The Second European Collaborative Study on the frequency of antimicrobial resistance in Haemophilus influenzae

In the second European survey of the prevalence of antimicrobial resistance in Haemophilus influenzae, 2529 clinical isolates collected in 1988/89 from 78 laboratories in nine countries (Austria, Belgium, Federal Republic of Germany, France, Italy, The Netherlands, Spain, Switzerland, United Kingdom) were examined. Of these, 23.8% were type b strains. The overall rate of beta-lactamase production was 9.1%, being slightly higher in type b isolates (10.5%) compared to non-type b isolates (8.6%). The MICs of six antimicrobials (ampicillin, cefaclor, chloramphenicol, erythromycin, tetracycline, and cotrimoxazole) were determined by an agar dilution procedure at a single central laboratory. The proportion of isolates resistant to the antimicrobials varied considerably amongst the individual countries. The highest incidence of resistance to all six drugs was observed in strains collected in Spain, whereas resistance was rarely encountered among strains isolated in Austria and the FRG. Resistance to ampicillin (MIC greater than or equal to 4 mg/l) among strains that lacked beta-lactamase activity was uncommon (0.3%). Based on the NCCLS Haemophilus influenzae breakpoints, the rates of susceptibility and resistance to cefaclor, chloramphenicol, tetracycline, and cotrimoxazole were 96.4/1.5, 96.2/2.8, 92.4/4.7, and 87.9/7.3%, respectively. The rate of susceptibility and resistance to erythromycin was 2.3/19.9. Multiple resistance to ampicillin, chloramphenicol, tetracycline, and cotrimoxazole was observed in 15 isolates (0.6%), and resistance to three drugs simultaneously in 72 (1.5%). The incidence of beta-lactamase producing strains was similar to that seen in the first European study performed in 1986 (9.1% vs. 10.9%), and was half that observed in US isolates collected in 1986.