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World-wide development of antibiotic resistance in pneumococci
1Department of Pathology, Hershey Medical Center, Hershey, Pennsylvania 17033.
Abstract:
Antibiotic-resistant pneumococci, especially penicillin-resistant strains, are being increasingly isolated. Pneumococci with intermediate penicillin-resistance (MIC 0.1-1.0 micrograms/ml) have been reported from many parts of the world over the past two decades, and highly resistant strains (penicillin MICs greater than or equal to 2 micrograms/ml) have also appeared. Infection may be acquired in the hospital or community, and nosocomial outbreaks may occur which require control measures to limit organism spread. Most infections occur in children with diminished host responses. Disease caused by pneumococci with intermediate penicillin-resistance may be treated with high doses of penicillin, but disease caused by highly resistant strains, especially meningitis, may require alternative therapy. Pneumococci resistant to sulfonamides, tetracyclines, erythromycin, lincomycin, clindamycin, chloramphenicol, aminoglycosides and rifampin have also appeared. Strains resistant to all the above-mentioned agents, including all beta-lactam antibiotics tested, have been reported from South Africa and Spain. Alternative therapy for resistant strains may include vancomycin, cefotaxime, cefoperazone, ceftriaxone and imipenem. Pneumococci isolated from sites suggestive of infection, especially blood and cerebrospinal fluid, should be routinely tested for penicillin-susceptibility.
Insights
Antibiotic-resistant pneumococci are increasing globally. Penicillin-intermediate strains can be treated with high-dose penicillin, but highly resistant strains require alternative therapies like vancomycin.
Area of Science:
- Microbiology
- Infectious Diseases
- Pharmacology
Background:
- Increasing prevalence of antibiotic-resistant *Streptococcus pneumoniae* strains globally.
- Emergence of penicillin-intermediate (MIC 0.1-1.0 µg/mL) and high-resistance (MIC ≥ 2 µg/mL) pneumococci over two decades.
- Infections can be hospital or community-acquired, with potential for nosocomial outbreaks, particularly in immunocompromised children.
Purpose of the Study:
- To review the current landscape of pneumococcal antibiotic resistance.
- To discuss treatment strategies for infections caused by resistant strains.
- To emphasize the importance of susceptibility testing for guiding therapy.
Main Methods:
- Literature review of studies on pneumococcal resistance patterns.
- Analysis of reported resistance to various antibiotic classes including penicillin, sulfonamides, tetracyclines, and others.
- Identification of alternative therapeutic agents for resistant infections.
Main Results:
- Documented rise in penicillin-resistant pneumococci worldwide.
- Identification of pneumococcal resistance to multiple antibiotics, including beta-lactams, in some regions.
- Emergence of pan-resistant strains reported from South Africa and Spain.
Conclusions:
- Intermediate penicillin-resistant pneumococcal infections may respond to high-dose penicillin.
- Highly resistant pneumococcal strains, especially in meningitis, necessitate alternative treatments such as vancomycin, cefotaxime, cefoperazone, ceftriaxone, or imipenem.
- Routine penicillin susceptibility testing for pneumococci from sterile sites (blood, CSF) is crucial for effective management.