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The prevalence of drug-resistant Streptococcus pneumoniae in Atlanta
J Hofmann1, M S Cetron, M M Farley
1Childhood and Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Background:
Streptococcus pneumoniae is a major cause of illness, and the emergence of drug-resistant strains threatens to complicate the management of pneumococcal infections. We conducted a laboratory-based surveillance for drug-resistant S. pneumoniae among patients with invasive pneumococcal infections in Atlanta.
Methods:
From January through October 1994, pneumococcal isolates from 431 patients with invasive disease in metropolitan Atlanta were serotyped and tested to determine their susceptibility to various antimicrobial agents. Susceptibility to the antimicrobial agents was defined according to guidelines established by the National Committee for Clinical Laboratory Standards.
Results:
The annual incidence of invasive pneumococcal infection was 30 cases per 100,000 population. Isolates from 25 percent of the patients were resistant to penicillin (7 percent were highly resistant), and isolates from 26 percent were resistant to trimethoprim-sulfamethoxazole (7 percent highly resistant). Fifteen percent of the isolates were resistant to erythromycin, 9 percent to cefotaxime (4 percent were highly resistant), and 25 percent to multiple drugs. Drug-resistant pneumococci were found in both children and adults. Children under six years of age were more likely than older children and adults to have isolates resistant to multiple drugs or cefotaxime. Whites were more likely than blacks to have invasive pneumococcal infections caused by drug-resistant organisms. Among white children younger than six years, 41 percent of the S. pneumoniae isolates were resistant to penicillin.
Conclusions:
Drug-resistant strains of S. pneumoniae are common among both children and adults in Atlanta. Although blacks had a higher incidence of invasive pneumococcal infections than whites, whites were more likely to be infected with a drug-resistant isolate. Control of drug-resistant pneumococci will require more judicious use of antimicrobial agents and wider use of the pneumococcal polysaccharide vaccine.
Insights
Drug-resistant Streptococcus pneumoniae (pneumococcus) is common in Atlanta. Whites, particularly young children, were more likely to have infections from these resistant strains, highlighting the need for careful antimicrobial use and vaccination.
Area of Science:
- Microbiology
- Infectious Diseases
- Public Health
Background:
- Streptococcus pneumoniae causes significant illness.
- Emerging drug-resistant strains complicate pneumococcal infection management.
- Laboratory surveillance is crucial for tracking resistance patterns.
Purpose of the Study:
- To assess the prevalence of drug-resistant Streptococcus pneumoniae in invasive infections in Atlanta.
- To identify demographic factors associated with drug-resistant pneumococcal infections.
Main Methods:
- Collected and serotyped pneumococcal isolates from 431 patients with invasive disease in Atlanta (Jan-Oct 1994).
- Determined antimicrobial susceptibility according to National Committee for Clinical Laboratory Standards guidelines.
- Analyzed resistance patterns for penicillin, trimethoprim-sulfamethoxazole, erythromycin, and cefotaxime.
Main Results:
- Invasive pneumococcal infection incidence was 30 per 100,000 population.
- 25% of isolates were penicillin-resistant; 26% were trimethoprim-sulfamethoxazole-resistant.
- 15% were erythromycin-resistant, 9% cefotaxime-resistant, and 25% multidrug-resistant.
- Drug resistance observed in children and adults; young children and whites showed higher rates of specific resistance.
- 41% of S. pneumoniae isolates from white children under six were penicillin-resistant.
Conclusions:
- Drug-resistant S. pneumoniae strains are prevalent in Atlanta's pediatric and adult populations.
- While blacks had higher infection incidence, whites were more prone to drug-resistant isolates.
- Judicious antimicrobial use and wider pneumococcal polysaccharide vaccine adoption are essential for control.