Epidemiology of resistance to antimicrobial drugs in the major respiratory pathogens circulating in Europe.

There is an overwhelming consensus on the fact that Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis represent the prevailing bacterial pathogens of community-acquired lower respiratory tract infections. Their specific incidence as causative agents of the more common syndromes is known to vary even profoundly depending on geographic location, and the same holds true for the rates of resistance to antimicrobial drugs. Europe does not escape the threat posed by the present pandemic spread of penicillin resistance in S. pneumoniae although, as expected, countries like Spain and France are greatly affected, while others including Germany, Italy, The Netherlands and the Scandinavian region are comparatively spared. In several sites multiple resistance has been described in S. pneumoniae and the most affected drugs include penicillin, the macrolides, co-trimoxazole and tetracycline. In H. influenzae synthesis of beta-lactamases the main trait of resistance is expressed. Lack of susceptibility to beta-lactams dictated by a different mechanism remains extremely rare. Considerable variations in the incidence of this characteristic are apparent when European countries are considered. France and Spain are again widely affected, while Germany, The Netherlands and Italy display rates of beta-lactamase-positive H. influenzae of about 10%. M. catarrhalis must be considered generally resistant to non-protected aminopenicillins since over 90% of these organisms produce beta-lactamases.