Background During childhood pneumococccus (S.pneumoniae) is identified not only in nasopharynx (carriers), but also as etiological agent in conjunctivitis, respiratory airways infections, meningitis etc. Choosing the optimal therapy is difficult due to: prolonged time necessary to antibiotic sensitivity test (AST) achievement, difficulty to perform it and pneumococcus strains growing resistance. In Romania vaccination against S.pneumoniae is not offered in routine immunisation program.

Aims

1. To analyse resistance spectrum for S.pneumoniae strains; 2. Establishing empirical therapeutic decisions according to pneumococcus resistance profile in our county.

Methods During October 2011–January 2014, there were performed AST for S.pneumoniae using Vitek AST-P576 cards. Samples origin10 nasal secretions, 21 conjunctival secretions, 12 ear samples, 4 hemocultures, 1 cerebrospinal fluid sample, 1 urine culture. Correlated with minimal inhibitory concentration to penicillin, strains were divided into: sensitive, intermediate, resistant (penicillin resistant pneumococcus-PRP). Authors took also into consideration for AST: Amoxicillin (AMX), Cefotaxime (CTX), Ceftriaxone (CRO), Eritromicine (E), Levofloxacin (L), Vancomycin (VA), Trimethoprim-Sulfamethoxazole (SXT).

Results Among 51 validated AST, authors noticed: 58.8% Penicillin resistance (30 PRP strains); 43.7% AMX resistance; 38 E resistant strains (82.6%); 74.5% SXT resistance; for CRO resistance reached 33.3%; 21.5% CTX resistance. All strains were sensitive for L, VA.

Conclusions

1. Authors observed increased resistance to penicillin, E and STX in our county; 2. Therapeutic options are limited in S.pneumoniae infection; 3. According to resistance pattern, authors restrict use of macrolides and STX in otitis media (most frequent etiological agent is S.pneumoniae); 4. In severe infections, therapeutic choices are CTX, CRO, VA; 5. Implementation of educational measures is important in order to avoid antibiotic overuse.