f3S"{l )-07/ -ottt re,
,:F
.i
Jor-rrnal
Bodtt
4,
No. I
A Survey on Antimicrobial Susceptibility of
Strepto co cct,rs pnet;l1.Loniae from Different Diagnostic
,Centers in Dhaka CitY, Banglaclesh
, K.2007.
glitazone
-alget
Q Dhaka International Univclsity,
for
Mol'ramnrad Shahriar and Sanj ida Shahicil
"rnd tlace
en
s:;olu
Abstract: Strcptococctts pttt:rrntoninc (irneumococcal) rert-rairrs an impot'tirnL c;'tttsc ol
pneumgnia, nreningitis, Lracteremias, arrd ncLrtc otitis mctlia rvorldr'r'ic1c.
Antirnic;obial resistance among pnelrmocc.rcci has ntt.;r-renLcd clt'rn-raticalltr ove r tl'rc
past Lhree clecac-les, and is inflr-rcnccd by patterns ol anlibiotic .,t". aun.i.1gral'rlc
nccessiiates regional resistatrce tracl<inq. The
1;cogr.piric variation ip slsceprtibiliLl,
teral
p
oL.,.,.ti,r" of the str-rdy is to assr-.ss antil-iotic sr-rsccptibility ol S, pttr'rrnrotlinc to lrctat'r-l
tion
a^C Macrolide antimicrobial agcnts. The data u'as collected lctrclspeclivclv
fr:ollr
antibiotic susceptibility re;rorts from clif{c'r'ent laLrctlatories atrcl assesscc'i Sirt?iococctt:;
srsceplibility to nrr,rltiple igcnts. Aggrcgating data is a fc'asible and tirr.rely tncthod of
PP.
moniioring regional susceptibilitl/ paLterns and mav also ptovc bcnefici;rl irr
measgring- t1-r,: effects of ilterventions [o c'lecrease antimicrolriirl rtsis[atrcc lrncl gr.riclt:
in ernprili6 ;rnl imiclobial
Key worcls:
trea
tment'
Strt,ptococctrs y;ttt'tnttottioc, SLrsceptibility,
Antimiclobial re'sistarrcc,
p
lactam, Nfacrolides.
Introduction
I
i
l
I
)
j
t
t
I
e=
)l
l
I
is onc of the leading catlscs oI
ptrettrnoni;r, b:'tc[cmctnir,
Chiltlhood lltretttnorri:t
worlcl'"vide.r-r
infections
tract
meningilis, url.l .rpp". respiraiory
6t-'
ihe estirrrated 'ltlntt:rl
mort;rlitl'
child
40'/o
annttal
and meningitis, acconnt for 20 to
colrtrtrics.5'6
in
developing
pncumouia
frorn
gtobal burdin of 2.7 million childhood deatl-r
-lob"lly, pnc,rnococcal diseases accorlnt for I to 2 million dcaths arnl-rttallv irr lrotl-r
extrernes of age.7 S.Ttnantonil7d often colonizes the nasopharvnx of heaithv chilc'lrcn ar.rcl
can then, in specific situations, spread to thc lungs, paranasal tissues and caltse t.t-tt-tcosai
infectiols, r.,ah, or pncumonia, or invade the bloodstreat.u aud caltse lrrcuit-rgitis.s Anlimicrobial resistanci: of S. pntttrtttorrinr, lo p-laclant, r-nacroliclcs, arrcl othcr antilriotic clrls:rcs
has ipcrease dranratically throughorrt the lvorld in the past ihrcc clccacie.''-ll Thc
ipfections c;rusetf try Lhis pathogen arc anong thosc least iil<elv to bc lt'solvecl urilhoul
effectirre antibioiic treatment. I-'[o,wc..'er, sirrcc ]980s, a clramalic incrt:ase ir-r.rntiLriotir:
rcsistance ait1ol1g S, pnt:ttntitttinc lras bccu clbscrved in l.uarrv parls ol llls 1r.'1'lf ii'.l .rr-Lt'
Treatment failure associatecl I'r,ith antibiolic-rc-'sisl.ruI ptleLllnococci has bccn rcpor'i.ecl lor
patients rn,iih pnertrnonia.r6,lT i-ligh level oI antibiotic tlsc is plobably tl're r-najrr ilctor
drivir-rg thc emergencc of resistance.ls Additionaily, t'csistance to nraclolidcs and oihr:r
antibiotic classcs escalated in t:rnclem rt,ith pcnicilliu resistance. Crrrrctrtlv, l5 to 30'l' of S.
pnetnnonine rvr:rldwide are ptrlticlrrrg-rcsistar-rl (MDR) (i.c., rcsisiant to 2 3 clrsses of
antibiotics). Despite the dramatic escalalion in [ltc ratc of antimiclobial rcsis',ancc anlorrg
streptococciworliwide, the clirticnl itn1tnct of antir.nicrobial resistancc is diffictrlt lo defirrc'.
Strt:ptococctrs pnertmoninc
I
i
I
Department of Phamracy, Univer:sity oI Asia Pacilic, Dhantnontli, Dhalca- i209, Ban'.il;rclcslr
Corrcspondence to: Mohammad shahriar, Il-nlail: shahriar-l 2(uryahoo.corn
r
88
A Strrt,ctl
ot1
/\tltinticrobinl StrscL'ptiltilil.tl
ol'SLrcplococL-t!s In(uurotrint.f
l )l/7r / ros/ l. (lr,l ir,r--s i t t D I n lin C i
r
1
lltt
.t1. E n
DiJJ't,rt:ttl
t t 14 I
n rl
rcl
l'rclttl-rlcrrt iailrrrcs clLre lo arliibioIic-rcsistirrrI sIrc;-rIococci havc Lrt-.crr rcportccl \viLh
lllcrlillsiLis, oIi lis i.ncdi;'r, ancl lower rcspirator\r iract inl'ccLiolls, bqt l6e rel;rtior.r bctr,r,ecrr
clrr-tr; r'csistatrcc atrcl Ircitlr.ncnt 1'.rilurcs ]-ras noI bccr.r convincingllr csL;rLrlisirecl.re,zo Thcse
"nrLrlIicll'trg rcsist.rnl"
Pncultloc()cci havc notv Lrcc:r-r rc;trtrtccl all orrcr: t5c,,rrt>t.]cl.:t
lniccIicllrs cltt'tsctl lt1, r'csisLanI rnicrobcs f;ril Lo rcspond to Ir.catr.ncr.rL, rcsrrlliug ir.r
prolorlq'-11 illrless llld grcitcr risk of dcirth. TrcriInrcrrt [aiitLrcs a]so lead lo longcr
pr.rio.l.
ol ink.clir''it1', which ittcrcas:L thc nuri.rbers of inl'ccLcd pcopJc rnovirlg in thc ionrirLrpitl;
al-icl LhLrs cxposc Lhc genclal population lo thc risk ol contracting a r.esisLant straip
of
infcctior-r. N4trch cviclcncc strpporls ll-rc vicu, ih;il thc lotlticotrsut.nptiop of arrtjmicr-olria.ls
is tl'ic critical factor in selccLirrg rcsis[ancr'. Tl-re objcctive of thc s1r.rc-ly is lo asscss airl.ibiotic
strsceplibility of S. Ttttttttrtt'ttrine to 11 l.rclam and macrolicie aniinricrobial agents. T6e data
was collcctccl r^r:trosprcctirrcly fronr ,antibiotic sr.rsccptibility rcports fror-n ciiflercrrl
laLroratorics and asscsscd stt'tyttococcris susccptiLrility to mr,rltiplc agents.
resistant
I
pt-LclttltoCOCr
resis tance
resistaltce
modificatir
efflux nrec$
both p lacri
l
resistance
level resis
oLltcomes
likely med
,
,
stable over rr
azithromyc
erythromyr
prescribed '
Iow-level n
I
Table 1: Pe
l
,.
**
Table 2: P,.
generation
Rcsults and Discussion
,
All
the data from 5
laboratorrcs w'1rost: pneumococcal ar-rtibiotic ir-rsceptibilitv t-esting resr-rlls \,vcre
summarizcd. ln lhc pleggnt sttrdy, rve folurd the pcrccnt;rge of norr-si,rscJptible isoiates ir-r
case oI peniciliin is 59.85"i', cephaiosporin \1 .27o/r, and 47.56"/" forl }lrythro1nyci1.
Ptrricillin rcsislatlcc alllollg S. Ttnctnitoniac is a global ploblem. Laboratoly nurtar-ris ol
pllcLlrttococci rcsistant to penicillin wcre selccled as ear.l1, as t|e l9{0s.22.2r lr wrs 20
1,ears
beforc th'c first clinical isolate, with rcduced susccptibility to p"ni.ittir.r, *"r',..i-,i.,"a
flotn IJosLon, il'lassachusetts;21 Literaturc revealed that, a +% totat resislance to pcrlic;llin
and 10'll, irrtelmecliate resjstat-Lcc, as observed irr the present str.rdy, shor.t,s i.he incr.easirrg
emergence of resistancc str.ains oi S. prtLtutrrcrtinc in Irrdia.-Earlici, tirree,year sr.rniCillar-rci
for pcr-ricilliu
upPer resl
.
Methodology
The data of antin-riclobial sr-rsceptibilitv was rctrospectively colleclecl from differ:errt
diagnostic centets in Dhaka city. The data covcrs the iast 3 years period (August 2O0g to
Augusi 2011) ior which cot'nplcte sLrsceptibility data were availible at the-ti11e of tire
ir-rqtrirv. We compiied total trnmbcrs of S. pnannonlcc isolates identified fror-n the lab.s
along lvith thc pcrcent of ir.rtcn-nediate arld rcsistant isolates, focr,rsilg on 11ol1
sttsccptibilitY to pcnicillin, uracrolidcs, arrd extcr-rdcd-sp.rcctrtrm cephalospo'rirr,s (e.g.,
cefotaxin-re, ceftriaxone). Wc clefirred ncn susceptible iiolates nu il"ror.' ihat were
of
intermediate alnd irig)r-levcl resistance or those were siurply described as noL sLrsceplible
to tire arrtibiotic tcsled. If only a subset of isolates rvcr-e tesied a$rinst eryLhrorr)/ciii and
cxtcnded-speclrttm cephaiosporins, wc exch-rclcd thcse rcsults frorn the iggregatecl
total
ittr crv th ronr),ci r-r,
Five diffcrerrt di.rgnos[ic centcrs in Dhaka city compleLet] thc srlr'cvs.
[otrrrnl ol D
t
frotn Vellole revealed 1.6nL of interr-nediatc resista.ce to
penicillin,?s whereas, a Nolth hrdiarr str-rdy rcported 15.2% (26/lZ0) ipterprediate
resistancc
resistance arrd 2.3'lo (4/170) penicillin t"rirlor-,i".2r,'ihe differer-rce in thc resistance pattcm
of S. pnettrttottiue as observed irr South and North lndian sttrdies has been
iy or.'
thc basis of the high genctic divcrsity that exisLs among strairrs isolated"*ptuin"j
froqr diffe1elt
geograplrical areas within ]rrdia.z7 Ptttrtntococcal resistance rates tend to ipcrease pror,,ilg
along the spc'ctrLtnl of isolatcs obtained from bloodstrealn to lower lespiratory tract to
upper respiratorv-tract.28 This fact potentially corlfor,urds point comparisorrs of rlesistalce
rates siuce a marked increase itr resistance can result frbm testing a preporrderancc
of
No. of
Dj
r,
Cenl
i
Table 3: pe
generation I:
No. of Di;
Centr
1
2
3
4
5
iv
i
tl
.(
F
i
t
I
Irlu*l o{
Vol'
Dhakn Intarnntional LJrtioersity '
89
4' No'
..p8":r'i1::yi::'3:::;;^ffiii'",lii*:'J':"i*1i];'ii,r;:'*ffi1:':?i:l'l"tJ."1
m
resisbant sLrarns
;;;;;.;'t'115lJj{iTgg$*ilt;\,'.:Jf#$Ui9.1"."'l':,:i'il::li'l?:
reslstance may incl
of t'e trvo nrechat'risms -
;;".-,;
jd,r#il';#,+r11;i
jiJ::.Trf}*,:,a
jE:? jl':ac'[i'e
m:nruJii"";it.,,:h i;;tg"trt* o"i't''"iill
g"'* " iro"9pt"1'"0 o'9qt:::1"" ot
in per.ric'ri.
lo..&t'r"t
effrux mechanism,
.o',..r.. T^e inc'ease
-' both p lacram ma_r".je#iiai reEisrune" iJ orrf nrii*i.,
rathel than intermediate*itt-, ur',.1,r'..:;;il'itlilllevel
'itas beet-t associated wit6' w.rse
resistance appears i. ."*"r^r"
,""tjtt^'t*
le'el resistar.,.u u'd nign-terret,p.r,lcliiri
tnacrolide resista.ce is 'rost
i*fectio^r:i;'ih;";tt"ased
pr-r".rl,'o.Zlcal
remai.ed
outcomes ro,
since clir-rdalnycin susceptibilily
prrmf
effl'x
rry'^'io*-r"""r
-purioa.,*
likely mediut"a
tn'ility gunt"lly predicts tlrrI of
E.ytniffi'"'^t''"*f
strriy
the
stabie over
;"r :11,,{'}*,il*,i'uji:
;*"y:,1
azr
i';ii'::1H,,i;ili
;lt*y*:;':i';.;'
rntl
oi tont"'tu'''ity-acqr-rirccl pncutnonirt
ervdrromYcrfi'
prescribed
orri.i.,J witir clinicil [ailrrre'3('-]d
t
^^,,o,"iilr'i"i;.,ip",;;,.'a,..^i;;;i
Iorv-level ,nn.ro,,d"-r-"rir,nn."'t-,n, "".r
hle 'l: Percentage fSr tococcrrs prtctrnronineisolates "o^
Total nunrlrer ot
-F6tt *tc"Ptible isolates
ilo. of Diagnostic
isol a tes
tttt."p"Ot"
IlNon
(-enters
J
60.33
{f ,Jr)
lcX)
85
5
.
81.91
940
43)
4
59.85
2727
Total
Table
2: Percentage
No. of Diagnostic
Centers
I
2
3
4
5
of
S
strscepti['le
45 19
520
n5
7n
2
n"^i:]l'lin
30.57
1{\7
I
to
trep to co cclts
p1teu117o1t1
Non suscePtible
isolates
flc isolates
non susceptible to third
Total nulnber of
isolates
2.78
4.3s
72
?9n
z
t+
10.98
l/:l
G
7.56
2tl
450
Jr!
520
104
"l' Non
susccPtible
-+1./
1535
Total
StrePtoco ccrts Pttcttttlontne
N-o.-of Diagnostic
Non suscePtible
isolatcs non suscePtible to third
ffiLn.ttt',b"t
isolntes
of
% Nor.t susce Ptiblc
d,t?$W]ffi
&d'4$ffi lisi!r;$^.'i
t\
90
ol strcyttocctcctls pt1(tttlnttina t'ront Di'il'trntt
srrr|ty on AtttittttcroLtinl sttsccltttLtiliLll
Dltnkn Citq' Bnttl;lnLlult
1j;6'l,rosti,:t Cr'rrisrs
lou'nnl
of
,
in
I
Co.rclusion
to ilrcrcasc' caus1l1g slg.ificarrt morbicliiy ar-rd
coulitltlcs lo
"""''";n"r'rrrlitrrt.s
l)rug-r'csistaut S. Prir:ttrriottinc
lt:el I'^c cl'r-rg-rcsistirucc irrcitrde: irrarppropriatc
r-'ortriity. Tlie 3 *.t;;:';..;.;., it-,,',t
^a'e
r-lscoIar-r|.iLliotrcs,pro}olrgccidosagcregtl.llclls;rrrdr.rtrdcrdosirrg.Iitrrcl:gerrceofrcsislant
continr'rous local as well irs global
s.
of
lttrruitottitlrr nccrf
strairrs.ind also thc lvlDlislr:airrs
[6e linc of treat're't' Edtlcatio^ of
of tirc serrsili'il), pattc.l, rn ".'io fr"n
fot' errsltring the rational usc of
'-rouilori.g
hcaltir c.ri.c pror,iclc.rs arrci' rhc p,'.rblic is csscrrlial
a significalrt role. in. edttcating botir grollps'
anliuricrolriais. l)harrrracists cau play
vital iuformatio. that etlcottl'alges
as edltcators to assist i^ dissemirrati'g
assunirrg
'oies
judicious 1'se of a^tibiotics b-v lhe hcalth
the rationi'rl nsc o1' atrlinricrobi.-rls. Thc
atrd r.rse of arrtibiotics olficially irr tlre
profcssiorral irrrd cfforl.s to coirtrol p,o.'''l.,1.I.,-.'t
patSogens'
irrcreasirrq rate of clrr'rg resistarrce in t5e
locality will probabrf i''"rp to li'rit []ie
in this
and
exceptio^3')
the
tha.
I^ Ba^glacierr..,, "*pi.i.nt ,t.I"rnpy is the *rle .at6er
cor-rtcxtofchangingtl'redyuatnicsofrcsistar-rccloantibiotics'itisimperatil'eforoptirnal
for
of antibiotic sensitivity pral-tertr of patl-rogerrs
paticr-rt car:c that.ot",rio,-ti evalltatiolr
out'
carried
be
shor-rld
a partictrlar euvirontrtelrt
comuronly uscd antimicrobial agents in
I
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Senior SciIndustrial
2 Lecturer,
-
-
Universit5
3 Assistant Internatior3
Correspondt
Dr. Mohammad Shahriar