BSAC Respiratory Resistance Surveillance Programme Years 14

1
BSAC Respiratory Resistance Surveillance
Programme Years 1-4

• Initiator
• British Society for Antimicrobial Chemotherapy,
  with
• sponsorship from various pharmaceutical companies
  including
• Abbott Laboratories, Aventis Pharma, Bayer,
  GlaxoSmithKline and Genesoft.
• Objective
• Determination of the antimicrobial susceptibility
  of currently
• circulating lower respiratory tract isolates of
  Streptococcus
• pneumoniae, Haemophilus influenzae and Moraxella
• catarrhalis.

2
BSAC Respiratory Resistance Surveillance
Programme Years 1-4

• BSAC co-ordinator Dr. R. Reynolds
• Central testing laboratory G.R. Micro Ltd
• (D.Felmingham/J.Shackcloth)
• Website construction Micron Research Ltd
• (Dr. I. Harding/V. Reed)

3
BSAC Respiratory Resistance Surveillance
Programme Years 1-4

• Collecting laboratories
• England
• Birmingham City Hospital
• Bristol Southmead Hospital
• Cambridge Addenbrookes Hospital
• Gateshead Queen Elizabeth Hospital
• Leeds St James University Hospital
• Leicester Royal Infirmary
• Liverpool University of Liverpool
• London St Bartholomews and the Royal London
  Hospitals
• London University College London Hospitals
• Newcastle-upon-Tyne Royal Victoria Infirmary /
  Freeman Hospital
• Plymouth Derriford Hospital
• Salford Hope Hospital
• Southampton Southampton General Hospital

4
BSAC Respiratory Resistance Surveillance
Programme Years 1-4

• Collecting laboratories
• Wales
• Cardiff University Hospital of Wales
• Wrexham Wrexham Maelor Hospital
• Scotland
• Aberdeen Royal Infirmary
• Edinburgh Western General Hospital / Royal
  Infirmary
• Glasgow Southern General Hospital
• Ireland (North Republic)
• Belfast The Royal Hospitals / Dundonald
  Hospital
• Dublin Meath Adelaide / St Vincents / Beaumont
  Hospitals
• Galway University College Hospital

5
BSAC Respiratory Resistance Surveillance
Programme Years 1-4

• Selection of isolates
• Inclusion criteria
• Isolates of Streptococcus pneumoniae, Haemophilus
  
• influenzae and Moraxella catarrhalis from lower
  respiratory
• tract samples from patients with presumed lower
  respiratory
• tract infection in the winter season between
  October 1st and
• April 30th.
• Exclusion criteria
• - patients hospitalised for more than 48h at the
  time of sampling.
• - patients with cystic fibrosis.
• - repeat isolates from the same infection (i.e.
  isolates cultured within 2 weeks of a previous
  lower respiratory tract isolate from the same
  patient).

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BSAC Respiratory Resistance Surveillance
Programme Years 1-4

• Identification
• Streptococcus pneumoniae Gram stain positive
  diplococci, growing as
• alpha-haemolytic, sometimes umbonate or mucoid
  colonies on horse
• blood agar, catalase negative, optochin sensitive
  and bile soluble.
• Haemophilus influenzae Gram negative
  coccobacilli, requiring both X
• (haematin) and V (NAD) factors for growth on a
  non-supplemented base
• medium.
• Moraxella catarrhalis Gram negative
  coccobacilli, producing entire
• whitish/grey colonies on horse blood or
  chocolated horse blood agar,
• oxidase test positive, tributyrin hydrolysis test
  positive.

7
BSAC Respiratory Resistance Surveillance
Programme Years 1-4

• Susceptibility testing
• BSAC agar dilution method.
• ?-lactamase detection chromogenic cephalosporin
  
• (nitrocephin) test.
• Fluoroquinolone resistance in Haemophilus
• influenzae 30 ?g nalidixic acid disk

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BSAC Respiratory Resistance Surveillance
Programme Years 1-4

• Antimicrobials tested
• Streptococcus pneumoniae Haemophilus influenzae
• Penicillin Ampicillin
• Amoxycillin Amoxycillin
• Cefaclor Amoxycillin-clavulanate
• Cefuroxime Cefaclor
• Cefotaxime Cefuroxime
• Erythromycin Cefotaxime
• Clarithromycin Erythromycin
• Clindamycin Clarithromycin
• Tetracycline Tetracycline
• Ciprofloxacin Trimethoprim
• Trimethoprim Ciprofloxacin
• Levofloxacin Levofloxacin
• Moxifloxacin Moxifloxacin
• occasional experimental compounds

9
BSAC Respiratory Resistance Surveillance
Programme Years 1-4Streptococcus pneumoniae
penicillin susceptibility
Breakpoints (mg/L)- susceptible ?0.06,
intermediate 0.12-1, resistant ?2
10
BSAC Respiratory Resistance Surveillance
Programme Years 1-4Streptococcus pneumoniae
penicillin susceptibilityComparison of results
obtained by BSAC and NCCLS methods
Breakpoints (mg/L)- susceptible ?0.06,
intermediate 0.12-1, resistant ?2
11
BSAC Respiratory Resistance Surveillance
Programme Years 1-4 Streptococcus pneumoniae
comparative penicillin/macrolide susceptibility
12
BSAC Respiratory Resistance Surveillance
Programme Years 1-4Streptococcus pneumoniae
?-lactam/cephalosporin susceptibility
Breakpoints (mg/L) S R S
R Amoxycillin ?1 ?2 Cefuroxime ?1 ?2 Cefaclor
?1 ?2 Cefotaxime ?1 ?2
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BSAC Respiratory Resistance Surveillance
Programme Years 1-4 Streptococcus pneumoniae
erythromycin susceptibility
14
BSAC Respiratory Resistance Surveillance
Programme Years 1-4 Streptococcus pneumoniae
comparative prevalence of macrolide resistance
mechanisms
15
BSAC Respiratory Resistance Surveillance
Programme Years 1-4 Streptococcus pneumoniae
fluoroquinolone susceptibility
Breakpoints (mg/L) S
R S R S R
Ciprofloxacin ?2 ?4
Levofloxacin ?2 ?4 Moxifloxacin ?1 ?2
16
BSAC Respiratory Resistance Surveillance
Programme Years 1-4 Streptococcus pneumoniae
tetracycline susceptibility
Breakpoints (mg/L) susceptible ?1, resistant
?2
17
BSAC Respiratory Resistance Surveillance
Programme Years 1-4 Streptococcus pneumoniae
trimethoprim susceptibility
All isolates of Streptococcus pneumoniae
examined, except one from Year 4 requiring an MIC
of 0.5mg/L, were resistant to trimethoprim (MIC gt
1mg/L).
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BSAC Respiratory Resistance Surveillance
Programme Years 1-4Haemophilus
influenzae/Moraxella catarrhalis prevalence of
?-lactamase producing isolates
19
BSAC Respiratory Resistance Surveillance
Programme Years 1-4Haemophilus influenzae
comparative prevalence of


?-lactamase producing
isolates
20
BSAC Respiratory Resistance Surveillance
Programme Years 1-4Haemophilus influenzae
?-lactam/cephalosporin susceptibility
Breakpoints Ampicillin, amoxycillin/clavulanate,
cefaclor, cefuroxime and cefotaxime Slt 1mg/L,
Rgt 2mg/L
21
BSAC Respiratory Resistance Surveillance
Programme Years 1-4Haemophilus influenzae
?-lactam/cephalosporin susceptibility of non
?-lactamase producing isolates
Breakpoints Ampicillin, amoxycillin/clavulanate,
cefaclor, cefuroxime and cefotaxime Slt 1mg/L,
Rgt 2mg/L
22
BSAC Respiratory Resistance Surveillance
Programme Years 1-4 Haemophilus influenzae
erythromycin susceptibility
Breakpoints (mg/L) susceptible ?0.5,
intermediate 1-8, resistant ?16
23
BSAC Respiratory Resistance Surveillance
Programme Years 1-4 Haemophilus influenzae
fluoroquinolone susceptibility
Breakpoints (mg/L) S R S
R S R
Levofloxacin ?2 ?4
Ciprofloxacin ?1 ?2
Moxifloxacin ?1 ?2
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BSAC Respiratory Resistance Surveillance
Programme Years 1-4Haemophilus influenzae
tetracycline susceptibility
Breakpoints (mg/L) susceptible ?1, resistant
?2
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BSAC Respiratory Resistance Surveillance
Programme Years 1-4 Haemophilus influenzae
relationship between ?-lactamase production and
tetracycline resistance
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BSAC Respiratory Resistance Surveillance
Programme Years 1-4 Haemophilus influenzae
trimethoprim susceptibility
Breakpoints (mg/L) susceptible ?0.5, resistant
?1
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BSAC Respiratory Resistance Surveillance
Programme Years 1-4

• Moraxella catarrhalis
• With the exception of the amino-penicillins,
  amoxycillin
• and ampicillin, and trimethoprim, Moraxella
  catarrhalis
• remains generally susceptible to all
  antimicrobials tested.

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BSAC Respiratory Resistance Surveillance
Programme Years 1-4

• Summary
• The BSAC Respiratory Resistance Programme has
  established the prevalence of
• resistance amongst isolates of Streptococcus
  pneumoniae, Haemophilus
• influenzae and Moraxella catarrhalis to a range
  of antimicrobials commonly
• used for the treatment of lower respiratory tract
  infections in the UK and the
• Republic of Ireland.
• Generally, resistance to penicillin, erythromycin
  and tetracycline is considerably
• more prevalent amongst isolates of Streptococcus
  pneumoniae from centres in the Republic of
  Ireland than from those in the United Kingdom
  (including Belfast, Northern Ireland).
• ?-lactamase production amongst isolates of
  Haemophilus influenzae ranged from 7.3 to 21.9
  depending upon the year of study and geographical
  region.
• The great majority of isolates of Moraxella
  catarrhalis produced ?-lactamase.

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BSAC Respiratory Resistance Surveillance
Programme Years 1-4

• Data is available on the study website

www.bsacsurv.org