The Activity of Levofloxacin and Comparator Agents against Clinical Isolates of Streptococcus pneumoniae Collected Worldwide during 1999 and 2000

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Abstract
Background: Increases in penicillin-resistant Streptococcus pneumoniae have been documented worldwide. Methods: During 1999 and 2000, 5,015 S. pneumoniae isolates were collected from 13 countries on five continents and tested for antimicrobial susceptibility. Results: Penicillin resistance rates were as follows: South Korea, 70.1%; Hong Kong, 50.3%; Thailand, 39.3%; France, 28.7%; Spain, 24.8%; Mexico, 18.1%; Ireland, 11.8%; South Africa, 11.1%; Italy, 9.4%; United Kingdom, 3.1%; Brazil, 2.9%; China, 2.3%, and Germany, 0.7%. Resistance to azithromycin, clarithromycin and trimethoprim-sulfamethoxazole was commonly associated with penicillin resistance. Levofloxacin-resistant isolates were detected in 8 of 13 countries: Germany (0.2%), France (0.4%), Thailand (0.5%), South Korea (0.9%), Mexico (1.5%), Spain (1.6%), China (3.3%) and Hong Kong (8.0%). Multidrug resistance (resistance to ≧3 antimicrobial classes) occurred in 626/5,015 isolates (12.5%). Levofloxacin was active against 96.0% (601/626) of the multidrug-resistant (MDR) isolates and 99.7% (4,374/4,389) of the non-MDR isolates. Conclusion: Although relatively high levels of levofloxacin resistance were detected in China and Hong Kong, overall, levofloxacin remained active against >99% of clinical isolates of S. pneumoniae despite their resistance to other agents. Continued surveillance of S. pneumoniae will track any changes in levofloxacin activity, should they occur.