Rise of multidrug-resistant non-vaccine serotype 15A Streptococcus pneumoniae in the United Kingdom, 2001 to 2014.

Conjugate vaccines have reduced pneumococcal disease in vaccinated children and unvaccinated adults, but non-vaccine serotypes are of concern, particularly if antibiotic resistant. We reviewed Streptococcus pneumoniae collected via: (i) the British Society for Antimicrobial Chemotherapy (BSAC) surveillances from 2001-2014; (ii) Public Health England's (PHE) invasive isolate surveillance from 2005-2014 and (iii) referral to PHE for resistance investigation from 2005-2014. Serotype 15A increased in all series, with many representatives showing triple resistance to macrolides, tetracyclines and penicillin. 15A was consistently among the 10 most prevalent serotypes from 2011 in PHE and BSAC invasive isolate/bacteraemia surveillance but never previously; 26-33% of these invasive 15A isolates had triple resistance. BSAC respiratory isolates were only serotyped in 2013/14 and 2014/15 (October to September); 15A was most prevalent serotype in both periods, comprising 9-11% of isolates, 38-48% of them with triple resistance. Serotype 15A represented 0-4% of S. pneumoniae referred to PHE for reference investigation annually until 2008 but rose to 29% (2013) and 32% (2014). Almost all multidrug-resistant 15A isolates were sequence type (ST) 63 variants, whereas susceptible 15A isolates were clonally diverse. The rise of serotype 15A suggests that pneumococcal conjugate vaccines will need ongoing adaptation.

Surveillance of the Activity of Aminoglycosides and Fluoroquinolones Against Ophthalmic Pathogens from Europe in 2010-2011.

PURPOSE/AIM: Bacterial infections of the ocular surface are commonly treated empirically with broad spectrum antibiotics. Due to concerns over increasing antibiotic resistance, we evaluated current susceptibility patterns of the ocular bacterial pathogens in Europe. MATERIALS AND METHODS: Non-consecutive ocular isolates of Staphylococcus aureus, coagulase-negative staphylococci (CoNS), Streptococcus pneumoniae, Haemophilus influenzae, and Pseudomonas aeruginosa were collected in 2011 from centers in France, Germany, Italy, Poland, Slovak Republic, Spain, and the United Kingdom. Centers were asked to provide similar numbers of methicillin-susceptible and -resistant staphylococcal isolates. Minimum inhibitory concentrations were determined for fluoroquinolones (besifloxacin, ciprofloxacin, moxifloxacin), aminoglycosides (tobramycin, gentamicin, netilmicin), oxacillin, chloramphenicol and erythromycin. Isolates were categorized as susceptible, intermediate, or resistant according to European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria. RESULTS: A total of 741 ocular isolates were obtained. Antibiotic resistance rates depended not only on the antibiotic and species, but also varied greatly by the country of origin. Resistance to ciprofloxacin, tobramycin, erythromycin, and to a lesser extent, chloramphenicol, was a concern for all staphylococci. Multidrug resistance was common among methicillin-resistant S. aureus (MRSA) and MRCoNS and isolates of S. pneumoniae, H. influenzae, and P. aeruginosa were frequently non-susceptible to erythromycin, beta-lactams, and ciprofloxacin/tobramycin, respectively. Resistance rates showed substantial differences among the seven countries tested. Fluoroquinolones and aminoglycosides showed differences in antibacterial potency and resilience toward the antibiotic resistance mechanisms. CONCLUSIONS: Methicillin-resistant staphylococcal isolates were frequently non-susceptible to a multitude of other antibiotics, making MRSA and MRCoNS a potentially significant concern. The broad range of resistance rates observed across Europe in this study confirms the importance of considering current local resistance patterns when antibacterial agents are chosen for empiric management of ocular infections.

Activity of oritavancin against methicillin-resistant staphylococci, vancomycin-resistant enterococci and ß-haemolytic streptococci collected from western European countries in 2011.

OBJECTIVES: To determine the activity of oritavancin against methicillin-resistant staphylococci, vancomycin-resistant enterococci (VRE) and ß-haemolytic streptococci recently isolated from acute bacterial skin and skin structure infections or bacteraemia in western Europe. METHODS: Forty-one centres in Spain (8), Italy (9), Germany (8), France (8) and the UK (8) submitted 866 isolates [204 methicillin-resistant Staphylococcus aureus (MRSA), 177 methicillin-resistant coagulase-negative staphylococci (MRCoNS), 101 VRE, 193 Streptococcus agalactiae and 191 Streptococcus pyogenes] that were collected during the first 6 months of 2011. These were re-identified and susceptibilities to oritavancin and comparators were determined. RESULTS: Oritavancin was very active against MRSA (MIC(50)/MIC(90) 0.03/0.06 mg/L), MRCoNS (0.06/0.12 mg/L), VRE (0.03/0.06 mg/L), S. agalactiae (0.03/0.06 mg/L) and S. pyogenes (0.06/0.25 mg/L). The highest oritavancin MIC observed was 0.25 mg/L (species were S. aureus, Staphylococcus epidermidis, Staphylococcus hominis, S. agalactiae, S. pyogenes and Enterococcus faecalis). CONCLUSIONS: These data from recently collected Gram-positive bacteria in western Europe confirm the potent in vitro activity of oritavancin against a wide range of resistant MRSA, MRCoNS and VRE isolates, including ones resistant to newer agents.

Activity of the new cephalosporin ceftaroline against bacteraemia isolates from patients with community-acquired pneumonia.

The activity of ceftaroline, a novel cephalosporin, was evaluated against 1337 isolates from patients with bacteraemic community-acquired pneumonia (CAP) requiring hospitalisation (including 119 Haemophilus influenzae, 9 Moraxella catarrhalis, 164 Staphylococcus aureus, 1007 Streptococcus pneumoniae and 38 Streptococcus pyogenes). Minimum inhibitory concentrations (MICs) were determined by broth microdilution according to Clinical and Laboratory Standards Institute (CLSI) guidelines, and susceptibility category assessments were made using CLSI or US Food and Drug Administration (FDA) breakpoints. Ceftaroline MICs were < or = 0.008-0.06 mg/L against H. influenzae, 0.25-2mg/L against methicillin-resistant S. aureus (MRSA), 0.06-1mg/L against methicillin-susceptible S. aureus, 0.015-0.5mg/L against M. catarrhalis and < or = 0.008-0.5mg/L against S. pneumoniae, and all S. pyogenes isolates had ceftaroline MICs < or = 0.008mg/L. Ceftaroline was more active than ceftriaxone or cefepime both against MRSA and penicillin-resistant pneumococci. More than 90% of MRSA isolates were resistant to clarithromycin and levofloxacin but were susceptible to linezolid or tigecycline. A high rate of clarithromycin resistance was also observed in the pneumococci. Ceftaroline was very active in vitro against all CAP isolates, including MRSA and penicillin-non-susceptible pneumococci, in contrast to the other beta-lactams tested. These data confirm ceftaroline as a new cephalosporin with enhanced anti-Gram-positive activity and suggest that ceftaroline has the potential to be a useful new agent in the treatment of CAP-associated bacteraemic infections.