Antimicrobial susceptibility of community-acquired respiratory tract pathogens in the UK during 2002/3 determined locally and centrally by BSAC methods

Objectives: To determine the antimicrobial susceptibility of Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pneumoniae causing community-acquired lower respiratory tract infection in the UK during 2002/2003 and to compare susceptibilities determined locally by disc diffusion with agar dilution MICs determined at a central laboratory. Methods: H. influenzae, M. catarrhalis and S. pneumoniae were isolated in 30 laboratories and susceptibility determined locally by the BSAC standardized disc diffusion method. At a central laboratory, isolates were re-identified, tested for beta-lactamase production (H. influenzae and M. catarrhalis only) and MICs determined using the BSAC agar dilution method. Results: Five hundred and eighty-one H. influenzae, 269 M. catarrhalis and 519 S. pneumoniae were collected. Over 93% of M. catarrhalis and nearly 15% of H. influenzae were beta-lactamase positive rendering these sub-populations resistant to aminopenicillins. Overall, the antibacterial susceptibility rates for the isolates were high. However, macrolides showed poor activity against H. influenzae (0.86-1.38% susceptible by disc or MIC methods) and, compared with other antimicrobials, against S. pneumoniae (approximately 88% susceptible). Between 84% and 95% of H. influenzae, M. catarrhalis and S. pneumoniae were susceptible to cefuroxime but all isolates were susceptible to cefotaxime. Eighty-five percent of H. influenzae were susceptible to trimethoprim. The fluoroquinolones were very active against the isolates, with moxifloxacin showing lower MICs than levofloxacin against S. pneumoniae. Susceptibility determined locally by disc diffusion was in general agreement with that determined centrally by agar dilution MIC testing. However, there was one inconsistency with H. influenzae where disc diffusion indicated 22.9% and 46.8% resistance to clarithromycin and erythromycin, respectively but by MIC, only 0.9% and 6.9% were resistant, respectively. Conclusions: Rates of resistance within community-acquired respiratory tract isolates were relatively low in the UK, in agreement with other studies. Moxifloxacin was the only antibacterial with over 99% isolates susceptible for each of the three pathogens investigated where breakpoints are available. The comparison between disc susceptibility testing and MIC determination using BSAC methods indicated generally good correlation but has highlighted a methodological problem with macrolides against H. influenzae in particular.