The Resistance to Antibiotics of Strains of Streptococcus Viridans

Bull. Org. mwnd. SantO 1966, 35, 243-246 Bull. Wld Hlth Org.

The Resistance to Antibiotics of Strains of Streptococcus viridans, Streptococcus faecalis, Escherichia coli, Pseudomonas aeruginosa, Proteus and Klebsiella Isolated in Poland*

J. JELJASZEWICZ 1 & J. HAWIGER2

A nation-wide survey has been carried out in Poland into the susceptibility ofsix genera ofbacteria to eight antibiotics. The antibiotic-resistance ofstreptococci differedfrom that

of the Gram-negative rods studied. 4 Escherichia coli, Klebsiella and Pseudomonas aeruginosa are known to be completely resistant to penicillin. Streptococcus faecalis was much more resistant to antibiotics than Streptococcus viridans (highest resistance to streptomycin 90.3% and 74.9%, respectively; least resistance to chloramphenicol - 47.3% and 9.1%). More than 90% of all Pseudomonas aeruginosa strains isolated were resistant to all the antibiotics; high resistance was also exhibited by E. coli (94.5% resistant to erythromycin and 59.5% to chloramphenicol), Proteus (92.3 % topenicillin and63.0 % to chloramphenicol) andKlebsiella (84.0% to erythromycin and 62.8% to oxytetracycline).

Progress in vaccination and the widespread use of_ picture of the susceptibility of such bacteria to anti- antibiotics has decreased the importance of the clas- biotics commonly used in Poland. sical infectious diseases. Recently, more and more infections have been caused by bacteria that are the components of the normal flora of man. Many of MATERIAL AND METHODS these micro-organisms are highly resistant to the During 1960-63, in eleven centres throughout action of antibiotics. The purpose of our study was Poland and one large clinical hospital, the suscep- to collect sufficient data to provide a nation-wide tibility of six bacterial genera to eight antibiotics was examined. The number of strains of each type of * A contribution from the Department of Bacteriology, micro-organism are given in Table 1. Strains of State Institute of Hygiene, Warsaw, Poland. The study was Escherichia coli, Klebsiella and Pseudomonas aerugi- supported by research grant No. CDC-LP-3 from the Communicable Disease Center, US Public Health Service. nosa were not tested against penicillin, as they are The determinations were carried out by the following staff known to be completely resistant to this antibiotic. of sanitary and epidemiological stations and of the State Clinical Hospital No. 3 Wroclaw: M. Cygankiewicz-Sien- The sources of the strains, the methods of col- nicka, I. Czacka, A. Gorska, J. Guli6ski, C. Hebenstreit, lection of specimens and of despatch to the labora- H. Klimek, K. Klapkowska, J. Kr6l, 0. Lenartowicz, A. Luft, tories, the single-disc method of determining anti- Z. Moskwa, T. Noc6n, I. Pawlowska, W. Pedrycz, C. Pernal, A. Pogorzelska, L. Rodzihski, W. Siennicki, G. Sikora, biotic-resistance, and the principles of the statistical A. Szymahczyk, I. Terech, M. Wawrzyhska, Z. Wencel analysis used have already been described and A. Znis. (Jeljaszewicz & Hawiger, 1966).3 1 Chief, Staphylococcus and Streptococcus Laboratory, State Institute of Hygiene, Public Health Service, Warsaw, It should be added that streptococci were isolated Poland. mainly from throat, faeces, urine and blood, and 'Senior Assistant, Staphylococcus and Streptococcus Laboratory. ",See the article on page 231 of this issue.

1851 -243- 244 J. JELJASZEWICZ & J. HAWIGER

TABLE I TABLE 2 NUMBER OF STRAINS OF MICRO-ORGANISMS TESTED ANTIBIOTIC-RESISTANCE OF STREPTOCOCCUS VIRIDANS

Micro-organism No. of strains tested Antibiotic 1I No. of str;ins J Resistant strains

Streptococcus viridans 6 959 Streptococcus faecalis 3 416 Penicillin 6 578 1118 17.0 Escherichia coli 9 250 Streptomycin 6 768 5 069 74.9 Proteus sp. 3 992 Tetracycline 3 588 1 203 33.5 Pseudomonas aeruginosa 697 Oxytetracycline 6 765 996 14.7 Klebsiella sp. 1 293 Chlortetracycline 6 959 1137 16.3 Chloramphenicol 6 958 630 9.1 Total 25 607 Erythromycin 6 622 928 14.0 Neomycin 6 515 3 171 48.7 from patients suffering from diseases with a specific localization. Escherichia coli and Proteus strains were isolated chiefly from patients with diarrhoea of other TABLE 3 than Shigella or Salmonella etiology. Pseudomonas ANTIBIOTIC-RESISTANCE OF STREPTOCOCCUS FAECALIS aeruginosa strains were found almost in exclusively [No. of strains Resistant strains samples derived from infected wounds. Klebsiella Antibiotic tested No bacilli were received in samples of sputum of patients with a respiratory tract infection or in faeces from diarrhoeas of unknown etiology. Penicillin 3 416 2 399 70.2 Bacteria were identified by methods laid down by Streptomycin 3 399 3 068 90.3 the State Institute of Hygiene. These are based on Tetracycline 2 662 1 933 72.6 modem serological and biochemical techniques used Oxytetracycline 3 311 1 796 54.2 conventionally in reference laboratories (Lachowicz, Kaluiewski & Macierewicz, 1964; Staphylococcus Chlortetracycline 3 408 1 855 54.4 and Streptococcus Laboratory, 1966). Chloramphenicol 3 396 1 608 47.3 Erythromycin 2 962 1 757 59.3 RESULTS Neomycin 2 655 1 972 74.3 Streptococcus viridans (Table 2) The highest percentage of resistant strains was noted for streptomycin (74.9 %), the next highest for neomycin was not significantly different from re- neomycin (48.7 %) and the lowest for chlorampheni- sistance to tetracycline; differences in resistance to to col (9.1 %). The percentage of strains resistant to chlortetracycline and oxytetracycine were also not other antibiotics did not exceed 17 %. No significant statistically significant. differences were noted between the number of strains Escherichia coli (Table 4) resistant to penicillin and to chlortetracycline or between the number resistant to oxytetracycline and Almost all strains (94.5 %) were resistant to erythro- to erythromycin. mycin; 59.5% (the lowest percentage) were resistant to chloramphenicol. The percentages ofstrains resis- Streptococcus faecalis (Table 3) tant to streptomycin, oxytetracycline and chlortetra- The number of resistant strains was much higher cycline did not differ significantly. than with Streptococcus viridans. A very high percentage was resistant to streptomycin (90.3%) and Proteus (Table 5) to neomycin (74.3 %), and the lowest resistance was Strains of this genus were highly resistant to peni- shown to chloramphenicol (47.3 %). Resistance to cillin (92.3 %), erythromycin (91.8 %) and tetra- ANTIBIOTIC-RESISTANCE OF STREPTOCOCCI AND OTHER BACTERIA IN POLAND 245

TABLE 4 TABLE 7 ANTIBIOTIC-RESISTANCE OF ESCHERICHIA COLI ANTIBIOTIC-RESISTANCE OF KLEBSIELLA SP.

No. of strains Resistant strains No. of strains Resistant strains AntibioticAntibiotic | °t°estSedin Antibiotic tested No. tested ~No. %

Streptomycin 9 210 6 355 69.0 Streptomycin 1 275 899 70.5 Tetracycline 7 233 5 512 76.2 Tetracycline 1 246 859 68.9 Oxytetracycline 9 250 6 231 67.4 Oxytetracycline 1 278 802 62.8 Chlortetracycline 8 306 5 586 67.3 Chlortetracycline 1 277 828 64.8 Chloramphenicol 9 214 5 486 59.5 Chloramphenicol 1 293 790 61.1 Erythromycin 7 506 7 096 94.5 Erythromycin 1 238 1 040 84.0 Neomycin 7112 5172 72.7 NeomycTn 974 590 60.6

TABLE 5 cycline (88.6%) and least resistant to chlorampheni- ANTIBIOTIC-RESISTANCE OF PROTEUS SP. col (63.0 %). Resistance to penicillin and to erythromycin did not differ significantly; nor did resistance No. of strains Resistant strains to chlortetracycline and to oxytetracycline. Antibiotic tested No. % Pseudomonas aeruginosa (Table 6) Penicillin 3 992 3 686 92.3 Streptomycin 3 800 2 956 77.8 These bacteria were resistant to all the antibiotics Tetracycline 3 453 3 058 88.6 tested at levels higher than 90 %. Differences in susceptibility between the antibiotics are not signi- Oxytetracycline 3 796 3 297 86.9 ficant, except for erythromycin and tetracycline, and Chlortetracycline 3 804 3309 87.0 for chloramphenicol and streptomycin. Chloramphenicol 3 800 2 394 63.0 Erythromycin 3 499 3 213 91.8 Klebsiella (Table 7) Neomycin 3 465 2 846 82.1 The percentage of resistant strains was highest for erythromycin (84.0%) and then streptomycin (70.5%), and least for chloramphenicol (61.1 %). No significant TABLE 6 differences in resistance to chlortetracycline, neo- ANTIBIOTIC-RESISTANCE OF mycin, oxytetracycline and chloramphenicol were PSEUDOMONAS AERUGINOSA detected.

No. of strains Resistant strains Antibiotic tested No. % DISCUSSION As was to be expected, the antibiotic-resistance Streptomycin 697 639 91.7 patterns for streptococci and for the Gram-negative Tetracycline 662 646 97.6 bacteria were different. Differences were also ob- Oxytetracycline 697 674 96.7 served between the data obtained in the eleven centres Chlortetracycline 697 673 96.5 and results collected in the clinical hospital, as shown Chloramphenicol 697 663 95.1 in Table 8. The percentage of resistant strains was higher for Erythromycin 669 663 99.1 material studied in the hospital, emphasizing the Neomycin 672 645 96.0 typical phenomenon of higher antibiotic-resistance of bacteria in a hospital environment.

11 246 J. JELJASZEWICZ & J. HAWIGER

TABLE 8 COMPARISON OF ANTIBIOTIC-RESISTANCE OF BACTERIA: NATION-WIDE SURVEY AND SINGLE-HOSPITAL DATAa

Percentage of resistant strains Streptococcus Streptococcus Proteus Antibiotic viridans faecalls Escherkchiacoi Klebsiella Nation Hospital Nation Hospital Nation T Hospital Nation Hospital Nation Hospital

Penicillin 17.0 26.7 70.2 95.5 92.3 98.2 Streptomycin 74.9 87.5 90.3 93.6 69.0 80.0 77.8 92.2 70.5 83.5 Tetracycline 33.5 40.5 72.6 74.6 76.2 70.8 88.6 93.1 68.9 82.4 Oxytetracycline 14.7 33.9 54.2 75.3 67.4 66.6 86.9 92.2 62.8 81.4 Chlortetracycline 16.3 23.5 54.4 74.0 67.3 68.0 87.0 92.2 64.8 81.4 Chloramphenicol 9.1 30.7 47.3 71.5 59.5 74.1 63.0 81.8 61.1 63.9 Erythromycin 14.0 26.5 59.3 81.6 94.5 96.7 91.8 98.2 84.0 97.9 Neomycin 48.7 86.9 74.3 96.2 72.7 81.0 82.1 93.1 60.6 90.7

a State Clinical Hospital No. 3 in Wroclaw (determinations made by Dr W. Siennicki); number of strains tested: Streptococcus viridans, 163; Streptococcus faecalis, 158; Escherichia coli, 216; Proteus, 116; Klebsiella, 97 (total 757).

'RI'lSUMI

Les auteurs ont etudie la sensibilit6 de six genres de est connue, n'ont pas e soumis a des essais avec cet bacteries A huit antibiotiques, selon la methode employ6e antibiotique. pour 1'etude de la r6sistance de Staphylococcus aureus Parmi les souches de Streptococcus faecalis, 90,3% d6crite dans un autre article du present numero. etaient r6sistantes a la streptomycine, 74,3% a la neo- Au total, 25 607 souches ont ete 6tudi6es dans onze mycine et 47,3% au chloramphenicol, t6moignant ainsi laboratoires et un grand hopital de Pologne. Les strepto- d'une r6sistance beaucoup plus e1ev&e que Streptococcus coques ont ete isoles surtout de frottis de gorge, des selles, viridans, dont 74,9% des souches etaient resistantes a la de l'urine et du sang, ainsi que chez des malades pr6sen- streptomycine et 9,1 % au chloramphenicol. Plus de tant une localisation specifique; Escherichia coli et 90% des souches de Pseudomonas aeruginosa etaient Proteus, chez des patients atteints de diarrhee non due a resistantes a tous les antibiotiques; E. coli montrait des salmonelloses et des shigelloses; Pseudomonas 6galement une forte resistance envers 1'erythromycine aeruginosa, presque exclusivement de plaies infectees; (94,5% des souches) et le chloramph6nicol (59,5%). En Klebsiella, d'expectorations de malades porteurs d'infec- ce qui concerne Proteus, 92,3 % des souches r6sistaient a tions respiratoires ou des selles de sujets presentant une la penicilline et 63,0 % au chloramph6nicol cependant que diarrhee d'origine inconnue. E. coli, Klebsiella et Pseudo- 84,0 % des souches de Klebsiella 6taient resistantes a monas aeruginosa, dont la resistance totale a la penicilline 1'6rythromycine et 62,8 % a l'oxytetracycline.

REFERENCES

Lachowicz, K., Kahi±ewski, S. & Macierewicz, H. (1964) [Isolation and differentiation of Enterobacteriaceae], Warsaw, State Institute of Hygiene Staphylococcus and Streptococcus Laboratory, State Institute of Hygiene (1966) [Identification of staphylococci, streptococci and pneumococci], Warsaw, State Institute of Hygiene