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Macrolide resistance among invasive Streptococcus pneumoniae isolates.
T B Hyde1, K Gay, D S Stephens
1National Center for Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop C-23, Atlanta, GA 30333, USA.
JAMA
|October 26, 2001
Summary
Macrolide antibiotic resistance in Streptococcus pneumoniae is rising, particularly among young children. Most resistant strains show moderate to high minimum inhibitory concentrations (MICs), raising concerns for treatment effectiveness.
Area of Science:
- Microbiology
- Infectious Diseases
- Public Health
Background:
- Macrolide antibiotics are primary treatments for community-acquired pneumonia.
- Increasing macrolide resistance in Streptococcus pneumoniae poses a growing public health concern in the US.
- The clinical significance of macrolide resistance in Streptococcus pneumoniae remains unclear.
Purpose of the Study:
- To investigate the epidemiology of macrolide-resistant pneumococci in the United States.
- To analyze trends in macrolide resistance and associated factors.
Main Methods:
- Analysis of 15,481 invasive Streptococcus pneumoniae isolates from 1995-1999.
- Utilized data from the Centers for Disease Control and Prevention's Active Bacterial Core surveillance system.
- Examined trends in macrolide use, resistance phenotypes (M and MLS(B)), and minimum inhibitory concentrations (MICs).
Main Results:
- Macrolide antibiotic use increased by 13% from 1993-1999, with a 320% rise in children under 5.
- Macrolide resistance in Streptococcus pneumoniae rose from 10.6% in 1995 to 20.4% in 1999.
- The M phenotype, associated with moderate MICs, increased significantly, while the MLS(B) phenotype remained stable. M phenotype strains were more prevalent in young children and white populations.
Conclusions:
- Macrolide resistance in Streptococcus pneumoniae is common in the US, correlating with increased antibiotic use.
- A significant proportion of resistant strains exhibit MICs associated with reported treatment failures.
- Further research and surveillance are essential to understand the clinical impact of these findings on pneumonia treatment.
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