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Surveillance for penicillin-nonsusceptible Streptococcus pneumoniae--New York City, 1995
Insights
Penicillin-nonsusceptible Streptococcus pneumoniae (PNSP) is a growing public health concern, particularly in young children and HIV-infected adults. Surveillance is crucial for monitoring PNSP prevalence and guiding treatment strategies.
Area of Science:
- Microbiology
- Infectious Diseases
- Public Health
Background:
- Streptococcus pneumoniae is a major cause of serious infections like pneumonia and meningitis in the US.
- Increasing antimicrobial resistance, particularly to penicillin (PNSP), is a significant challenge.
- PNSP strains show reduced susceptibility to multiple antibiotics, limiting treatment options.
Purpose of the Study:
- To monitor the local prevalence of penicillin-nonsusceptible Streptococcus pneumoniae (PNSP) in New York City.
- To understand the demographic distribution and risk factors associated with PNSP infections.
Main Methods:
- The New York City Department of Health (NYCDOH) implemented mandatory reporting for PNSP in December 1994.
- Surveillance data from 1995 were analyzed to identify case rates and associated characteristics.
Main Results:
- The highest rates of PNSP infections were observed in children under 4 years of age.
- Among adults aged 20-44 with PNSP infections, 71.4% were also infected with human immunodeficiency virus (HIV).
Conclusions:
- PNSP infections pose a significant threat, especially to vulnerable populations.
- Effective surveillance systems are essential for tracking antimicrobial resistance trends.
- Targeted public health interventions may be needed for high-risk groups, including young children and HIV-positive adults.
Abstract:
Streptococcus pneumoniae has become a leading cause of bacteremia, pneumonia, meningitis, and otitis media in the United States. Persons at increased risk include young children, immunocompromised persons, and the elderly. Until 1987, S. pneumoniae was uniformly susceptible to penicillin; since then, in the United States, there has been increased identification of penicillin-nonsusceptible S. pneumoniae (PNSP) (defined as minimum inhibitory concentration [MIC] to penicillin > or = 0.1 microgram/mL), especially penicillin-resistant S. pneumoniae (PRSP) (defined as MIC to penicillin > or = 2.0 micrograms/mL). In addition, PNSP is becoming less susceptible to other antimicrobial drugs, including tetracycline, erythromycin, extended-spectrum cephalosporins, and chloramphenicol; some are susceptible only to vancomycin. Because of the emergence of PNSP, in December 1994, the New York City Department of Health (NYCDOH) amended the New York City health code to require reporting of PNSP to monitor the local prevalence of resistance to penicillin. This report summarizes surveillance findings from NYCDOH's data for 1995, which indicate that the highest case rates were among children aged < 4 years and that, among adults aged 20-44 years with PNSP infections, 71.4% also were infected with human immunodeficiency virus (HIV).