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Antimicrobial resistance with Streptococcus pneumoniae: much ado about nothing?
1Department of Pathology, University of Iowa College of Medicine, Iowa City, IA 52242, USA. gary-doern@uiowa.edu
Abstract:
During the past decade in the United States, Streptococcus pneumoniae has changed dramatically in the context of antimicrobial resistance. Resistance to multiple different antibiotic classes including beta-lactams (penicillins, cephalosporins, and beta-lactamase inhibitor combinations), macrolides, clindamycin, the tetracyclines, chloramphenicol, and trimethoprim-sulfamethoxazole (TMP/SMX) has emerged at high rates with this important respiratory tract pathogen. There is no question that the in vitro activity of these antimicrobial agents is substantially lower for many strains of S. pneumoniae than it was even a few years ago. The larger question is, however, what does this decrease in activity mean from a clinical perspective? Stated another way, does resistance defined according to current standards in the laboratory, translate into diminished effectiveness when these agents are used to treat patients with pneumococcal infections? It is this question that serves as the principal basis for this review.
Insights
Streptococcus pneumoniae exhibits increasing antimicrobial resistance, impacting antibiotic effectiveness. This review examines if laboratory-defined resistance correlates with diminished clinical outcomes in pneumococcal infections.
Area of Science:
- Microbiology
- Infectious Diseases
- Pharmacology
Background:
- Streptococcus pneumoniae is a major respiratory pathogen.
- High rates of antimicrobial resistance have emerged in S. pneumoniae strains.
- Resistance spans multiple antibiotic classes, including beta-lactams, macrolides, and TMP/SMX.
Purpose of the Study:
- To evaluate the clinical implications of rising antimicrobial resistance in Streptococcus pneumoniae.
- To determine if laboratory-defined resistance correlates with reduced treatment effectiveness in patients.
Main Methods:
- Review of scientific literature on Streptococcus pneumoniae antimicrobial resistance.
- Analysis of in vitro antibiotic activity data.
- Correlation of laboratory resistance data with clinical outcomes.
Main Results:
- Significant decrease in in vitro activity of various antibiotics against S. pneumoniae strains.
- Emergence of high-level resistance to multiple drug classes.
Conclusions:
- The clinical significance of laboratory-defined antimicrobial resistance in S. pneumoniae requires further investigation.
- Understanding the translation of in vitro resistance to clinical effectiveness is crucial for treatment guidelines.