Cent Eur J Public Health 2025, 33(3):187-192 | DOI: 10.21101/cejph.a8464

Increased macrolide resistance in Streptococcus pneumoniae in Slovakia may be linked to increased macrolide consumption

Peter Kunč1, Jaroslav Fábry1, Katarina Ištvánková1, Martina Neuschlová2, Renata Péčová2
1 Clinic of Paediatric Respiratory Diseases and Tuberculosis, National Institute of Paediatric Tuberculosis and Respiratory Diseases, Dolný Smokovec, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
2 Department of Pathological Physiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic

Objectives: Given the widespread use of macrolide antibiotics and growing concerns over antimicrobial resistance, this study aimed to investigate recent trends in macrolide consumption in Slovakia and to determine the corresponding changes in Streptococcus pneumoniae resistance in a paediatric cohort.

Methods: We conducted a retrospective analysis of 1,083 nasal swab cultures from children with recurrent respiratory infections and atopy, comparing two distinct 5-year periods: 2008-2012 and 2019-2023. Consumption data was based on the European Centre for Disease Prevention and Control reports.

Results: National data confirmed that Slovakia has one of the highest consumption rates of macrolides, lincosamides, and streptogramins (ATC group J01F) in Europe. The comparative analysis of patient samples revealed a statistically significant 11% increase in erythromycin-resistant S. pneumoniae (p < 0.001) and a 5% increase in clindamycin-resistant strains (p < 0.001) between the two study periods.

Conclusions: The concurrent rise in macrolide consumption and S. pneumoniae resistance in Slovakia highlights a significant public health threat. These findings underscore the urgent need for robust antibiotic stewardship programmes and the promotion of rational prescribing practices to preserve the efficacy of macrolides.

Klíčová slova: macrolide antibiotics, antibiotic resistance, Streptococcus pneumoniae, macrolide consumption, antibiotic stewardship, Slovakia

Vloženo: 16. listopad 2024; Revidováno: 7. červenec 2025; Přijato: 7. červenec 2025; Zveřejněno: 30. září 2025  Zobrazit citaci

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Kunč P, Fábry J, Ištvánková K, Neuschlová M, Péčová R. Increased macrolide resistance in Streptococcus pneumoniae in Slovakia may be linked to increased macrolide consumption. Cent Eur J Public Health. 2025;33(3):187-192. doi: 10.21101/cejph.a8464.
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    Reference

    1. Oliynyk M, Samborskyy M, Lester JB, Mironenko T, Scott N, Dickens S, et al. Complete genome sequence of the erythromycin-producing bacterium Saccharopolyspora erythraea NRRL23338. Nat Biotechnol. 2007 Apr;25(4):447-53. Přejít k původnímu zdroji...
    2. Jelić D, Antolović R. From erythromycin to azithromycin and new potential ribosome-binding antimicrobials. Antibiotics (Basel). 2016 Sep 1;5(3):29. doi: 10.3390/antibiotics5030029. Přejít k původnímu zdroji... Přejít na PubMed...
    3. Nor Amdan NA, Shahrulzamri NA, Hashim R, Mohamad Jamil N. Understanding the evolution of macrolides resistance: a mini review. J Glob Antimicrob Resist. 2024 Sep 1;38:368-75. Přejít k původnímu zdroji...
    4. Leclercq R. Mechanisms of resistance to macrolides and lincosamides: nature of the resistance elements and their clinical implications. Clin Infect Dis. 2002 Feb 15;34(4):482-92. Přejít k původnímu zdroji...
    5. Setchanova L, Murdjeva M, Stancheva I, Alexandrova A, Sredkova M, Stoeva T, et al. Serotype changes and antimicrobial nonsusceptibility rates of invasive and non-invasive Streptococcus pneumoniae isolates after implementation of 10-valent pneumococcal nontypeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) in Bulgaria. Braz J Infect Dis. 2017 Aug;21(4):433-40. Přejít k původnímu zdroji...
    6. Debess Magnussen M, Erlendsdóttir H, Gaini S, Gudnason T, Kristinsson KG. Streptococcus pneumoniae: antimicrobial resistance and serotypes of strains carried by children and causing invasive disease in the Faroe Islands. Microb Drug Resist. 2018 Dec;24(10):1507-12. Přejít k původnímu zdroji...
    7. Xiao Y, Wei Z, Shen P, Ji J, Sun Z, Yu H, et al. Bacterial-resistance among outpatients of county hospitals in China: significant geographic distinctions and minor differences between central cities. Microbes Infect. 2015 Jun 1;17(6):417-25. Přejít k původnímu zdroji...
    8. National Health Information Centre. [Consumption of medicinal products for human use, medical devices and dietetic foods in the Slovak Republic 2023] [Internet]. Bratislava: NCZI; 2024 [cited 2024 Oct 29]. Available from: https://data.nczisk.sk/statisticke_vystupy/top_100_liekov/spotreba_liekov/Spotreba_liekov_a_zdravotnickych_pomocok_v_SR_2023.pdf. Slovak.
    9. European Centre for Disease Prevention and Control. Antimicrobial consumption in the EU/EEA (ESAC-Net) - Annual Epidemiological Report for 2022 [Internet]. Stockholm: ECDC; 2023 [cited 2024 Oct 29]. Available from: https://www.ecdc.europa.eu/en/publications-data/surveillance-antimicrobial-consumption-europe-2022.
    10. Sharland M, Pulcini C, Harbarth S, Zeng M, Gandra S, Mathur S, et al. Classifying antibiotics in the WHO Essential Medicines List for optimal use-be AWaRe. Lancet Infect Dis. 2018 Jan;18(1):18-20. Přejít k původnímu zdroji...
    11. Bogdanić N, Močibob L, Vidović T, Soldo A, Begovać J. Azithromycin consumption during the COVID-19 pandemic in Croatia, 2020. PloS One. 2022;17(2):e0263437. doi: 10.1371/journal.pone.0263437. Přejít k původnímu zdroji... Přejít na PubMed...
    12. de Martino M, Ballotti S. The child with recurrent respiratory infections: normal or not? Pediatr Allergy Immunol Off Publ Eur Soc Pediatr Allergy Immunol. 2007 Nov;18 Suppl 18:13-8. Přejít k původnímu zdroji...
    13. Walker CLF, Rudan I, Liu L, Nair H, Theodoratou E, Bhutta ZA, et al. Global burden of childhood pneumonia and diarrhoea. Lancet Lond Engl. 2013 Apr 20;381(9875):1405-16. Přejít k původnímu zdroji...
    14. Muteeb G, Rehman MT, Shahwan M, Aatif M. Origin of antibiotics and antibiotic resistance, and their impacts on drug development: a narrative review. Pharmaceuticals. 2023 Nov;16(11):1615. doi: 10.3390/ph16111615. Přejít k původnímu zdroji... Přejít na PubMed...
    15. Kovács E, Sahin-Tóth J, Tóthpál A, Kristóf K, van der Linden M, Tirczka T, et al. Vaccine-driven serotype-rearrangement is seen with latency in clinical isolates: comparison of carried and clinical pneumococcal isolates from the same time period in Hungary. Vaccine. 2019 Jan 3;37(1):99-108. Přejít k původnímu zdroji...
    16. Vester B, Douthwaite S. Macrolide resistance conferred by base substitutions in 23S rRNA. Antimicrob Agents Chemother. 2001 Jan;45(1):1-12. Přejít k původnímu zdroji...
    17. Gonzales BE, Mercado EH, Pinedo-Bardales M, Hinostroza N, Campos F, Chaparro E, et al. Increase of macrolide-resistance in streptococcus pneumoniae strains after the introduction of the 13-valent pneumococcal conjugate vaccine in Lima, Peru. Front Cell Infect Microbiol. 2022 May 9:12:866186. doi: 10.3389/fcimb.2022.866186. Přejít k původnímu zdroji... Přejít na PubMed...
    18. Adriaenssens N, Bruyndonckx R, Versporten A, Hens N, Monnet DL, Molenberghs G, et al. Consumption of macrolides, lincosamides and streptogramins in the community, European Union/European Economic Area, 1997-2017. J Antimicrob Chemother. 2021 Jul 26;76(12 Suppl 2):ii30-6. Přejít k původnímu zdroji...
    19. Holstiege J, Enders D, Schink T, Innocenti F, Oteri A, Bezemer I, et al. Trends in paediatric macrolide use in five European countries-a population-based study. Eur J Clin Pharmacol. 2015 Aug;71(8):991-9. Přejít k původnímu zdroji...
    20. Cohen R, Pettoello-Mantovani M, Giardino I, Carrasco-Sanz A, Somekh E, Levy C. The shortage of amoxicillin: an escalating public health crisis in pediatrics faced by several western countries. J Pediatr. 2023 Jun 1;257:113321. doi: 10.1016/j.jpeds.2023.01.001. Přejít k původnímu zdroji... Přejít na PubMed...
    21. Hinnerskov M, Therkildsen JM, Cordoba G, Bjerrum L. Macrolide overuse for treatment of respiratory tract infections in general practice. Dan Med Bull [Internet]. 2011 Nov [cited 2024 Oct 29];58(11):A4356. Available from: https://ugeskriftet.dk/dmj/macrolide-overuse-treatment-respiratory-tract-infections-general-practice.
    22. Nandi A, Pecetta S, Bloom DE. Global antibiotic use during the COVID-19 pandemic: analysis of pharmaceutical sales data from 71 countries, 2020-2022. EClinicalMedicine. 2023 Mar;57:101848. doi: 10.1016/j.eclinm.2023.101848. Přejít k původnímu zdroji... Přejít na PubMed...
    23. Eurostat. How often did Europeans consult a doctor in 2021? - Products Eurostat News - Eurostat [Internet]. Luxembourg: Eurostat; 2023 [cited 2023 Nov 18]. Available from: https://ec.europa.eu/eurostat/web/products-eurostat-news/-/ddn-20230829-2.
    24. Spagnolo P, Fabbri LM, Bush A. Long-term macrolide treatment for chronic respiratory disease. Eur Respir J. 2013 Jun 30;42(1):239-51. Přejít k původnímu zdroji...
    25. Choo JM, Martin AM, Taylor SL, Sun E, Mobegi FM, Kanno T, et al. The impact of long-term macrolide exposure on the gut microbiome and its implications for metabolic control. Microbiol Spectr. 2023 Aug 17;11(4):e0083123. doi: 10.1128/spectrum.00831-23. Přejít k původnímu zdroji... Přejít na PubMed...
    26. Kenyon C, Laumen J, Manoharan-Basil SS, Buyze J. Strong association between adolescent obesity and consumption of macrolides in Europe and the USA: an ecological study. J Infect Public Health. 2020 Oct;13(10):1517-21. Přejít k původnímu zdroji...

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