Increasing Prevalence of Multidrug-Resistant Streptococcus pneumoniae in the United States

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http://www.nejm.org/content/2000/0343/0026/1917.asp

The New England Journal of Medicine -- December 28, 2000 -- Vol. 343, No. 26

Increasing Prevalence of Multidrug-Resistant Streptococcus

pneumoniae in the United States

G. Whitney, M. Farley, Hadler, Lee H. on,

Lexau, Arthur Reingold, Lefkowitz,

R. Cieslak, Cetron, R. Zell, H. nsen, Anne

Schuchat, R. Facklam, M. ,

for the Active Bacterial Core Surveillance Program of the Emerging

Infections Program Network

Abstract

Background. The emergence of drug-resistant strains of bacteria

has complicated treatment decisions and may lead

to treatment failures.

Methods. We examined data on invasive pneumococcal disease in

patients identified from 1995 to 1998 in the

Active Bacterial Core Surveillance program of the Centers for

Disease Control and Prevention. Pneumococci that

had a high level of resistance or had intermediate resistance

according to the definitions of the National Committee

for Clinical Laboratory Standards were defined as " resistant " for

this analysis.

Results. During 1998, 4013 cases of invasive Streptococcus

pneumoniae disease were reported (23 cases per

100,000 population); isolates were available for 3475 (87

percent). Overall, 24 percent of isolates from 1998 were

resistant to penicillin. The proportion of isolates that were

resistant to penicillin was highest in Georgia (33 percent)

and Tennessee (35 percent), in children under five years of age

(32 percent, vs. 21 percent for persons five or more

years of age), and in whites (26 percent, vs. 22 percent for

blacks). Penicillin-resistant isolates were more likely than

susceptible isolates to have a high level of resistance to other

antimicrobial agents. Serotypes included in the 7-valent

conjugate and 23-valent pneumococcal polysaccharide vaccines

accounted for 78 percent and 88 percent of

penicillin-resistant strains, respectively. Between 1995 and 1998

(during which period 12,045 isolates were collected),

the proportion of isolates that were resistant to three or more

classes of drugs increased from 9 percent to 14

percent; there also were increases in the proportions of isolates

that were resistant to penicillin (from 21 percent to

25 percent), cefotaxime (from 10 percent to 14 percent),

meropenem (from 10 percent to 16 percent), erythromycin

(from 11 percent to 15 percent), and

trimethoprim-sulfamethoxazole (from 25 percent to 29 percent). The increases

in the frequency of resistance to other antimicrobial agents

occurred exclusively among penicillin-resistant isolates.

Conclusions. Multidrug-resistant pneumococci are common and are

increasing. Because a limited number of

serotypes account for most infections with drug-resistant

strains, the new conjugate vaccines offer protection against

most drug-resistant strains of S. pneumoniae. (N Engl J Med

2000;343:1917-24.)

Source Information

From the Division of Bacterial and Mycotic Diseases, National

Center for Infectious Diseases, Centers for Disease

Control and Prevention, Atlanta (C.G.W., M.C., E.R.Z., A.S.);

Emory University School of Medicine and the

Veterans Affairs Medical Center, Atlanta (M.M.F.); the

Connecticut Department of Public Health, Hartford (J.H.);

s Hopkins University School of Hygiene and Public Health,

Baltimore (L.H.H.); the Minnesota Department of

Health, Minneapolis (C.L.); the School of Public Health,

University of California, Berkeley (A.R.); the Department

of Preventive Medicine, Vanderbilt Medical Center, Nashville

(L.L.); the Oregon Department of Human Services,

Health Division, Portland (P.R.C.); and the University of Texas

Health Science Center, San (J.H.J.).

Address reprint requests to Dr. Whitney at CDC Mailstop C-23,

1600 Clifton Rd. NE, Atlanta, GA 30333.

--------------------------------------------------------

Sheri Nakken, R.N., MA

Vaccination Information & Choice Network, Nevada City CA

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