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Antimicrobial resistance to benzylpenicillin in invasive pneumococcal disease in Belgium, 2003–2010: the effect of altering clinical breakpoints

  • M. C. GOOSSENS (a1), B. CATRY (a1) and J. VERHAEGEN (a2)
Abstract
SUMMARY

The Belgian data (2003–2010) for the European Antimicrobial Resistance Surveillance Network (EARS-Net) showed a significant decreasing trend in the proportion of penicillin non-susceptible Streptococcus pneumoniae (9·4% to <1%) from blood and CSF isolates. We found that 75% of this decrease was explained by a change in Clinical and Laboratory Standards Institute (CLSI) breakpoints as the trend disappeared if only the new breakpoints were applied. Applying only European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints also resulted in a relatively stable proportion of penicillin non-susceptibility (average 5%), but this proportion was 7–13 times higher than with the new CLSI breakpoints. When the new CLSI breakpoints alone are used, fewer than 1% of bacteraemia isolates were penicillin non-susceptible during the entire period, but the proportion of non-susceptible meningitis isolates rose from 6·3% in 2003 to 15·9% between 2003 and 2010. Changing breakpoints should lead to retrospective analysis of historical data to minimize wrongly interpreting resistance trends.

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Copyright
The online version of this article is published within an Open Access environment subject to the conditions of the Creative Commons Attribution-NonCommercial-ShareAlike licence <http://creativecommons.org/licenses/by-nc-sa/2.5/>. The written permission of Cambridge University Press must be obtained for commercial re-use.
Corresponding author
*Author for correspondence: Dr M. C. Goossens, Scientific Institute of Public Health, Healthcare Associated Infections & Antimicrobial Resistance, Rue Juliette Wytsmanstraat 14, 1050 Brussels, Belgium. (Email: Mat.goossens@wiv-isp.be)
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This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

1.D Van Kerkhoven , Breakthrough pneumococcal bacteraemia in patients treated with clarithromycin or oral beta-lactams. Journal of Antimicrobial Chemotherapy 2003; 51: 691696.

5.G Masiero , Socioeconomic determinants of outpatient antibiotic use in Europe. International Journal of Public Health 2010; 55: 469478.


7.MW Pletz , Pneumococcal vaccines: mechanism of action, impact on epidemiology and adaption of the species. International Journal of Antimicrobial Agents 2008; 32: 199206.

9.MP Weinstein , KP Klugman , RN Jones . Rationale for revised penicillin susceptibility breakpoints versus Streptococcus pneumoniae: coping with antimicrobial susceptibility in an era of resistance. Clinical Infectious Diseases 2009; 48: 15961600.

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Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
  • URL: /core/journals/epidemiology-and-infection
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