RESULTS OF THE ALEXANDER PROJECT - A CONTINUING, MULTICENTER STUDY OFTHE ANTIMICROBIAL SUSCEPTIBILITY OF COMMUNITY-ACQUIRED LOWER RESPIRATORY-TRACT BACTERIAL PATHOGENS

In 1992, an ongoing, international multicenter study was established t o investigate the antimicrobial susceptibility of community-acquired l ower respiratory tract bacterial pathogens: the Alexander Project. Iso lates cultured from patients living in geographically separated areas, ten in the European Union (EU) and five in the United States (US), we re collected and tested using standard methods in a central laboratory . A total of 4,155 isolates of Haemophilus influenzae was collected du ring the period 1992-1994. beta-lactamase production was the principal mechanism of resistance observed with overall rates in the US (1992 = 26.3%; 1993 = 28.2%; and 1994 = 30.1%) generally twice those seen in the EU (1992 = 12.3%; 1993 = 14.4%; and 1994 = 15.5%). Chloramphenicol resistance was generally low except in Spanish centers where rates ra nging from 4.0 to 15.9% were observed during the study period. One tho usand one hundred ninety-three isolates of Moraxella catarrhalis were tested. beta-lactamase production was the only mechanism of resistance of any importance detected, with the vast majority of isolates produc ing the enzyme. Two thousand eight hundred twenty-nine isolates of Str eptococcus pneumoniae were tested. French and Spanish centers provided isolates with the highest rates of either low-level (intermediate) or high-level penicillin resistance, which in 1994 ranged from 10.2 to 3 1.4% and 30.4 to 40.1% for each resistance category, respectively. Wit h the exception of the fluoroquinolones, rates of resistance to other antimicrobials including the macrolides, doxycycline, chloramphenicol, and trimethorprim/sulfamethoxazole were high, generally, in centers w ith a high prevalence of penicillin resistance. However, in some cente rs (Toulouse, France and Genon, Italy) this association was not comple te for the macrolides. (C) 1996 Elsevier Science Inc.