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. 2021 Apr;62(4):306-314.
doi: 10.3349/ymj.2021.62.4.306.

Antimicrobial Susceptibility Trends of Streptococcus pneumoniae by Age Groups Over Recent 10 Years in a Single Hospital in South Korea

Hyunjoo Oh  1 , Sang Taek Heo  1   2 , Misun Kim  1 , Young Ree Kim  3 , Jeong Rae Yoo  1   4
Affiliations

Antimicrobial Susceptibility Trends of Streptococcus pneumoniae by Age Groups Over Recent 10 Years in a Single Hospital in South Korea

Hyunjoo Oh et al. Yonsei Med J. 2021 Apr.

Abstract

Purpose: Streptococcus pneumoniae (S. pneumoniae) causes respiratory tract infections. Its non-vaccine serotypes and multidrug-resistant pneumococcal diseases have increased during the post-pneumococcal vaccination era. Therefore, it is important to understand the regional and age-related antimicrobial susceptibility of S. pneumoniae to select appropriate empirical antimicrobials.

Materials and methods: We retrospectively studied trends in the antimicrobial resistance of S. pneumoniae to commonly prescribed antibiotics in patient groups of various ages at a single teaching hospital in Jeju Island from 2009 to 2018.

Results: In total, 1460 S. pneumoniae isolates were obtained during the study period. The overall antimicrobial resistance rates of S. pneumoniae to penicillin, erythromycin, ceftriaxone, levofloxacin, and vancomycin were 16.2%, 84.7%, 25.9%, 3.3%, and 0.0%, respectively, and the MDR rate was 6.7%. Erythromycin and ceftriaxone resistance rates increased by years; however, they were significantly reduced in adult groups. Levofloxacin resistance and MDR rates were also higher in adult groups. Overall, the MDR rate significantly increased during the recent 10 years, as well as in patients with a history of hospitalization within 90 days [odds ratio (OR)=3.58, 95% confidence interval (CI)=1.91-6.71] and sinusitis (OR=4.98, 95% CI=2.07-11.96).

Conclusion: Erythromycin and ceftriaxone resistance rates and the MDR rate of S. pneumoniae significantly increased during the recent 10 years; the trends in individual antimicrobial resistance rates significantly differed between the age groups. This study indicates the need for caution when using ceftriaxone as an empirical antimicrobial against pneumococcal infections.

Keywords: Streptococcus pneumoniae; antibiotics; antimicrobial resistance; multidrug resistance; pneumonia; susceptibility.

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Conflict of interest statement

The authors have no potential conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1. Trend in antibiotics resistance to Streptococcus pneumoniae during 2009–2018. Since the susceptibility test to penicillin was not performed from May 2011 to April 2013 and the new CLSI penicillin susceptibility breakpoints for S. pneumoniae was adopted from 2013 at our hospital, the analysis was performed using the data from 2013 to 2018. MDR, multidrug-resistance.
Fig. 2
Fig. 2. Comparison of overall antibiotic resistance rates among the three age groups during 2009–2018. Chi-square test was used to compare the antibiotics resistance rates among the three age groups. Since the susceptibility test to penicillin was not performed from May 2011 to April 2013 and the new CLSI penicillin susceptibility breakpoints for S. pneumoniae was adopted from 2013 at our hospital, the analysis was performed using the data from 2013 to 2018. MDR, multidrug-resistance.
Fig. 3
Fig. 3. Trends in antibiotic resistance rates of Streptococcus pneumoniae during 2009–2018 by age groups. (A) Penicillin. (B) Erythromycin. (C) Ceftriaxone. (D) Levofloxacin. (E) Vancomycin. (F) MDR. Since the susceptibility test to penicillin was not performed from May 2011 to April 2013 and the new CLSI penicillin susceptibility breakpoints for S. pneumoniae was adopted from 2013 at our hospital, the analysis was performed using the data from 2013 to 2018. MDR, multidrug-resistance.
See this image and copyright information in PMC

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