ArticleThe Journal of antimicrobial chemotherapy2025
Results from the Survey of Antibiotic Resistance (SOAR) 2018-21 in Tunisia: data based on CLSI, EUCAST (dose-specific) and pharmacokinetic/pharmacodynamic (PK/PD) breakpoints.
Article in The Journal of antimicrobial chemotherapy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo determine the antibiotic susceptibility of community-acquired respiratory tract infection (CA-RTI) isolates of Streptococcus pneumoniae and Haemophilus influenzae collected in 2018-21 from two hospitals in Tunisia.
methodsMICs were determined by CLSI broth microdilution, and susceptibility data were interpreted using CLSI, EUCAST (dose-specific) and pharmacokinetic/pharmacodynamic (PK/PD) breakpoints.
resultsS. pneumoniae (n = 58) and H. influenzae (n = 71) isolates were collected; 22.4% of pneumococci were penicillin-susceptible by CLSI oral/EUCAST low-dose breakpoints, but 89.7% were susceptible by EUCAST high-dose/CLSI intravenous administration breakpoints. Susceptibility to ceftriaxone, levofloxacin and moxifloxacin was ≥91.4% by CLSI or PK/PD breakpoints which reduced to 82.8%-87.9% for amoxicillin, amoxicillin/clavulanic acid and cefotaxime. Tetracyclines, macrolides and trimethoprim/sulfamethoxazole were 41.4%-65.5% susceptible, with cefdinir and second-generation cephalosporins less active (24.1%-51.7% susceptible). EUCAST indicated ≥96.6% susceptibility only to high-dose ceftriaxone, moxifloxacin and high-dose levofloxacin. Most H. influenzae (66.2%) were β-lactamase negative, of which six and two isolates were ampicillin-resistant following EUCAST and CLSI criteria, respectively. Antibiotic susceptibility was ≥91.5% (CLSI) except for ampicillin (60.6%) and trimethoprim/sulfamethoxazole (77.5%). Susceptibility by EUCAST was lower than CLSI for most other antimicrobials, except for high dose amoxicillin/clavulanic acid (93.0% by EUCAST, 97.2% high dose PK/PD). Both CLSI and EUCAST showed 100% susceptibility to ceftriaxone.
conclusionsFew therapeutic options with ≥90% susceptibility for the treatment of S. pneumoniae from CA-RTIs in Tunisia remain. Although H. influenzae isolates displayed higher susceptibility, only ceftriaxone provides 100% coverage for both species following CLSI and EUCAST guidelines. Continued surveillance is important for guiding empiric therapy.
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