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[The latest trend of PRSP infection]
1First Department of Internal Medicine, Faculty of Medicine, University of the Ryukyus.
Abstract:
Streptococcus pneumoniae is an important pathogen and is a leading cause of pneumonia, meningitis, otitis media and sinusitis. Penicillin-resistant Streptococcus pneumoniae(PRSP) first appeared in the 1970s, and its has been increasing recently worldwide. Penicillin resistance among streptococcal isolates has been rapidly emerged in Japan the last decade, too. Penicillin and beta-lactam resistance due to altered penicillin binding protein was recognized. Resistant strains to other non-beta-lactam drugs, such as the macrolides, clindamycin, minocycline began to increase. Despite the use of appropriate antimicrobial agents, therapeutic failure in-patients with pneumococcal infection were increasing. It will be more important to select antimicrobial agent for PRSP infection, especially in meningitis, where the minimum inhibitory concentration of drug in cerebrospinal fluid may be less than the MIC in the blood. In the future 23-valent pneumococcal capsular polysaccharide vaccine should be used all persons 2 years of age and older who are at risk for serious pneumococcal disease and in all persons 65 years of age and older.
Insights
Penicillin-resistant Streptococcus pneumoniae (PRSP) is a growing global threat, leading to increased treatment failures. Vaccination and careful antimicrobial selection are crucial for managing PRSP infections.
Area of Science:
- Microbiology
- Infectious Diseases
- Pharmacology
Context:
- Streptococcus pneumoniae is a major cause of bacterial infections like pneumonia and meningitis.
- The emergence and increasing prevalence of penicillin-resistant Streptococcus pneumoniae (PRSP) worldwide, including Japan, pose significant public health challenges.
- Resistance has expanded beyond penicillin to other drug classes like macrolides and clindamycin, complicating treatment options.
Purpose:
- To highlight the increasing challenge of penicillin-resistant Streptococcus pneumoniae (PRSP) infections.
- To underscore the need for careful antimicrobial selection, particularly in meningitis cases.
- To advocate for the use of the 23-valent pneumococcal capsular polysaccharide vaccine.
Summary:
- Penicillin resistance in Streptococcus pneumoniae, first identified in the 1970s, has rapidly increased globally and in Japan.
- Resistance mechanisms involve altered penicillin-binding proteins, and strains resistant to other antibiotics like macrolides and clindamycin are also rising.
- Therapeutic failures in pneumococcal infections are increasing, necessitating strategic antimicrobial agent selection, especially for meningitis due to lower drug concentrations in cerebrospinal fluid.
Impact:
- Increased rates of therapeutic failure in patients with pneumococcal infections despite appropriate antimicrobial use.
- Heightened importance of selecting effective antimicrobial agents for PRSP infections, particularly in critical conditions like meningitis.
- The 23-valent pneumococcal capsular polysaccharide vaccine is recommended for at-risk individuals and the elderly to prevent serious pneumococcal disease.