B. Moreau (Cayenne), A. Morel (Le Havre), O. Morvan (Saint Brieuc), D. Neri Schiavini (Cannes), G. Otterbein (Bry Sur Marne), X. Palette (Plaisir), B. Pangon (Versailles), J. Paul (Boulogne sur Mer), C. Payen (Brignoles), M. Perrin (Thionville), D. Pierrejean (Auch), P. Pouedras (Vannes), D. Pressac (Tulle), G. Rast (Poissy), D. Reisz (Montceau les Mines), F. Richardin (Mantes La Jolie), Y. Rio (Metz), P. Roos (Thionville), P. Roussellier (Salon De Provence), Rousset (Beaune), M. Rouviere (Mende), O. Sabot (Belley), Saly (St Denis de la Réunion), S. Samaille (Saint Omer), R. Sanchez (Perigueux), A. Scanvic (Argenteuil), Y. Scat (Paris), A. Secher (Chartres), H. Sep-Hieng (Avranches), D. P. Simeon (Langres), V. Simha (Hyeres), C. Sire-Bidault (Chalon sur Saone), Smati (Aubenas), A. Sommabere (Brive), P. Stoessel (Neufchateau), P. Stolidi (Aubagne), F. Templier (Armentieres), J. P. Thellier (Chateau Thierry), Thore (Beaune), J. Tous (Chambery), A. Trevoux (Mulhousse), A. Vachee (Roubaix), E. Vallee (Eaubonne), J. Vaucel (St Brieuc), A. Verhaeghe (Dunkerque), M. Villemain (Aurillac), M. Viot (Nice), I. Vray (Voiron), J. F. Ygout (Lorient).
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