Antibacterial resistance of community-acquired respiratory tract pathogens recovered from patients in Latin America: results from the PROTEKT surveillance study (1999-2000)

• Published in: The Brazilian journal of infectious diseases 2003-02, Vol.7 (1), p.44-61
• Main Authors: Mendes, C, Marin, M E, Quiñones, F, Sifuentes-Osornio, J, Siller, C Cuilty, Castanheira, M, Zoccoli, C M, López, H, Súcari, A, Rossi, F, Angulo, G Barriga, Segura, A J A, Starling, C, Mimica, I, Felmingham, D
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Argentina - epidemiology; Brazil - epidemiology; Community-Acquired Infections - drug therapy; Community-Acquired Infections - epidemiology; Community-Acquired Infections - microbiology; Drug Resistance, Multiple; Erythromycin - pharmacology; Erythromycin - therapeutic use; Gram-Negative Bacteria - drug effects; Gram-Positive Bacteria - drug effects; Haemophilus influenzae; Haemophilus influenzae - drug effects; Haemophilus influenzae - isolation & purification; Humans; INFECTIOUS DISEASES; Latin America; Mexico - epidemiology; Microbial Sensitivity Tests; Moraxella (Branhamella) catarrhalis - drug effects; Moraxella (Branhamella) catarrhalis - isolation & purification; Moraxella catarrhalis; Penicillin Resistance; Population Surveillance; PROTEKT; resistance; respiratory tract infections; Respiratory Tract Infections - drug therapy; Respiratory Tract Infections - epidemiology; Respiratory Tract Infections - microbiology; Staphylococcus aureus; Staphylococcus aureus - drug effects; Staphylococcus aureus - isolation & purification; Streptococcus pneumoniae; Streptococcus pneumoniae - drug effects; Streptococcus pneumoniae - isolation & purification; Streptococcus pyogenes; Streptococcus pyogenes - drug effects; Streptococcus pyogenes - isolation & purification
• ISSN: 1413-8670; 1678-4391; 1413-8670; 1678-4391
• DOI: 10.1590/S1413-86702003000100006

PROTEKT (Prospective Resistant Organism Tracking and Epidemiology for the Ketolide Telithromycin) is a global surveillance study established in 1999 to monitor antibacterial resistance of respiratory tract organisms. Thirteen centers from Argentina, Brazil and Mexico participated during 1999-2000; they collected 1806 isolates (Streptococcus pneumoniae 518, Haemophilus influenzae 520, Moraxella catarrhalis 140, Staphylococcus aureus 351, S. pyogenes 277). Overall, 218 (42.1%) of the S. pneumoniae isolates had reduced susceptibility to penicillin, 79 (15.3%) were penicillin-resistant and 79 (15.3%) were erythromycin-resistant. Mexico had the highest prevalence of penicillin (76.5%) and erythromycin (31.2%) resistance. Of 77 erythromycin-resistant S. pneumoniae tested for resistance genotype, 43 possessed mef(A), 33 possessed erm(B) and 1 possessed both erm(B) and mef(A) mechanism. All S. pneumoniae isolates were fully susceptible to telithromycin, linezolid, teicoplanin and vancomycin. Among H. influenzae isolates, 88 (16.9%) produced beta-lactamase, ranging from 11% (Brazil) to 24.5% (Mexico). Among M. catarrhalis isolates, 138 (98.6%) produced beta-lactamase. Twenty-four (8.7%) of the S. pyogenes isolates were erythromycin-resistant; resistance being attributable to mefA (n=18), ermTR (n=5) and ermB (n=1). All H. influenzae, M. catarrhalis and S. pyogenes were fully susceptible to telithromycin. Methicillin resistance was found in 26.5% of the S. aureus isolates (Argentina 15%; Mexico 20%; Brazil 31.3%). Telithromycin was effective against 97.7% of methicillin-susceptible isolates. PROTEKT confirms that antibacterial resistance is an emerging problem in Latin America. The previously reported high levels of pneumococcal resistance to the beta-lactam and macrolides were exceeded. New agents that do not induce resistance or that exert low selective pressure, e.g. telithromycin, are essential to safeguard future antibacterial efficacy.