Estudo Viriato: Actualização de dados de susceptibilidade aos antimicrobianos de bactérias responsáveis por infecções respiratórias adquiridas na comunidade em Portugal em 2003 e 2004

The Viriato Study: Update of antimicrobial susceptibility data of bacterial pathogens from community-acquired respiratory tract infections in Portugal in 2003 and 2004

 

 

J. Melo-Cristino¹

Letícia Santos¹

Mário Ramirez¹

Grupo de Estudo Português de Bactérias Patogénicas Respiratórias²

 

 

Resumo

O Estudo Viriato é um estudo nacional, prospectivo e multicêntrico, de vigilância da susceptibilidade aos antimicrobianos de bactérias frequentemente responsáveis por infecções do aparelho respiratório adquiridas na comunidade. Nos anos de 2003 e 2004 participaram 29 laboratórios de todo o país. Isolaram-se 2945 microrganismos que foram estudados num laboratório coordenador. Das 513 estirpes de Streptococcus pyogenes de doentes com amigdalo-faringite aguda, todas eram susceptíveis à penicilina e outros antibióticos beta-lactâmicos, mas 18,9% eram resistentes à eritromicina, claritromicina e azitromicina. Nas estirpes resistentes foi mais frequente o fenótipo M (67,0%) que confere resistência à eritromicina (CIM₉₀=16 mg/L), claritromicina e azitromicina, mas susceptibilidade à clindamicina (CIM₉₀=0,094 mg/L). De doentes com infecção do aparelho respiratório inferior estudaram-se 1300 estirpes de Streptococcus pneumoniae (pneumococos), 829 de Haemophilus influenzae e 303 de Moraxella catarrhalis. Em S. pneumoniae, 18,4% das estirpes eram resistentes à penicilina (3,5% com resistência elevada), 7,1% à cefuroxima, 0,5% à amoxicilina, 0,5% à amoxicilina/clavulanato, 18,8% à eritromicina, claritromicina e azitromicina, 14,5 % à tetraciclina, 16,5% ao co-trimoxazol e 0,4% à levofloxacina. Nas estirpes resistentes aos macrólidos, dominou o fenótipo MLS_B (83,7%), caracterizado por resistência elevada (CIM₉₀>256 mg/L) à eritromicina, claritromicina, azitromicina e clindamicina. Produziam beta-lactamase 10,0% de H. influenzae e 96,4% de M. catarrhalis. Em H. influenzae demonstrou-se 5,5% de resistência à claritromicina e 13,4% ao co-trimoxazol. A quase totalidade das estirpes era susceptível à amoxicilina / clavulanato, cefuroxima, azitromicina, tetraciclina e ciprofloxacina. Em M. catarrhalis a resistência ao co-trimoxazol foi de 27,1% e à tetraciclina de 1,0%. Todas as estirpes eram susceptíveis à amoxicilina / clavulanato, cefuroxima, claritromicina, azitromicina e ciprofloxacina. De entre o conjunto de antibióticos ensaiado, a penicilina continua a ser o mais activo contra S. pyogenes e a amoxicilina / clavulanato e as quinolonas os mais activos simultaneamente contra S. pneumoniae, H. influenzae e M. catarrhalis.

Palavras-chave: Portugal, Estudo Viriato, infecção respiratória, comunidade, 2003, 2004, susceptibilidade aos antimicrobianos, Streptococcus pyogenes, Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis.

 

Abstract

The Viriato Study is a nationwide, prospective, multicenter surveillance study of the antimicrobial susceptibility of bacterial pathogens commonly associated with community-acquired respiratory tract infections in Portugal. In 2003 and 2004 a total of 2945 isolates was recovered in the 29 laboratories that participated in the study. Testing was undertaken in a central laboratory. Of the 513 Streptococcus pyogenes strains isolated from patients with acute tonsillitis all were susceptible to penicillin and other beta-lactams but 18.9% were resistant to erythromycin, clarithromycin and azithromycin. The M phenotype dominated (67%), conferring resistance to erythromycin (MIC₉₀=16mg/L), clarythromycin and azithromycin, but susceptibility to clindamycin (MIC₉₀=0.094 mg/L). From patients with lower respiratory tract infection 1,300 strains of Streptococcus pneumoniae, 829 of Haemophilus influenzae, and 303 of Moraxella catarrhalis were studied. Among S. pneumoniae isolates 18.4% were resistant to penicillin (3.5% showing high-level resistance), 7.1% to cefuroxime, 0.5% to amoxicillin and amoxicillin/clavulanate, 18.8% to erythromycin, clarithromycin and azithromycin, 14.9% to tetracycline, 16.5% to co-trimoxazol, and 0.4% to levofloxacin. Beta-lactamases were produced by 10.0% of H. influenzae and 96.4% of M. catarrhalis. In H. influenzae resistance to clarithromycin was 5.5% and to co-trimoxazole was 13.4%. Most strains were susceptible to amoxicillin/clavulanate, cefuroxime, azithromycin, tetracycline and ciprofloxacin. In M. catarrhalis resistance to co-trimoxazole was 27.1% and to tetracycline 1.0%. All strains were susceptible to amoxicillin/clavulanate, cefuroxime, clarithromycin, azithromycin and ciprofloxacin. Penicillin was the most active antimicrobial agent against S. pyogenes and amoxycillin / clavulanate and the quinolones the most active in vitro simultaneously against S. pneumoniae, H. influenza and M. catarrhalis.

Key-words: Portugal, Viriato Study, respiratory tract infections, community, 2003, 2004, antimicrobial resistance, Streptococcus pyogenes, Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis.

 

 

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Bibliografia

1. Melo-Cristino J, Fernandes Ml, Serrano N and The Portuguese Surveillance Group For The Study Of Respiratory Pathogens. A multicenter study of the antimicrobial susceptibility of Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis isolated from patients with community-acquired lower respiratory tract infections in 1999 in Portugal. Microbial Drug Resistance 2001; 7: 33-37.        [ Links ]

2. Melo-Cristino J, Fernandes Ml, Serrano N, e o Grupo de Estudo Português de Bactérias Patogénicas Respiratórias. Susceptibilidade aos antimicrobianos de Streptococcus pyogenes, Haemophilus influenzae, Streptococcus pneumoniae e Moraxella catarrhalis de infecções respiratórias adquiridas na comunidade em 2000. Acta Médica Portuguesa 2001; 14: 459-468.        [ Links ]

3. Melo-Cristino J, Serrano N, e o Grupo de Estudo Português de Bactérias Patogénicas Respiratórias. Estudo Viriato: Actualização de dados de susceptibilidade aos antimicrobianos de bactérias responsáveis por infecções respiratórias adquiridas na comunidade em Portugal em 2001 e 2002. Rev Port Pneumol 2003; 9: 293-310.        [ Links ]

4. Bartlett Rc, Mazens-Sullivan M, Tetreault Jz, Lobel S, Nivard J. Evolving approaches to management of quality in clinical microbiology. Clinical Microbiology Reviews 1994; 7: 55-88.        [ Links ]

5. Barenfanger J. Improving the clinical utility of microbiology data: An update. Clinical Microbiology Newsletter 2003; 25: 1-8.        [ Links ]

6. National Committee For Clinical Laboratory Standards. 2004. Performance Standards for Antimicrobial Susceptibility Testing - Fourteenth Informational Supplement 24 (1) (M100-S14). National Committee for Clinical Laboratory Standards, Wayne, PA.        [ Links ]

7. Melo-Cristino J, Fernandes Ml and The Portuguese Surveillance Group for the Study of Respiratory Pathogens. Streptococcus pyogenes isolated in Portugal: Macrolide resistance phenotypes and correlation with T types. Microbial Drug Resistance 1999; 5: 219-225.        [ Links ]

8. Bisno Al, Gerber Ma, Gwaltney Jr Jm, Kaplan El, Schwartz Rh. Diagnosis and management of group A streptococcal pharingitis: A practice guideline. Clinical Infectious Diseases 1997; 25: 574-583.        [ Links ]

9. Silva-Costa C, Ramirez M, Melo-Cristino J, and The Portuguese Surveillance Group for the Study of Respiratory Pathogens. Rapid inversion of the prevalences of macrolide resistance phenotypes paralleled by a diversification of T and emm types among Streptococcus pyogenes in Portugal. Antimicrob Agents Chemother 2005; 49: 2109-2111.        [ Links ]

10. Albertí S, Garcia-Rey C, Dominguez Ma, Aguilar L, Cercenado E, Gobernado M, Garcia-Perea A, and The Spanish Surveillance Group for Respiratory Pathogens. Survey of emm gene sequences from pharyngeal Streptococcus pyogenes isolates collected in Spain and their relationship with erythromycin susceptibility. J Clin Microbiol 2003; 41: 2385-2390.        [ Links ]

11. Vaz Pato Mv, Carvalho Cb, Tomasz A, and The Multicenter Study Group. Antibiotic susceptibility of Streptococcus pneumoniae isolates in Portugal. A multicenter study between 1989 and 1993. Microbial Drug Resistance 1995; 1: 59-69.        [ Links ]

12. Serrano I, Ramirez M, The Portuguese Surveillance Group for the Study of Respiratory Pathogens And Melo-Cristino J. Invasive Streptococcus pneumoniae from Portugal: implications for vaccination and antimicrobial therapy. Clin Microbiol Infect 2004; 10: 652-656.        [ Links ]

13. Serrano I, Melo-Cristino J, Carriço J, Ramirez M. Characterization of the genetic lineages responsible for pneumococcal invasive disease in Portugal. J Clin Microbiol 2005; 43: 1706-1715.        [ Links ]

14. Heffelfinger Jd, Dowell Sw, Jorgensen Jh, Klugman Kp, Mabry Lr, Musher Dm, Plouffe Jf, Rakowsky A, Schuchat A, Whitney Cg, and the Drug-Resistant Streptococcus Pneumoniae Therapeutic Working Group. Management of community-acquired pneumonia in the era of pneumococcal resistance. A report from the drug-resistant Streptococcus pneumoniae working group. Archives of Internal Medicine 2000; 160: 1399-1408.        [ Links ]

15. Melo-Cristino J, Ramirez M, Serrano N, Hänscheid T, and The Portuguese Surveillance Group for the Study of Respiratory Pathogens. Macrolide resistance in Streptococcus pneumoniae isolated from patients with community-acquired lower respiratory tract infections in Portugal: Results of a 3-year (1999-2001) multicenter surveillance study. Microbial Drug Resistance 2003; 9: 73-80.        [ Links ]

16. Bajanca-Lavado Mp, Casin I, Vaz Pato Mv and The Multicentre Study Group. Antimicrobial resistance and epidemiological study of Haemophilus influenzae strains isolated in Portugal. Journal of Antimicrobial Chemotherapy 1996; 38: 615-625.        [ Links ]

17. Verduin Cm, Hol C, Fleer A, Van Dijk H, Van Belkum A. Moraxella catarrhalis: from emerging to established pathogen. Clinical Microbiology Reviews 2002; 15: 125-144.        [ Links ]

 

 

¹ Instituto de Microbiologia. Instituto de Medicina Molecular. Faculdade de Medicina de Lisboa/Microbiology Institute. Molecular Medicine Institute Lisbon Medical School.

Av. Prof Egas Moniz 1649-028 Lisboa. Tel. 217999458. Fax. 217999459.

² Grupo de Estudo Português de Bactérias Patogénicas Respiratórias/Portuguese Respiratory Bacterial Pathogens Research Group: Centro Hospitalar do Alto Minho, Viana do Castelo: Sílvia Lozano; Centro Hospitalar de Cascais: Ana Fonseca, Adriana Coutinho; Centro Hospitalar de Coimbra: Ana Florinda Alves, Luís Albuquerque; Centro Hospitalar da Póvoa do Varzim/Vila do Conde: Fernando Fonseca; Centro Hospitalar de Vila Nova de Gaia: Paulo Lopes, Ismália Calheiros, Luísa Felício, Lourdes Sobral; Hospital do Barlavento Algarvio: Teresa Vaz, Marília Gião; Hospital Central do Funchal: Teresa Afonso; Hospital Curry Cabral, Lisboa: Maria José Silvestre, Helena Peres, Teresa Pina; Hospital Distrital de Abrantes: Clotilde Roldão; Hospital do Divino Espírito Santo, Ponta Delgada: Eulália Carvalho; Hospital Infante D. Pedro, Aveiro: Elmano Ramalheira, Ana Margarida Paradela; Hospital D. Estefânia, Lisboa: Rosa M. Barros, Maria Isabel Peres; Hospital Garcia de Orta, Almada: José Diogo, Ana Rodrigues, Isabel Nascimento; Hospital Pedro Hispano, Matosinhos: Valquíria Alves, Antónia Read, Margarida Monteiro; Hospital de Pulido Valente, Lisboa: Margarida Abecassis, Isilda Alves, Rita Pinto; Hospital dos S.A.M.S., Lisboa: Luísa Cabral, Olga Neto; Filipa Antunes; Hospital de Santa Luzia, Elvas: Ilse Fontes; Hospital de Santa Maria, Lisboa: Luís Lito, Maria Luís Fernandes, Maria José Salgado; Hospital de Santa Marta, Lisboa: Margarida Pinto, Hermínia Choon; Hospital de Santo António, Porto: Ana Paula Castro, Maria Helena Ramos, José Manuel Amorim; Hospital de São Francisco Xavier, Lisboa: Filomena Martins, Maria Ana Pessanha, Elsa Gonçalves; Hospital de São João, Porto: Fernanda Cotta, J. Correia da Fonseca; Hospital de São José, Lisboa: Maria Odete Spencer, João Marques; Hospital de São Marcos, Braga: Maria Alberta Faustino, Adelaide Alves; Hospital de São Teotónio, Viseu: Isabel Marques, José Miguel Ribeiro; Hospital Senhora da Oliveira, Guimarães: Ana Paula M. Vieira, Francisco B. Moniz; Hospitais da Universidade de Coimbra: Rosa Velho, Rui Tomé, Celeste Pontes; Hospital de Vila Real: Ana Paula Castro; Instituto Nacional de Saúde Dr. Ricardo Jorge, Porto: Mª. Olinda Basílio, Mª da Graça Martins, Cristiana Pereira, Engrácia Raposo, Maria de Lurdes Magalhães, Helena Rocha.

 

Recebido para publicação/received for publication: 05.12.13

Aceite para publicação/accepted for publication: 06.01.04