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Penicillin-resistant pneumococci in southern Sweden, 1993-1997
Abstract:
In Malmöhus County, Southern Sweden, the frequency of penicillin-resistant pneumococci in nasopharyngeal specimens of outpatients with respiratory tract infections increased from 3.1% in 1993 to 7.6% in 1995, and was thereafter rather stable. Over the period, 82-85% of the patients with penicillin-resistant strains were children 0-6 years of age. Ten groups/types constituted 96-100% of the penicillin-resistant isolates. Grouping/typing of 200 consecutive isolates in October and November each year indicated that the distribution of groups/types amongst patients with respiratory tract infections was rather constant over the period. The frequency of penicillin-resistant pneumococci of groups/types 6, 14, and 19 roughly corresponded to the occurrence of these groups/types amongst the consecutive isolates. Other groups/types 9, 15, 21, and 23 either showed a pronounced increase or decrease, which could not be related to the prevalence of these groups/types among the consecutive isolates or degree of antibiotic resistance. Penicillin-resistant group 9, introduced in the area in 1993, consisted of one single clone, 9V. The stabilized level of penicillin resistance since 1995 may be related to the preventive measures implemented in the area, including day-care interventions, and measures to reduce the prescription rate of antibiotics to outpatients with respiratory tract infections.
Insights
Penicillin resistance in pneumococci rose in Sweden but stabilized after 1995, mainly affecting young children. Preventive measures may have curbed further increases in antibiotic resistance.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Epidemiology
Background:
- Penicillin-resistant pneumococci pose a significant public health challenge, particularly in pediatric respiratory tract infections.
- Understanding trends in antibiotic resistance is crucial for effective treatment strategies and public health interventions.
Purpose of the Study:
- To analyze the trends of penicillin-resistant pneumococci in outpatients with respiratory tract infections in Malmöhus County, Sweden.
- To identify specific pneumococcal groups/types associated with penicillin resistance and their epidemiological dynamics.
Main Methods:
- Retrospective analysis of nasopharyngeal specimens from outpatients between 1993 and 1995.
- Serotyping and antibiotic susceptibility testing of Streptococcus pneumoniae isolates.
- Monitoring of pneumococcal group/type distribution and penicillin resistance prevalence over time.
Main Results:
- Penicillin resistance increased from 3.1% (1993) to 7.6% (1995), then stabilized.
- Children aged 0-6 years accounted for 82-85% of cases with penicillin-resistant strains.
- Specific serotypes (6, 14, 19) showed resistance correlating with prevalence, while others (9, 15, 21, 23) exhibited independent fluctuations, including the emergence of a penicillin-resistant clone 9V.
Conclusions:
- The stabilization of penicillin resistance since 1995 may be linked to implemented preventive strategies.
- Interventions such as day-care measures and reduced antibiotic prescriptions appear effective in controlling resistance.
- Continued surveillance of antibiotic resistance patterns in pneumococci is essential.