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Trends in Streptococcus pneumoniae Antimicrobial Resistance in US Children: A Multicenter Evaluation
Salini Mohanty1, Kristen Feemster1, Kalvin C Yu2
1Center for Observational and Real World Evidence (CORE), Merck & Co, Inc, Rahway, New Jersey, USA.
Insights
Antimicrobial resistance in Streptococcus pneumoniae is a major concern in US children. Resistance to multiple antibiotics, including macrolides, has significantly increased over the past decade.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Resistance Research
- Clinical Microbiology
Background:
- Antimicrobial resistance (AMR) presents a critical obstacle in treating pneumococcal disease.
- Streptococcus pneumoniae is a leading cause of bacterial infections in children.
Purpose of the Study:
- To assess trends in antimicrobial resistance in Streptococcus pneumoniae isolates from children in the United States.
- To analyze resistance patterns over a nearly decade-long period.
Main Methods:
- Analysis of 7605 nonduplicate Streptococcus pneumoniae isolates from children (<18 years) across 219 US hospital settings (January 2011-February 2020).
- Evaluation of antibiotic resistance based on facility antimicrobial susceptibility reports (intermediate/resistant).
- Descriptive statistics and generalized estimating equations were used to characterize resistance rates and temporal trends.
Main Results:
- A high proportion of isolates exhibited resistance to at least one drug class (56.8%) and at least two drug classes (30.7%).
- Significant annual increases in resistance were observed for at least one drug class (+0.9%), at least two drug classes (+1.8%), and macrolides (+5.0%).
- Resistance rates were notably higher in noninvasive isolates compared to invasive isolates.
Conclusions:
- Streptococcus pneumoniae isolates from US children demonstrate persistent high rates of antibiotic resistance.
- There are significant upward trends in resistance to multiple drug classes, particularly macrolides.
- Strategies including vaccines for resistant serotypes and antimicrobial stewardship are crucial for combating AMR in Streptococcus pneumoniae.
Background:
Antimicrobial resistance (AMR) poses a significant challenge for treating pneumococcal disease. This study assessed AMR trends in Streptococcus pneumoniae from US children.
Methods:
We evaluated antibiotic resistance, defined as facility antimicrobial susceptibility reports of intermediate/resistant, in 30-day nonduplicate S pneumoniae isolates from children (<18 years of age) with invasive (blood or cerebrospinal fluid/neurological) or noninvasive (respiratory or ear/nose/throat) isolates at 219 US hospital inpatient/outpatient settings in the BD Insights Research Database (January 2011-February 2020). We used descriptive statistics to characterize the percentage of antimicrobial-resistant isolates and generalized estimating equations to assess variations in resistance over time.
Results:
Of 7605 S pneumoniae isolates analyzed, 6641 (87.3%) were from noninvasive sources. Resistance rates were higher in noninvasive versus invasive isolates. Isolates showed high observed rates of resistance to ≥1 drug class (56.8%), ≥2 drug classes (30.7%), macrolides (39.9%), and penicillin (39.6%) and significant annual increases in resistance to ≥1 drug class (+0.9%), ≥2 drug classes (+1.8%), and macrolides (+5.0%).
Conclusions:
Among US children over the last decade, S pneumoniae isolates showed persistently high rates of resistance to antibiotics and significant increases in ≥1 drug class, ≥2 drug classes, and macrolide resistance rates. Efforts to address AMR in S pneumoniae may require vaccines targeting resistant serotypes and antimicrobial stewardship efforts.
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