Penicillin susceptibility breakpoints for Streptococcus pneumoniae and their effect on susceptibility categorisation in Germany (1997–2013)

Imöhl, Matthias;Reinert, Ralf René;Tulkens, Paul M.;van der Linden, Mark
(2014) European Journal of Clinical Microbiology & Infectious Diseases : an international journal on pathogenesis, diagnosis, epidemiology, therapy, and prevention of infectious diseases — Vol. 33, n° 11, p. 2035-2040 (2014)

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Authors
  • Imöhl, Matthias
    Author
  • Reinert, Ralf René
    Author
  • Tulkens, Paul M.UCLouvain
    Author
  • van der Linden, Mark
    Author
Abstract
Continuous nationwide surveillance of invasive pneumococcal disease (IPD) was conducted in Germany. From July 1, 1997, to June 30, 2013, data on penicillin susceptibility were available for 20,437 isolates. 2,790 of these isolates (13.7 %) originate from patients with meningitis and 17,647 isolates (86.3 %) are from non-meningitis cases. A slight decline in isolates susceptible at 0.06 and 0.12 μg/ml can be noticed over the years. Overall, 89.1 % of the isolates had minimum inhibitory concentrations (MICs) of ≤0.015 μg/ml. In 2012/2013, the first three isolates of Streptococcus pneumoniae with MICs of 8 μg/ml were found. The application of different guidelines with other MIC breakpoints for the interpretation of penicillin resistance leads to differences in susceptibility categorisation. According to the pre-2008 Clinical and Laboratory Standards Institute (CLSI) interpretive criteria, 5.3 % of isolates overall were intermediate and 1.4 % were resistant to penicillin. Application of the 2008–2014 CLSI interpretive criteria resulted in 7.6 % resistance among meningitis cases and 0.5 % intermediate resistance in non-meningitis cases. Referring to the 2009–2014 European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints, 7.6 % of the isolates in the meningitis group were resistant to penicillin. In the non-meningitis group, 6.1 % of the isolates were intermediate and 0.5 % were resistant. These differences should be kept in mind when surveillance studies on pneumococcal penicillin resistance are compared.
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Imöhl, M., Reinert, R. R., Tulkens, P. M., & van der Linden, M. (2014). Penicillin susceptibility breakpoints for Streptococcus pneumoniae and their effect on susceptibility categorisation in Germany (1997–2013). European Journal of Clinical Microbiology & Infectious Diseases : an international journal on pathogenesis, diagnosis, epidemiology, therapy, and prevention of infectious diseases, 33(11), 2035-2040. https://doi.org/10.1007/s10096-014-2174-z (Original work published 2014)