ANTIBIOTIC SUSCEPTIBILITY OF STREPTOCOCCUS PNEUMONIAE STRAINS ISOLATED FROM PATIENTS WITH MENINGITIS
Objective. To study in vitro activity of antibiotics against pneumococcus strains isolated from patients with meningitis, to assess the resistance rates and resistance profiles, to analyze the usage opportunities of different classes of antibiotics for treatment.
Materials and methods. Examination of phenotypic resistance of 19 pneumococcus strains isolated from patients with community-acquired meningitis during 2013—2016 in Belarus broth microdilutions reference method have been used. Results interpretation have been performed according to CLSI 2017 criteria.
Results. Analyzed pneumococcus population is characterized by extremely high rates of clinically not susceptible strains to benzylpenicillin (63.2%), macrolides (63.2%), tetracyclines (52.7%), folate pathway inhibitors (63.2%), by evaluated rates — to III—IV generation cephalosporins and carbapenems (32—37%), lincosamides (47.4%), phenicols (10.5%) and by absolute clinical susceptibility to fluoroquinolones, ansamycins, glycopeptides and oxazolidinones. Strains with natural antibiotic susceptibility were rare (21.1%), while XDR and MDR strains ranged from 31.6% to 36.2% and mostly (92—100%) belonged to “pediatric” and vaccine serotypes (19F, 6A/6B, 14 and 23F).
Conclusions. Such a wide circulation of penicillin resistant meningeal pneumococcal strains is not common for most regions of the world and haven’t been observed in Belarus earlier. Resistant to III—IV generation cephalosporins and carbapenems strains haven’t been described in Belarus as well. For today Belarus should be considered as a region with high level of S. pneumoniae penicillin resistance with frequent circulation of strains with resistance to III—IV generation cephalosporins and carbapenems. These findings should be used for correction of national guidelines for treatment the patients with central nervous system infections. Clinicians should demonstrate highest clinical suspicion during beta-lactams treatment of pneumococcal bacterial meningitis and other invasive forms of pneumococcal infection.