Table 2.
Antimicrobial Susceptibility and Frequency of Multidrug-Resistant and Extensively Drug-Resistant Isolates Among Streptococcus pneumoniae Isolates Collected in 2015–2016, Stratified by Geographic Region and Patient Age Group
| % Susceptible per CLSI,a No. Tested | |||||||
|---|---|---|---|---|---|---|---|
| Antimicrobial Agent | MIC50, mg/L | MIC90, mg/L | NA | EUR | APAC | LATAM | All Regions |
| All isolates | (3621) | (2111) | (643) | (191) | (6566) | ||
| Amoxicillin-clavulanate | ≤0.03 | 2 | 94.9 | 94.1 | 87.7 | 93.7 | 93.9 |
| Azithromycin | 0.06 | >4 | 56.2 | 76.6 | 55.0 | 72.8 | 63.1 |
| Ceftaroline | ≤0.008 | 0.12 | 100.0b | >99.9b | 99.2b | 100.0b | 99.9b |
| Ceftriaxone | 0.03 | 1 | 88.2c 97.7b | 87.6c 96.4b | 77.7c 89.5b | 90.6c 95.8b | 87.1c 96.5b |
| Clindamycin | ≤0.25 | >1 | 86.0 | 83.3 | 65.4 | 84.3 | 83.1 |
| Erythromycin | 0.03 | >2 | 56.1 | 76.7 | 54.5 | 72.8 | 63.1 |
| Levofloxacin | 1 | 1 | 99.1 | 98.2 | 97.0 | 100.0 | 98.6 |
| Linezolid | 1 | 1 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 |
| Meropenem | 0.015 | 0.5 | 82.7 | 86.7 | 70.8 | 88.3 | 83.2 |
| Penicillin | ≤0.06 | 2 | 64.1d 96.6e | 71.6d 95.5e | 55.2d 89.6e | 70.2d 94.8e | 65.8d 95.5e |
| Tetracycline | ≤0.25 | >4 | 80.7 | 78.2 | 56.1 | 70.0 | 77.2 |
| Tigecycline | 0.03 | 0.06 | 99.5f | 99.5f | 98.6f | 99.5f | 99.4f |
| TMP-SMX | ≤0.5 | >4 | 73.7 | 72.1 | 63.1 | 64.4 | 71.9 |
| Vancomycin | 0.25 | 0.25 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 |
| Pediatric patients | (990) | (365) | (138) | (63) | (1556) | ||
| Amoxicillin-clavulanate | ≤0.03 | 2 | 94.8 | 94.0 | 83.6 | 88.9 | 93.4 |
| Azithromycin | 0.06 | >4 | 53.9 | 72.9 | 42.0 | 61.9 | 57.6 |
| Ceftaroline | ≤0.008 | 0.12 | 100.0b | 100.0b | 100.0b | 100.0b | 100.0b |
| Ceftriaxone | 0.03 | 1 | 87.1c 97.8b | 86.8c 95.1b | 73.9c 85.8b | 84.1c 90.5b | 85.8c 95.8b |
| Clindamycin | ≤0.25 | >1 | 87.8 | 79.2 | 51.5 | 79.4 | 82.3 |
| Levofloxacin | 1 | 1 | 99.6 | 99.2 | 100.0 | 100.0 | 99.6 |
| Penicillin | ≤0.06 | 2 | 61.4d 96.4e | 69.9d 96.2e | 47.1d 83.3e | 57.1d 90.5e | 62.0d 94.9e |
| Tetracycline | ≤0.25 | >4 | 82.4 | 75.1 | 44.2 | 68.3 | 76.7 |
| TMP-SMX | ≤0.5 | >4 | 70.8 | 73.7 | 60.1 | 55.6 | 69.9 |
| Adult patients | (2439) | (1514) | (469) | (126) | (4548) | ||
| Amoxicillin-clavulanate | ≤0.03 | 2 | 94.9 | 93.6 | 88.6 | 96.0 | 93.8 |
| Azithromycin | 0.06 | >4 | 57.1 | 76.1 | 57.5 | 77.8 | 64.0 |
| Ceftaroline | ≤0.008 | 0.12 | 100.0b | 99.9b | 98.9b | 100.0b | 99.9b |
| Ceftriaxone | 0.03 | 1 | 88.8c 97.7b | 86.9c 96.6b | 78.3c 90.4b | 93.7c 98.4b | 87.3c 96.6b |
| Clindamycin | ≤0.25 | >1 | 85.2 | 83.2 | 68.1 | 86.5 | 82.8 |
| Levofloxacin | 1 | 1 | 99.0 | 98.3 | 96.2 | 100.0 | 98.5 |
| Penicillin | ≤0.06 | 2 | 64.9d 96.7e | 70.7d 94.8e | 57.1d 91.3e | 76.2d 96.8e | 66.4d 95.5e |
| Tetracycline | ≤0.25 | >4 | 80.0 | 77.5 | 58.2 | 72.0 | 76.7 |
| TMP-SMX | ≤0.5 | >4 | 74.8 | 70.7 | 64.8 | 68.3 | 72.3 |
| Frequency of resistance phenotypes (all ages combined), % | |||||||
| MDR | 17.3 | 19.1 | 39.2 | 20.9 | 20.1 | ||
| XDR | 3.5 | 4.0 | 10.9 | 4.2 | 4.4 | ||
Abbreviations: CLSI, Clinical and Laboratory Standards Institute; EUR, Europe; APAC, Asia-Pacific region; LATAM, Latin America; MIC, minimum inhibitory concentration; MDR, multidrug-resistant; NA, North America; TMP-SMX, trimethoprim-sulfamethoxazole; XDR, extensively drug-resistant.
aCriteria as published by CLSI 2018.
bUsing nonmeningitis breakpoints.
cUsing meningitis breakpoints.
dUsing oral breakpoints.
eUsing parenteral, nonmeningitis breakpoints.
fFood and Drug Administration breakpoints (https://www.fda.gov/Drugs/DevelopmentApprovalProcess/DevelopmentResources/ucm410971.htm).