[Streptococcus pneumoniae: serotypes, invasive and antibiotic resistant strains. Current situation in France]

Anti-pneumococcal antibiotic therapy has reduced morbidity and mortality of pneumococcal infections, but this success has retarded wide application of vaccination. The emergence and worldwide diffusion of antibiotic-resistant strains raises an important public health problem. The current situation requires determining the respective roles of antibiotic therapy and vaccine immunoprophylaxy. The aim of this work was to examine the data collected by the French National Pneumococci Registry.

The Nation Surveillance Network for Pneumococcal Infections was initiated in France in 1984. With this registry, it has been possible to follow regularly the evolution of serotypes and their sensitivity to antibiotics in 34,130 strains received from 1984 to 1996 and to compare these results with the clinical data.

Serotyping the invasive strains has shown that the relative frequency of these serotypes has been stable: the 23-valence pneumococca vaccine provided good serotype coverage from 1984 to 1996 (87.2% of the invasive strains isolated in 1996 belonged to the vaccine types). Penicillin-resistant pneumococci comprised 3.8% of the strains, isolated in 1987 and 42.8% of those isolated in 1996. Two-thirds of these penicillin-resistant pneumococci had high-level resistance and an equivalent percentage were multiresistant. The consequences of resistant strains on antibiotic therapy for pneumonia, acute otitis and meningitis is discussed.

Bacterio-clinical surveillance networks provide regular epidemiological data aimed at better use of antibiotics and the promotion of vaccination campaigns. In the future, the vaccination of children under 2 years of age with new conjugated polysaccharide vaccines should be an essential step in the global strategy against pneumococcal infections. The vaccinal formula of such a pediatric vaccine would contain 10 valences, defined according to the serotype results we have obtained: 1, 3, 4, 6, 7, 9, 14, 18, 19, 13. This vaccine would cover 86.1% of the invasive strains and 90.7% of the strains isolated from children with acute otitismedia.