Antibiotic resistance levels of Streptococcus pneumoniae and antibiotic consumption in Newfoundland and Labrador

Goodyear, Marilyn Dawn (2007) Antibiotic resistance levels of Streptococcus pneumoniae and antibiotic consumption in Newfoundland and Labrador. Masters thesis, Memorial University of Newfoundland.

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Abstract

Streptococcus pneumoniae is an important human pathogen, causing potentially life-threatening infections such as pneumonia and meningitis. Until recently, it was almost uniformly susceptible to penicillin and other antibiotics. However, research during the last few years has shown a dramatic increase in the levels of resistance of S. pneumoniae to several classes of antibiotics. Antibiotic resistance is a rapidly evolving problem of worldwide importance. Although antibiotic resistance is related to antibiotic use, the relationship is a complex one that requires further evaluation. -- Purpose: The purpose of this project was to provide baseline information on the levels of antibiotic resistance of Streptococcus pneumoniae for the province of Newfoundland and Labrador and to determine the relationship between different patient factors and resistance. We also compared the accuracy of various methods of susceptibility testing as well as described the trends in outpatient antibiotic consumption within Newfoundland and Labrador between 1997 and 2000. -- Methods: Isolates were collected from various regions of the province between January and December 2000. Patient demographics, including sex, age, specimen source and geographic location, were submitted with the isolates. Susceptibility testing was performed according to standard protocols using both disk diffusion and the E-test system. Information on antibiotic use was provided by IMS HEALTH Canada for the years of 1997 to 2000. -- Results: The levels of antibiotic resistance of S. pneumoniae as described by this study are comparable to the levels of resistance described elsewhere in Canada. Isolates tested during this study showed evidence of resistance to multiple antibiotics. Increased levels of resistance were shown in isolates retrieved from non-sterile sites, children and the elderly. There was little variation in the levels of resistance in isolates obtained from males and females. The E-test System was shown to provide a more specific susceptibility profile than disk diffusion. Between 1997 and 2000, the outpatient use of tetracyclines, trimethoprim and penicillins showed a steady decline while the use of cephalosporins and macrolides declined initially and then increased. Fluroquinolones were the only class of antibiotic studied that showed an increase in public consumption. -- Conclusion: Limitations in isolate availability and patient information as well as a lack of information regarding regional antibiotic consumption prevented any correlations from being made between resistance levels and patient risk factors or community antibiotic use. However, this study does indicate that antibiotic resistance is a significant problem in Newfoundland and Labrador that will require further evaluation.

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