Table 3.
Antimicrobial Susceptibility of Multidrug-Resistant and Extensively Drug-Resistant Streptococcus pneumoniae for All Years Combined and Stratified by Geographic Region
| % Susceptible per CLSI,a No. Tested | |||||||
|---|---|---|---|---|---|---|---|
| Antimicrobial Agent | MIC50, mg/L | MIC90, mg/L | NA | EUR | APAC | LATAM | All Regions |
| MDR isolates | (6155) | (4168) | (2968) | (553) | (13 844) | ||
| Amoxicillin-clavulanate | ≤2 | >4 | 56.6 | 82.4 | 72.6 | 74.5 | 68.5 |
| Azithromycin | >4 | >4 | 4.5 | 3.1 | 1.0 | 7.3 | 3.4 |
| Ceftaroline | 0.12 | 0.25 | >99.9b | 99.6b | 98.7b | 100.0b | 99.7b |
| Ceftriaxone | 1 | 2 | 43.3c 69.5b | 49.3c 82.6b | 32.3c 68.7b | 46.2c 72.7b | 42.8c 73.5b |
| Clindamycin | >1 | >1 | 27.2 | 16.7 | 26.5 | 37.5 | 24.3 |
| Erythromycin | >2 | >2 | 1.8 | 2.3 | 0.9 | 5.3 | 1.9 |
| Imipenem | ≤0.5 | 1 | 43.8 | 53.6 | 38.5 | 42.2 | 45.8 |
| Levofloxacin | 1 | 1 | 97.1 | 96.5 | 95.3 | 99.1 | 96.6 |
| Linezolid | 1 | 1 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 |
| Meropenem | 0.5 | 1 | 44.5 | 52.4 | 39.5 | 41.7 | 45.2 |
| Penicillin | 2 | 4 | 8.9d 58.8e | 25.1d 82.2e | 15.7d 64.3e | 20.1d 69.6e | 15.7d 67.4e |
| Tetracycline | >4 | >4 | 9.6 | 10.6 | 2.7 | 18.6 | 8.8 |
| Tigecycline | ≤0.12 | ≤0.12 | 97.2f | 94.9f | 98.7f | 96.1f | 96.8f |
| TMP-SMX | 4 | >4 | 18.3 | 34.6 | 27.5 | 19.0 | 25.2 |
| Vancomycin | ≤1 | ≤1 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 |
| XDR isolates | (2202) | (659) | (962) | (95) | (3918) | ||
| Amoxicillin-clavulanate | >4 | >4 | 8.1 | 35.2 | 32.2 | 14.7 | 18.8 |
| Azithromycin | >4 | >4 | 0.6 | 0.2 | 0.02 | 2.3 | 0.4 |
| Ceftaroline | 0.25 | 0.25 | 100.0b | 98.4b | 96.6b | 100.0b | 99.1b |
| Ceftriaxone | 2 | >2 | 2.6c 32.2b | 5.7c 23.4b | 1.7c 19.3b | 0.0c 26.6b | 2.9c 27.4b |
| Clindamycin | >1 | >1 | 6.0 | 10.8 | 12.9 | 14.9 | 8.7 |
| Erythromycin | >2 | >2 | 0.0 | 0.0 | 0.2 | 0.0 | 0.1 |
| Levofloxacin | 1 | 1 | 96.7 | 90.8 | 88.2 | 98.9 | 93.7 |
| Linezolid | 0.5 | 1 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 |
| Meropenem | 1 | 1 | 1.6 | 8.0 | 2.4 | 1.2 | 2.8 |
| Penicillin | 4 | 4 | 0.2d 5.4e | 3.0d 22.2e | 0.1d 13.7e | 0.0d 5.3e | 0.7d 10.3e |
| Tetracycline | >4 | >4 | 2.0 | 4.3 | 1.0 | 6.3 | 2.3 |
| Tigecycline | ≤0.12 | ≤0.12 | 95.4f | 94.7f | 98.2f | 98.9f | 96.0f |
| TMP-SMX | >4 | >4 | 0.4 | 3.3 | 1.9 | 0.0 | 1.2 |
| Vancomycin | ≤1 | ≤1 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 |
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).