EPIDEMIOLOGY OF PNEUMOCOCCAL RESISTANCE TO ANTIBIOTICS IN FRANCE - NATIONAL COOPERATIVE SURVEY (1984-1993)

The National Cooperative Survey of pneumococcal antimicrobial resistance in France (1984-1993; 14 786 strains studied) shows that the resistance reaches high levels: in 1993, the resistance rates were, tetracycline (24 %), erythromycin (34 %), chloramphenicol (27 %) and sulfa/trimethoprim (37 %). Particularly alarming is the change in susceptibility to penicillin G: fewer than 1 % of strains isolated before 1986 exhibited diminished susceptibility, compared with 25 % in 1993. The frequency of strains with high-level resistance to penicillin (MIC > 1 mg/l) among penicillin resistant pneumococci (PRP) increased from 13 % in 1988 to 50 % in 1993. Among PRP isolated in 1992: the most prevalent serogroups or serotypes, in order of frequency, were: 23 (55 %), 9 (13.9 %), 6 (8.2 %), 14 (7.3 %), 15 (4.9 %), 19 (3.7 %). 70% of PRP combine multiresistance and penicillin resistance. Rigorous analytical techniques enable the detection of strains with reduced sensitivity to beta-lactams. The reduced sensitivity of PRP isolates leads to a fall in the sensitivity to all beta-lactams and the MIC will vary according to the type of beta-lactam. Infecting PRP strains should have penicillin and clinically useful beta-lactams MICs determination.