{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T09:55:49Z","timestamp":1763978149673,"version":"3.37.3"},"reference-count":21,"publisher":"Oxford University Press (OUP)","issue":"Supplement_1","license":[{"start":{"date-parts":[[2020,4,1]],"date-time":"2020-04-01T00:00:00Z","timestamp":1585699200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100004330","name":"GlaxoSmithKline","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004330","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To determine antibiotic susceptibility of community-acquired respiratory tract infection (CA-RTI) isolates of Streptococcus pneumoniae and Haemophilus influenzae collected in 2015\u201317 from Pakistan.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>MICs were determined by CLSI broth microdilution and susceptibility was assessed using CLSI, EUCAST (dose-specific) and pharmacokinetic\/pharmacodynamic (PK\/PD) breakpoints.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 94 S. pneumoniae and 122 H. influenzae isolates were collected. Susceptibility to penicillin was noted in 23.4% of the S. pneumoniae isolates by CLSI oral\/EUCAST low-dose IV breakpoints, although by CLSI IV and EUCAST high-dose breakpoints all isolates were characterized as susceptible. Susceptibility to trimethoprim\/sulfamethoxazole (10.6%), macrolides (33%) and cefaclor (28.7%) was low but higher susceptibility was observed to ceftriaxone (100%), amoxicillin and amoxicillin\/clavulanic acid (98.9%), cefuroxime (oral, 97.9%), cefpodoxime (96.8%), fluoroquinolones (93.6%\u201396.8%) and cefdinir (76.6%) by CLSI breakpoints. However, using EUCAST breakpoints, susceptibility to cefpodoxime (70.2%) and cefuroxime (oral, 61.7%) was reduced. H. influenzae isolates were almost all \u03b2-lactamase negative (96.7%). Using CLSI breakpoints, \u226593.4% of isolates were susceptible to all antibiotics tested except fluoroquinolones (75.4%\u201377.1%) and trimethoprim\/sulfamethoxazole (41%). The proportion of isolates susceptible using EUCAST breakpoints was similar or identical for penicillins, trimethoprim\/sulfamethoxazole and the cephalosporins that have EUCAST breakpoints; the proportion of isolates susceptible using EUCAST breakpoints was similar or identical to that using CSLI breakpoints except for cefuroxime (oral), where only 1.6% of isolates were considered susceptible. Susceptibility of H. influenzae to fluoroquinolones was also lower by EUCAST breakpoints (33.6%\u201334.4%). The application of different EUCAST breakpoints for low and higher doses for some of the antibiotics (amoxicillin, amoxicillin\/clavulanic acid, ampicillin, penicillin, ceftriaxone, clarithromycin, erythromycin, levofloxacin and trimethoprim\/sulfamethoxazole) allowed, for the first time in a SOAR study, the effect of raising the dosage on susceptibility to be quantified.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Antibiotic susceptibility in these important respiratory tract pathogens varied in Pakistan based on different breakpoints. These data are important for empirical therapy choices in the treatment of CA-RTIs.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jac\/dkaa085","type":"journal-article","created":{"date-parts":[[2020,3,16]],"date-time":"2020-03-16T20:33:21Z","timestamp":1584390801000},"page":"i76-i87","source":"Crossref","is-referenced-by-count":5,"title":["Results from the Survey of Antibiotic Resistance (SOAR) 2015\u201317 in Pakistan: data based on CLSI, EUCAST (dose-specific) and pharmacokinetic\/pharmacodynamic (PK\/PD) breakpoints"],"prefix":"10.1093","volume":"75","author":[{"given":"D","family":"Torumkuney","sequence":"first","affiliation":[{"name":"GlaxoSmithKline, 980 Great West Road, Brentford, Middlesex TW8 9GS, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S","family":"Anwar","sequence":"first","affiliation":[{"name":"Liaquat National Hospital and Medical College, Microbiology Department, Stadium Road, Karachi, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S","family":"Nizamuddin","sequence":"first","affiliation":[{"name":"Shaukat Khanum Memorial Cancer Hospital and Research Centre, Section of Microbiology, Department of Pathology, 7A Block R3, Johar Town, Lahore, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N","family":"Malik","sequence":"first","affiliation":[{"name":"Shaukat Khanum Memorial Cancer Hospital and Research Centre, Section of Microbiology, Department of Pathology, 7A Block R3, Johar Town, Lahore, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"I","family":"Morrissey","sequence":"first","affiliation":[{"name":"IHMA Europe S\u00e0rl, Route de l\u2019Ile-au-Bois 1A, 1870 Monthey\/VS, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2020,4,21]]},"reference":[{"key":"2020042620060777400_dkaa085-B1","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1080\/17476348.2019.1562339","article-title":"The burden of community-acquired bacterial pneumonia in the era of antibiotic resistance","volume":"13","author":"Peyrani","year":"2019","journal-title":"Expert Rev Respir Med"},{"key":"2020042620060777400_dkaa085-B2","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1080\/17476348.2019.1555040","article-title":"Epidemiology of lower respiratory tract infections in adults","volume":"13","author":"Feldman","year":"2019","journal-title":"Expert Rev Respir Med"},{"key":"2020042620060777400_dkaa085-B3","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1097\/MCC.0000000000000550","article-title":"Community-acquired pneumonia as an emergency condition","volume":"24","author":"Cill\u00f3niz","year":"2018","journal-title":"Curr Opin Crit Care"},{"key":"2020042620060777400_dkaa085-B4","first-page":"184","article-title":"Anti-microbial resistance in Pakistan: a public health issue","volume":"29","author":"Shaikh","year":"2017","journal-title":"J Ayub Med Coll Abbottabad"},{"key":"2020042620060777400_dkaa085-B5","doi-asserted-by":"crossref","first-page":"E1152","DOI":"10.3390\/ijerph14101152","article-title":"Antibiotic self-medication among non-medical university students in Punjab, Pakistan: a cross-sectional survey","volume":"14","author":"Gillani","year":"2017","journal-title":"Int J Environ Res Public Health"},{"key":"2020042620060777400_dkaa085-B6","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1186\/s12879-018-3407-z","article-title":"Antimicrobial use by WHO methodology at primary health care centers: a cross sectional study in Punjab, Pakistan","volume":"18","author":"Sarwar","year":"2018","journal-title":"BMC Infect Dis"},{"key":"2020042620060777400_dkaa085-B7","doi-asserted-by":"crossref","first-page":"E44","DOI":"10.3390\/medicina55020044","article-title":"Antibiotic prescribing practices and errors among hospitalized pediatric patients suffering from acute respiratory tract infections: a multicenter, cross-sectional study in Pakistan","volume":"55","author":"Iftikhar","year":"2019","journal-title":"Medicina"},{"key":"2020042620060777400_dkaa085-B8","first-page":"e000214","article-title":"The return of Pfeiffer\u2019s bacillus: rising incidence of ampicillin resistance in Haemophilus influenzae","volume":"4","author":"Heinz","year":"2018","journal-title":"Microb Genom"},{"year":"2018","key":"2020042620060777400_dkaa085-B9"},{"year":"2019","key":"2020042620060777400_dkaa085-B10"},{"year":"2019","key":"2020042620060777400_dkaa085-B11"},{"key":"2020042620060777400_dkaa085-B12","first-page":"1","article-title":"Antimicrobial treatment guidelines for acute bacterial rhinosinusitis","volume":"130 Suppl 1","author":"Anon","year":"2004","journal-title":"Otolaryngol Head Neck Surg"},{"key":"2020042620060777400_dkaa085-B13","doi-asserted-by":"crossref","first-page":"i103","DOI":"10.1093\/jac\/dkw076","article-title":"Antibiotic susceptibility in Streptococcus pneumoniae, Haemophilus influenzae and Streptococcus pyogenes in Pakistan: a review of results from the Survey of Antibiotic Resistance (SOAR) 2002-15","volume":"71 Suppl 1","author":"Zafar","year":"2016","journal-title":"J Antimicrob Chemother"},{"key":"2020042620060777400_dkaa085-B14","first-page":"701","article-title":"Prevalence and susceptibility patterns of bacteria causing respiratory tract infections in North Waziristan, Pakistan","volume":"29 Suppl 2","author":"Shah","year":"2016","journal-title":"Pak J Pharm Sci"},{"key":"2020042620060777400_dkaa085-B15","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1016\/j.ijmyco.2016.07.008","article-title":"Fluoroquinolone consumption and -resistance trends in Mycobacterium tuberculosis and other respiratory pathogens: ecological antibiotic pressure and consequences in Pakistan, 2009-2015","volume":"5","author":"Shakoor","year":"2016","journal-title":"Int J Mycobacteriol"},{"key":"2020042620060777400_dkaa085-B16","first-page":"1405","article-title":"Community acquired pneumonia in Pakistan: an analysis on the literature published between 2003 and 2013","volume":"64","author":"Ansarie","year":"2014","journal-title":"J Pak Med Assoc"},{"key":"2020042620060777400_dkaa085-B17","doi-asserted-by":"crossref","first-page":"2201","DOI":"10.1007\/s10096-018-3362-z","article-title":"Molecular characterization of fluoroquinolones, macrolides, and imipenem resistance in Haemophilus influenzae: analysis of the mutations in QRDRs and assessment of the extent of the AcrAB-TolC-mediated resistance","volume":"37","author":"Cherkaoui","year":"2018","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"2020042620060777400_dkaa085-B18","doi-asserted-by":"crossref","first-page":"832857","DOI":"10.1155\/2013\/832857","article-title":"Trends of empiric antibiotic usage in a secondary care hospital, Karachi, Pakistan","volume":"2013","author":"Ali","year":"2013","journal-title":"Int J Pediatr"},{"key":"2020042620060777400_dkaa085-B19","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1080\/14787210.2019.1581063","article-title":"A multicenter point prevalence survey of antibiotic use in Punjab, Pakistan: findings and implications","volume":"17","author":"Saleem","year":"2019","journal-title":"Expert Rev Anti Infect Ther"},{"key":"2020042620060777400_dkaa085-B20","doi-asserted-by":"crossref","first-page":"R84","DOI":"10.1186\/cc12705","article-title":"Meropenem and piperacillin\/tazobactam prescribing in critically ill patients: does augmented renal clearance affect pharmacokinetic\/pharmacodynamic target attainment when extended infusions are used?","volume":"17","author":"Carlier","year":"2013","journal-title":"Crit Care"},{"key":"2020042620060777400_dkaa085-B21","doi-asserted-by":"crossref","first-page":"1435","DOI":"10.1007\/s40262-018-0643-8","article-title":"Target-controlled continuous infusion for antibiotic dosing: proof-of-principle in an in-silico vancomycin trial in intensive care unit patients","volume":"57","author":"Colin","year":"2018","journal-title":"Clin Pharmacokinet"}],"container-title":["Journal of Antimicrobial Chemotherapy"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jac\/article-pdf\/75\/Supplement_1\/i76\/33121595\/dkaa085.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jac\/article-pdf\/75\/Supplement_1\/i76\/33121595\/dkaa085.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,4,27]],"date-time":"2020-04-27T00:06:43Z","timestamp":1587946003000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jac\/article\/75\/Supplement_1\/i76\/5824463"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,4,1]]},"references-count":21,"journal-issue":{"issue":"Supplement_1","published-online":{"date-parts":[[2020,4,21]]},"published-print":{"date-parts":[[2020,4,1]]}},"URL":"https:\/\/doi.org\/10.1093\/jac\/dkaa085","relation":{},"ISSN":["0305-7453","1460-2091"],"issn-type":[{"type":"print","value":"0305-7453"},{"type":"electronic","value":"1460-2091"}],"subject":[],"published-other":{"date-parts":[[2020,4]]},"published":{"date-parts":[[2020,4,1]]}}}