PURPOSE: Antimicrobial stewardship is most effective if pathogens are targeted at the local level. We documented degree of heterogeneity in Streptococcus pneumoniae resistance trends nationally, regionally, and locally, including within the State of Florida, among the 365 hospitals enrolled in the ARM Program.
METHODS: S pneumoniae isolate/drug comparisons (n=65,957) in the aggregate database were reviewed for each year from 1998-2003 for resistance to clindamycin and erythromycin as surrogates for rates of methylation (erm) and efflux pump-mediated (mef), respectively, and to fluoroquinolones ciprofloxacin, levofloxacin, ofloxacin, and gatifloxacin. For comparison, hospitals are grouped into Northeast (n=111), Southeast (n=107), North Central (n=53) South Central (n=58), Northwest (n=8), and Southwest (n=28) and, in Florida, North (n=8), Central (n=15), and South (n=15) regions.
RESULTS: Nationally, for 1998-2003, resistance to ciprofloxacin was 32.4% (46.3% for 1998 and 44.7% for 1999), compared with 2.3% for levofloxacin, 7.3% for ofloxacin, and 1.8% for gatifloxacin. In Florida, levofloxacin was the predominant antibiotic in use; resistance was 1.8%, compared with 2.6% for ofloxacin. Hospitals in South Florida had a 2.1% resistance rate to levofloxacin, compared with 1.0% in North Florida and 0.2% in Central Florida. For erm, rates from 1998-2003 nationally were 11%. Within regions, they varied from 8.6% in North Central to 13.4% in Northwest. Hospitals in Central Florida had rates (9.5%) most consistent with national trends; South Florida had the highest rates (29.5%). From 1998-2003, rates of mef were 21.6% nationally, with the lowest in the Southwest (10.5%) and the highest in the Northeast (25%) and South Central (25%). Hospitals in North (34.4%) and Central Florida (30.8%) had the highest mef rates; South Florida hospitals had the lowest (6.0%), due to resistance to clindamycin being greater than to erythromycin in 2002 and 2003.
CONCLUSION: S pneumoniae resistance to fluoroquinolones varied within the class, with gatifloxacin having the highest susceptibility. Rates of erm and mef were largely heterogenous among regions as well as within the State of Florida.
CLINICAL IMPLICATIONS: These results support targeting antimicrobial resistance at the local level.
DISCLOSURE: John Gums, No Product/Research Disclosure Information; Grant monies (from industry related sources) AstraZeneca, Roche; Consultant fee, speaker bureau, advisory committee, etc. Sanofi-Aventis, Schering-Plough