Emergence of high rates of antimicrobial resistance among viridans group streptococci in the United States.

Three hundred fifty-two blood culture isolates of viridans group streptococci obtained from 43 U.S. medical centers during 1993 and 1994 were characterized. Included were 48 isolates of "Streptococcus milleri," 219 S. mitis isolates, 29 S. salivarius isolates, and 56 S. sanguis isolates. High-level penicillin resistance (MIC, > or = 4.0 micrograms/ml) was noted among 13.4% of the strains; for 42.9% of the strains, penicillin MICs were 0.25 to 2.0 micrograms/ml (i.e., intermediate resistance). In general, amoxicillin was slightly more active than penicillin. The rank order of activity for five cephalosporins versus viridans group streptococci was cefpodoxime = ceftriaxone > cefprozil = cefuroxime > cephalexin. The percentages of isolates resistant (MIC, > or = 2 micrograms/ml) to these agents were 15, 17, 18, 20, and 96, respectively. The rates of resistance to erythromycin, tetracycline, and trimethoprim-sulfamethoxazole were 12 to 38%. Resistance to either chloramphenicol or ofloxacin was uncommon (i.e., < 1%). In general, among the four species, S. mitis was the most resistant and "S. milleri" was the most susceptible.

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Antimicrobial Resistance among Clinical Isolates ofStreptococcus pneumoniae in the United States during 1999–2000, Including a Comparison of Resistance Rates since 1994–1995

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.45.6.1721-1729.2001 ◽

2001 ◽

Vol 45 (6) ◽

pp. 1721-1729 ◽

Cited By ~ 390

Author(s):

Gary V. Doern ◽

Kristopher P. Heilmann ◽

Holly K. Huynh ◽

Paul R. Rhomberg ◽

Stacy L. Coffman ◽

...

Keyword(s):

United States ◽

Antimicrobial Resistance ◽

Antimicrobial Agents ◽

Rank Order ◽

The United States ◽

Clinical Isolates ◽

Beta Lactam ◽

High Level ◽

Resistance Rates

ABSTRACT A total of 1,531 recent clinical isolates of Streptococcus pneumoniae were collected from 33 medical centers nationwide during the winter of 1999–2000 and characterized at a central laboratory. Of these isolates, 34.2% were penicillin nonsusceptible (MIC ≥ 0.12 μg/ml) and 21.5% were high-level resistant (MIC ≥ 2 μg/ml). MICs to all beta-lactam antimicrobials increased as penicillin MICs increased. Resistance rates among non-beta-lactam agents were the following: macrolides, 25.2 to 25.7%; clindamycin, 8.9%; tetracycline, 16.3%; chloramphenicol, 8.3%; and trimethoprim-sulfamethoxazole (TMP-SMX), 30.3%. Resistance to non-beta-lactam agents was higher among penicillin-resistant strains than penicillin-susceptible strains; 22.4% of S. pneumoniae were multiresistant. Resistance to vancomycin and quinupristin-dalfopristin was not detected. Resistance to rifampin was 0.1%. Testing of seven fluoroquinolones resulted in the following rank order of in vitro activity: gemifloxacin > sitafloxacin > moxifloxacin > gatifloxacin > levofloxacin = ciprofloxacin > ofloxacin. For 1.4% of strains, ciprofloxacin MICs were ≥4 μg/ml. The MIC90s (MICs at which 90% of isolates were inhibited) of two ketolides were 0.06 μg/ml (ABT773) and 0.12 μg/ml (telithromycin). The MIC90 of linezolid was 2 μg/ml. Overall, antimicrobial resistance was highest among middle ear fluid and sinus isolates of S. pneumoniae; lowest resistance rates were noted with isolates from cerebrospinal fluid and blood. Resistant isolates were most often recovered from children 0 to 5 years of age and from patients in the southeastern United States. This study represents a continuation of two previous national studies, one in 1994–1995 and the other in 1997–1998. Resistance rates with S. pneumoniae have increased markedly in the United States during the past 5 years. Increases in resistance from 1994–1995 to 1999–2000 for selected antimicrobial agents were as follows: penicillin, 10.6%; erythromycin, 16.1%; tetracycline, 9.0%; TMP-SMX, 9.1%; and chloramphenicol, 4.0%, the increase in multiresistance was 13.3%. Despite awareness and prevention efforts, antimicrobial resistance with S. pneumoniae continues to increase in the United States.

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Surveillance of Omadacycline Activity Tested against Clinical Isolates from the United States and Europe as Part of the 2016 SENTRY Antimicrobial Surveillance Program

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.02327-17 ◽

2018 ◽

Vol 62 (4) ◽

Cited By ~ 37

Author(s):

Michael A. Pfaller ◽

Michael D. Huband ◽

Dee Shortridge ◽

Robert K. Flamm

Keyword(s):

United States ◽

Moraxella Catarrhalis ◽

The United States ◽

Surveillance Program ◽

Bacterial Isolates ◽

Content Type ◽

Medical Centers ◽

Antimicrobial Surveillance ◽

Serious Infections ◽

Viridans Group Streptococci

ABSTRACTOmadacycline was tested against 21,000 bacterial isolates collected prospectively from medical centers in Europe and the United States during 2016. Omadacycline was active againstStaphylococcus aureus(MIC50/MIC90, 0.12/0.25 mg/liter), including methicillin-resistantS. aureus(MRSA); streptococci (MIC50/MIC90, 0.06/0.12 mg/liter), includingStreptococcus pneumoniae, viridans group streptococci, and beta-hemolytic streptococci;Enterobacteriaceae, includingEscherichia coli(MIC50/MIC90, 0.5/2 mg/liter);Haemophilus influenzae(MIC50/MIC90, 1/1 mg/liter); andMoraxella catarrhalis(MIC50/MIC90, 0.25/0.25 mg/liter). Omadacycline merits further study in serious infections where resistant pathogens may be encountered.

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Activity of Ceftaroline and Epidemiologic Trends in Staphylococcus aureus Isolates Collected from 43 Medical Centers in the United States in 2009

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00315-11 ◽

2011 ◽

Vol 55 (9) ◽

pp. 4154-4160 ◽

Cited By ~ 51

Author(s):

Sandra S. Richter ◽

Kristopher P. Heilmann ◽

Cassie L. Dohrn ◽

Fathollah Riahi ◽

Andrew J. Costello ◽

...

Keyword(s):

United States ◽

Staphylococcus Aureus ◽

The United States ◽

Surveillance Program ◽

Content Type ◽

Type Iv ◽

Medical Centers ◽

High Level ◽

Resistance Rates

ABSTRACTAStaphylococcus aureussurveillance program was initiated in the United States to examine thein vitroactivity of ceftaroline and epidemiologic trends. Susceptibility testing by Clinical and Laboratory Standards Institute broth microdilution was performed on 4,210 clinically significant isolates collected in 2009 from 43 medical centers. All isolates were screened formecAby PCR and evaluated by pulsed-field gel electrophoresis. Methicillin-resistantS. aureus(MRSA) were analyzed for Panton-Valentine leukocidin (PVL) genes and the staphylococcal cassette chromosomemec(SCCmec) type. All isolates had ceftaroline MICs of ≤2 μg/ml with an MIC50of 0.5 and an MIC90of 1 μg/ml. The overall resistance rates, expressed as the percentages of isolates that were intermediate and resistant (or nonsusceptible), were as follows: ceftaroline, 1.0%; clindamycin, 30.2% (17.4% MIC ≥ 4 μg/ml; 12.8% inducible); daptomycin, 0.2%; erythromycin, 65.5%; levofloxacin, 39.9%; linezolid, 0.02%; oxacillin, 53.4%; tetracycline, 4.4%; tigecycline, 0%; trimethoprim-sulfamethoxazole, 1.6%; vancomycin, 0%; and high-level mupirocin, 2.2%. ThemecAPCR was positive for 53.4% of the isolates. The ceftaroline MIC90s were 0.25 μg/ml for methicillin-susceptibleS. aureusand 1 μg/ml for MRSA. Among the 2,247 MRSA isolates, 51% were USA300 (96.9% PVL positive, 99.7% SCCmectype IV) and 17% were USA100 (93.4% SCCmectype II). The resistance rates for the 1,137 USA300 MRSA isolates were as follows: erythromycin, 90.9%; levofloxacin, 49.1%; clindamycin, 7.6% (6.2% MIC ≥ 4 μg/ml; 1.4% inducible); tetracycline, 3.3%; trimethoprim-sulfamethoxazole, 0.8%; high-level mupirocin, 2.7%; daptomycin, 0.4%; and ceftaroline and linezolid, 0%. USA300 is the dominant clone causing MRSA infections in the United States. Ceftaroline demonstrated potentin vitroactivity against recentS. aureusclinical isolates, including MRSA, daptomycin-nonsusceptible, and linezolid-resistant strains.

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Antimicrobial Resistance in Respiratory Tract Streptococcus pneumoniae Isolates: Results of the Canadian Respiratory Organism Susceptibility Study, 1997 to 2002

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.47.6.1867-1874.2003 ◽

2003 ◽

Vol 47 (6) ◽

pp. 1867-1874 ◽

Cited By ~ 122

Author(s):

George G. Zhanel ◽

Lorraine Palatnick ◽

Kimberly A. Nichol ◽

Tracy Bellyou ◽

Don E. Low ◽

...

Keyword(s):

Streptococcus Pneumoniae ◽

Antimicrobial Resistance ◽

Antibiotic Consumption ◽

Multidrug Resistant ◽

Medical Centers ◽

Intermediate Resistance ◽

Susceptibility Study ◽

Resistant Strains ◽

Canadian Provinces ◽

High Level

ABSTRACT A total of 6,991 unique patient isolates of Streptococcus pneumoniae were collected from October 1997 to June 2002 from 25 medical centers in 9 of the 10 Canadian provinces. Among these isolates, 20.2% were penicillin nonsusceptible, with 14.6% being penicillin intermediate (MIC, 0.12 to 1 μg/ml) and 5.6% being penicillin resistant (MIC, ≥2 μg/ml). The proportion of high-level penicillin-resistant S. pneumoniae isolates increased from 2.4 to 13.8% over the last 3 years of the study, and the proportion of multidrug-resistant S. pneumoniae isolates increased from 2.7 to 8.8% over the 5-year period. Resistant rates (intermediate and resistant) among non-β-lactam agents were as follows: macrolides, 9.6 to 9.9%; clindamycin, 3.8%; doxycycline, 5.5%; chloramphenicol, 3.9%; and trimethoprim-sulfamethoxazole, 19.0%. Rates of resistance to non-β-lactam agents were higher among penicillin-resistant strains than among penicillin-susceptible strains. No resistance to vancomycin or linezolid was observed; however, 0.1% intermediate resistance to quinupristin-dalfopristin was observed. The rate of macrolide resistance (intermediate and resistant) increased from 7.9 to 11.1% over the 5 years. For the fluoroquinolones, the order of activity based on the MICs at which 50% of isolates are inhibited (MIC50s) and the MIC90s was gemifloxacin > clinafloxacin > trovafloxacin > moxifloxacin > grepafloxacin > gatifloxacin > levofloxacin > ciprofloxacin. The investigational compounds ABT-773 (MIC90, 0.008 μg/ml), ABT-492 (MIC90, 0.015 μg/ml), GAR-936 (tigecycline; MIC90, 0.06 μg/ml), and BMS284756 (garenoxacin; MIC90, 0.06 μg/ml) displayed excellent activities. Despite decreases in the rates of antibiotic consumption in Canada over the 5-year period, the rates of both high-level penicillin-resistant and multidrug-resistant S. pneumoniae isolates are increasing in Canada.

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In Vitro Activity of Delafloxacin against Contemporary Bacterial Pathogens from the United States and Europe, 2014

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.02609-16 ◽

2017 ◽

Vol 61 (4) ◽

Cited By ~ 42

Author(s):

M. A. Pfaller ◽

H. S. Sader ◽

P. R. Rhomberg ◽

R. K. Flamm

Keyword(s):

United States ◽

Antimicrobial Agents ◽

Respiratory Infections ◽

The United States ◽

Content Type ◽

Medical Centers ◽

Tract Infections ◽

Viridans Group Streptococci ◽

Gram Positive Cocci

ABSTRACT The in vitro activities of delafloxacin and comparator antimicrobial agents against 6,485 bacterial isolates collected from medical centers in Europe and the United States in 2014 were tested. Delafloxacin was the most potent agent tested against methicillin-susceptible Staphylococcus aureus (MSSA), methicillin-resistant S. aureus, Streptococcus pneumoniae, viridans group streptococci, and beta-hemolytic streptococci and had activity similar to that of ciprofloxacin and levofloxacin against certain members of the Enterobacteriaceae. Overall, the broadest coverage of the tested pathogens (Gram-positive cocci and Gram-negative bacilli) was observed with meropenem and tigecycline in both Europe and the United States. Delafloxacin was shown to be active against organisms that may be encountered in acute bacterial skin and skin structure infections, respiratory infections, and urinary tract infections.

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Antimicrobial resistance of Streptococcus pneumoniae recovered from outpatients in the United States during the winter months of 1994 to 1995: results of a 30-center national surveillance study.

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.40.5.1208 ◽

1996 ◽

Vol 40 (5) ◽

pp. 1208-1213 ◽

Cited By ~ 309

Author(s):

G V Doern ◽

A Brueggemann ◽

H P Holley ◽

A M Rauch

Keyword(s):

Streptococcus Pneumoniae ◽

Antimicrobial Agents ◽

Clinical Laboratory ◽

Rank Order ◽

The United States ◽

Penicillin Resistance ◽

National Committee ◽

Medical Centers ◽

Resistant Strains ◽

High Level

A total of 1,527 clinically significant outpatient isolates of Streptococcus pneumoniae were prospectively collected in 30 different U.S. medical centers between November 1994 and April 1995. Overall, 23.6% of strains were not susceptible to penicillin, with 14.1% intermediate and 9.5% high-level resistant. The frequencies of recovery of intermediate and high-level resistant strains varied considerably between different medical centers and in different geographic areas. In general, intermediate and high-level penicillin resistance was most common with isolates of S. pneumoniae recovered from pediatric patients. The in vitro activities of 22 other antimicrobial agents were assessed against this collection of isolates. Ampicillin was consistently 1 twofold dilution less active than penicillin. Amoxicillin and amoxicillin-clavulanate were essentially equivalent to penicillin in activity. The rank order of activity for cephalosporins was cefotaxime = ceftriaxone > or = cefpodoxime > or = cefuroxime > cefprozil > or = cefixime > cefaclor = loracarbef > cefadroxil = cephalexin. The National Committee for Clinical Laboratory Standards [Performance Standards for Antimicrobial Susceptibility Testing, Sixth Information Supplement (M100-S6), 1995] has established MIC breakpoints for resistance (i.e., > or = 2 micrograms/ml) with three cephalosporins versus S. pneumoniae, namely, cefotaxime, ceftriaxone, and cefuroxime. The overall percentages of strains resistant to these three antimicrobial agents were 3, 5, and 12, respectively. The overall frequency of resistance was 10% with all three macrolides examined in this study, clarithromycin, erythromycin, and azithromycin. The overall percentages of chloramphenicol, tetracycline, and trimethoprim-sulfamethoxazole resistance were 4.3, 7.5, and 18, respectively. The resistance percentages among the cephalosporins, macrolides, chloramphenicol, tetracycline, and trimethoprim-sulfamethoxazole were consistently higher among penicillin-intermediate strains than among susceptible isolates and even higher still among organisms expressing high-level penicillin resistance. Multiply resistant strains represented 9.1% of the organisms examined in this study. Finally, rifampin resistance was uncommon (i.e., 0.5%), and vancomycin resistance was not detected. The quinopristin-dalfopristin combination was consistently active at concentrations of 0.25 to 4 micrograms/ml, but rates of resistance could not be determined in the absence of established interpretive criteria for MIC results.

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Beyond Religiosity: A Model to Explain Spirituality Among Middle-Aged and Older Adults

Innovation in Aging ◽

10.1093/geroni/igaa057.1333 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 413-414

Author(s):

Carlyn Vogel ◽

Debra Dobbs ◽

Brent Small

Keyword(s):

United States ◽

Older Adults ◽

Good Life ◽

Multinomial Logistic Regression ◽

College Experience ◽

The United States ◽

Strong Connection ◽

Deep Appreciation ◽

The World ◽

High Level

Abstract Spirituality is difficult to define as researchers assign it different meanings and individuals’ perceptions can vary. For example, spirituality may connect to religiosity, while others consider religiosity a less significant part of spirituality. This study investigates factors outside of religiosity that are significantly associated with spirituality to inform the characteristics of the concept. Webster’s (2004) existential framework of spirituality was used to guide variable selection. The National Survey of Midlife in the United States wave three (MIDUS 3; 2013-2014; n = 2,594; Mage = 63.5, SD = 11, range = 39–92) was used to examine individuals’ reported levels of spirituality. Multinomial logistic regression was conducted to examine factors related to low and high levels of spirituality compared to a moderate level. Participants with low spirituality were more likely to be male, less likely to be mindful, mediate/chant, feel a strong connection to all life, to indicate that they cannot make sense of the world, and to be religious. Participants with high spirituality were more likely to be female, have at least some college experience, be mindful, meditate/chant, feel deep inner peace, have a sense of deep appreciation, think that a sense of purpose is important for a good life, and have a high level of religiosity. Framed by Webster’s conceptual model, the current study observed that religiosity is significantly associated with spirituality and that other mindfulness-based aspects are also present within this concept. Incorporating mindfulness with religious efforts will more accurately and holistically address spirituality.

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Employment Diversification as a Determinant of Economic Resilience and Sustainability in Provincial Cities

Sustainability ◽

10.3390/su13094861 ◽

2021 ◽

Vol 13 (9) ◽

pp. 4861

Author(s):

Marcin Bogdański

Keyword(s):

United States ◽

The United States ◽

Real Estate Market ◽

Living Standards ◽

Economic Resilience ◽

The Real Estate ◽

The Real Estate Market ◽

Moderate Negative Correlation ◽

High Level ◽

Level Of Living

Differentiated response of selected economies to the global economic crisis caused by the collapse of the real estate market in the United States has drawn the attention of economists to the concept of economic resilience. At the same time, once again, it showed the importance of analysing and creating suitable conditions for sustainable development. Resilient economies are less exposed to the risk of economic crises or slowdowns, which is vital for ensuring stable incomes and high level of living standards. Therefore, the presented analysis was aimed at evaluating the level of economic resilience of provincial cities in Poland in relation to the situation on their labour markets. For this purposes, selected measures of the variation in the distribution feature (e.g., coefficient of variation) and the degree of structure diversification of the examined feature (Amemiya’s index) were used. Subsequently, using correlation analysis, the research determined whether any relationships could be observed between the investigated variables. The results of the research indicate that for provincial cities sub-regions in Poland, a statistically significant, moderate negative correlation could be observed between the degree of employment structure diversification in 2009 and the scale and scope of the collapse in the number of employed persons in subsequent years. This suggests that a high level of employment diversification restricted the level of economic resilience in this case.

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