Iranian Journal of Microbiology 2014. 6(6):382-386.

Antimicrobial susceptibility trends among Streptococcus pneumoniae over an 11-year period in an Iranian referral children Hospital.
MohammadTaghi Haghi-Ashtiani, Majid Sadeghian, Bahram Nikmanesh, Babak Pourakbari, Shima Mahmoudi, Setareh Mamishi


Background and Objectives: The appearance of antibiotic resistance in Streptococcus pneumoniae has raised a global concern over the past three decades. This study was conducted to determine the antimicrobial susceptibility of S. pneumoniae isolated from patients in Children´s Medical Center (CMC) Hospital during 2001 to 2011.
Materials and Methods: During the 11 years period, a total of 194 S. pneumoniae isolates were collected in CMC Hospital. Antimicrobial susceptibility testing was performed by the Kirby-Bauer disk diffusion method and time-series analysis was used to evaluate the antimicrobial susceptibility changes over the time.
Results and Conclusion: Antimicrobial susceptibility of S. pneumoniae to different antibiotics decreased from 2001 to 2011 as: penicillin from 78% to 32%, erythromycin from 75% to 35%, chloramphenicol from 94% to 55%, ampicillin from 70% to 62%, ceftriaxone from 100% to 87%, sulfametoxazole from 57% to 40%. We did not find any significant difference between the susceptibility of isolates from sterile and non-sterile sources. It would be an important key to consider antimicrobial stewardship as an essential factor to prevent the development of antimicrobial resistance.


Iran; S. pneumonia; antibiotic resistance

Full Text:



Hussain M, Melegaro A, Pebody RG, George R, Edmunds WJ, Talukdar R, et al. A longitudinal household study of Streptococcus pneumoniae nasopharyngeal carriage in a UK setting. Epidemiol Infect 2005 Oct;133(5):891-8.

Green MC, Mason EO, Kaplan SL, Lamberth LB, Stovall SH, Givner LB, et al. Increase in prevalence of Streptococcus pneumoniae serotype 6C at eight children’s hospitals in the United States from 1993 to 2009. J Clin Microbiol 2011 Jun;49(6):2097-101.

Jones RN, Jacobs MR, Sader HS. Evolving trends in Streptococcus pneumoniae resistance: implications for therapy of community-acquired bacterial pneumonia. Int J Antimicrob Agents 2010; 36: 197-204.

Jones RN, Sader HS, Moet GJ, Farrell DJ. Declining antimicrobial susceptibility of Streptococcus pneumoniae in the United States: report from the SENTRY Antimicrobial Surveillance Program (1998-2009). Diagn Microbiol Infect Dis 2010; 68: 334-6.

Song JH, Jung SI, Ko KS, Kim NY, Son JS, Chang HH, et al. High prevalence of antimicrobial resistance among clinical Streptococcus pneumoniae isolates in Asia (an ANSORP study). Antimicrob Agents Chemother 2004 Jun;48(6):2101-7.

Pourakbari B, Sadr A, Ashtiani MT, Mamishi S, Dehghani M, Mahmoudi S, et al. Five-year evaluation of the antimicrobial susceptibility patterns of bacteria causing bloodstream infections in Iran. J Infect Dev Ctries 2012 Feb;6(2):120-5.

Patel SN, McGeer A, Melano R, Tyrrell GJ, Green K, Pillai DR, et al. Susceptibility of Streptococcus pneumoniae to fluoroquinolones in Canada. Antimicrob Agents Chemother 2011 Aug;55(8):3703-8.

Mera RM, Miller LA, Daniels JJ, Weil JG, White AR. Increasing prevalence of multidrug-resistant Streptococcus pneumoniae in the United States over a 10-year period: Alexander Project. Diagn Microbiol Infect Dis 2005 Mar;51(3):195-200.

Pottumarthy S, Fritsche TR, Sader HS, Stilwell MG, Jones RN. Susceptibility patterns of Streptococcus pneumoniae isolates in North America (2002-2003): contemporary in vitro activities of amoxicillin/ clavulanate and 15 other antimicrobial agents. Int J Antimicrob Agents 2005; 25: 282-9.

Mamishi S, Pourakbari B, Ashtiani MH, Hashemi FB.Frequency of isolation and antimicrobial susceptibility of bacteria isolated from bloodstream infections at Children’s Medical Center, Tehran, Iran, 1996-2000. Int J Antimicrob Agents 2005; 26: 373-9.

Brown SD, Rybak MJ. Antimicrobial susceptibility of Streptococcus pneumoniae, Streptococcus pyogenes and Haemophilus influenzae collected from patients across the USA, in 2001-2002, as part of the PROTEKT US study. J Antimicrob Chemother 2004 Aug;54 Suppl 1:i7-15.

Kohanteb J, Sadeghi E. Penicillin - resistant Streptococcus pneumoniae in Iran. Med Princ Pract 2007; 16: 29-33.

Luh KT, Hsueh PR, Teng LJ, Pan HJ, Chen YC, Lu JJ, et al. Quinupristin-dalfopristin resistance among gram-positive bacteria in Taiwan. Antimicrob Agents Chemother 2000;44:3374-80.

Feizabadi MM, Aliahmadi A, Mobasheri F, Asgharzadeh A, Asadi S, Etemadi G. Phenotypic characteristics and population genetics of Enterococcus faecalis cultured from patients in Tehran during 2000-2001. Can J Microbiol 2003; 49: 645-9.

Huang SS, Hinrichsen VL, Stevenson AE, Rifas- Shiman SL, Kleinman K, Pelton SI, et al. Continued impact of pneumococcal conjugate vaccine on carriage in young children. Pediatrics 2009;124:e1-11.

Clinical and Laboratory Standards Institute (CLSI).Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically; approved standard - eighth edition, M07-A8. Wayne, PA: 2009.

Mamishi M, Moradkhani S, Mahmoudi S, Hosseinpour Sadeghi R, Pourakbari B. Penicillin-Resistant trend of Streptococcus pneumoniae in Asia: A systematic review. Iran J Microbiol 2014; 6: 198-210.

Mera RM, Miller LA, Daniels JJ, Weil JG, White AR. Increasing prevalence of multidrug-resistant Streptococcus pneumoniae in the United States over a 10-year period: Alexander Project. Diagn Microbiol Infect Dis 2005; 51: 195-200.

Whitney CG, Farley MM, Hadler J, Harrison LH, Lexau C, Reingold A, et al. Increasing prevalence of multidrug-resistant Streptococcus pneumoniae in the United States. N Engl J Med 2000; 28;343:1917-1924.

Poulakou G, Katsarolis I, Matthaiopoulou I, Tsiodras S, Kanavaki S, Hatzaki D, et al. Nationwide surveillance of Streptococcus pneumoniae in Greece: patterns of resistance and serotype epidemiology. Int J Antimicrob Agents 2007;30:87-92.

Cardozo DM, Nascimento-Carvalho CM, Souza FR, Silva NM. Nasopharyngeal colonization and penicillin resistance among pneumococcal strains: a worldwide 2004 update. Braz J Infect Dis 2006; 10: 293-304.

Hoa NQ, Trung NV, Larsson M, Eriksson B, Phuc HD, Chuc NT, et al. Decreased Streptococcus pneumoniae susceptibility to oral antibiotics among children in rural Vietnam: a community study. BMC Infect Dis 2010;10:85.

Reinert RR, Reinert S, van der LM, Cil MY, Al- Lahham A, Appelbaum P. Antimicrobial susceptibility of Streptococcus pneumoniae in eight European countries from 2001 to 2003. Antimicrob Agents Chemother 2005; 49: 2903-13.

Sangthawan P, Chantaratchada S, Chanthadisai N, Wattanathum A. Prevalence and clinical significance of community-acquired penicillin - resistant pneumococcal pneumonia in Thailand. Respirology 2003; 8: 208-12.

Moore M, McNulty C. European Antibiotic Awareness Day 2012: TARGET antibiotics through guidance, education, and tools. Br J Gen Pract 2012; 62: 621-2.

Saha SK, Naheed A, El Arifeen S, Islam M, Al- Emran H, Amin R, et al. Surveillance for invasive Streptococcus pneumoniae disease among hospitalized children in Bangladesh: antimicrobial susceptibility and serotype distribution. Clin Infect Dis 2009 Mar 1;48 Suppl 2:S75-81.

Harrison CJ, Woods C, Stout G, Martin B, Selvarangan R. Susceptibilities of Haemophilus influenzae, Streptococcus pneumoniae, including serotype 19A, and Moraxella catarrhalis paediatric isolates from 2005 to 2007 to commonly used antibiotics. J Antimicrob Chemother 2009; 63: 511-9.Ebes,


  • There are currently no refbacks.

Creative Commons Attribution-NonCommercial 3.0

This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.