Ten-year surveillance of antimicrobial resistance of Streptococcus pneumoniae in a south-west German teaching hospital

Pneumococcal resistance has shown a steady increase worldwide over recent decades. Penicillin-resistant pneumococci were first reported in Australia in 1967 and then became widespread during the 1980s and 1990s. Pneumococcal strains with resistance to erythromycin, tetracycline, and cotrimoxazole were also identified in the late 1960s and early 1970s. More recently, pneumococci resistant to extended-spectrum cephalosporins and fluoroquinolones have been reported in the United States, South Africa and Europe. The rapid development of pneumococcal resistance to a broad range of antimicrobial agents has implications for the treatment of patients with systemic infections. To establish a rational basis for the therapy of pneumococcal infections, a prospective ten-year surveillance study of pneumococcal resistance in a 1070-bed south-west German teaching hospital was performed. In vitro activity of penicillin G, ceftriaxone, erythromycin and rifampin were studied against 988 non-repeat clinical isolates of Streptococcus pneumoniae. Minimum inhibitory concentrations (MICs) were determined by the E test (AB Biodisk, Solna, Sweden), which has proved to be a reliable alternative to conventional methods for antimicrobial susceptibility testing of pneumococci. The 988 primary clinical isolates of S. pneumoniae were collected from hospitalized patients between October 1992 and February 2003. Of the pneumococcal isolates, 765 were from adults and 223 from children. Sources of isolation of the strains were: lower respiratory tract (588), blood (195), eye (62), ear