Geographic diversity and temporal trends of antimicrobial resistance in Streptococcus pneumoniae in the United States

Resistance of Streptococcus pneumoniae to antibiotics is increasing throughout the United States, with substantial variation among geographic regions. We show that patterns of geographic variation are best explained by the intensity of selection for resistance, which is reflected by differences between the proportions of resistance within individual serotypes, rather than by differences between the frequencies of particular serotypes. Using a mathematical transmission model, we analyzed temporal trends in the proportions of singly and dually resistant organisms and found that pneumococcal strains resistant to both penicillin and erythromycin are increasing faster than strains singly resistant to either. Using the model, we predict that by 1 July 2004, in the absence of a vaccine, 41% of pneumococci at the Centers for Disease Control and Prevention (CDC)'s Active Bacterial Core surveillance (ABCs) sites, taken together, will be dually resistant, with 5% resistant to penicillin only and 5% to erythromycin only.

[1]  E. Lewis,et al.  Efficacy, safety and immunogenicity of heptavalent pneumococcal conjugate vaccine in children , 2000, The Pediatric infectious disease journal.

[2]  W. Goettsch,et al.  Antibiotic use and resistance of Streptococcus pneumoniae in The Netherlands during the period 1994-1999. , 2001, The Journal of antimicrobial chemotherapy.

[3]  Susan R. Johnson,et al.  Macrolide Resistance among Invasive Streptococcus Pneumoniae Isolates , 2022 .

[4]  M. Lipsitch,et al.  The rise and fall of antimicrobial resistance. , 2001, Trends in microbiology.

[5]  R. Breiman,et al.  Prevention of pneumococcal disease : recommendations of the Advisory Committee on Immunization Practices (ACIP) , 1997 .

[6]  M. Cetron,et al.  Increasing prevalence of multidrug-resistant Streptococcus pneumoniae in the United States. , 2000, The New England journal of medicine.

[7]  F. Baquero.  Pneumococcal Resistance to β-Lactam Antibiotics: A Global Geographic Overview , 1995 .

[8]  A. Schuchat,et al.  Epidemiology of invasive Streptococcus pneumoniae infections in the United States, 1995-1998: Opportunities for prevention in the conjugate vaccine era. , 2001, JAMA.

[9]  J. P. Davis,et al.  Prevention of pneumococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). , 1997, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[10]  I. Jado,et al.  Evolution of Streptococcus pneumoniaeSerotypes and Antibiotic Resistance in Spain: Update (1990 to 1996) , 1998, Journal of Clinical Microbiology.

[11]  E. Lewis,et al.  Efficacy, safety and immunogenicity of heptavalent pneumococcal conjugate vaccine in children. Northern California Kaiser Permanente Vaccine Study Center Group. , 2000, The Pediatric infectious disease journal.

[12]  F. Baquero,et al.  Importance of Local Variations in Antibiotic Consumption and Geographical Differences of Erythromycin and Penicillin Resistance in Streptococcus pneumoniae , 2002, Journal of Clinical Microbiology.

[13]  C. Whitney,et al.  Distribution of penicillin-nonsusceptible pneumococcal clones in the Baltimore metropolitan area and variables associated with drug resistance. , 2002, Clinical Infectious Diseases.

[14]  A. Tomasz,et al.  Nomenclature of Major Antimicrobial-Resistant Clones of Streptococcus pneumoniae Defined by the Pneumococcal Molecular Epidemiology Network , 2001, Journal of Clinical Microbiology.

[15]  B. Levin,et al.  The biological cost of antibiotic resistance. , 1999, Current opinion in microbiology.

[16]  L. Harrison,et al.  Active bacterial core surveillance of the emerging infections program network. , 2001, Emerging infectious diseases.

[17]  Mary Jane Ferraro,et al.  Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically : approved standard , 2000 .

[18]  G. Doern.  Antimicrobial use and the emergence of antimicrobial resistance with Streptococcus pneumoniae in the United States. , 2001, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[19]  G. Doern,et al.  Antimicrobial-drug use and changes in resistance in Streptococcus pneumoniae. , 2000, Emerging infectious diseases.

[20]  M. Lipsitch.  Interpreting results from trials of pneumococcal conjugate vaccines: a statistical test for detecting vaccine-induced increases in carriage of nonvaccine serotypes. , 2000, American journal of epidemiology.

[21]  Paterick Bd,et al.  Geographic Variation in Penicillin Resistance in Streptococcus pneumoniae: Selected Sites, United States, 1997. , 2000, Annals of emergency medicine.

[22]  J. Modlin,et al.  Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). , 2006, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[23]  J. Karlowsky,et al.  Relationship between Antibiotic Resistance in Streptococcus pneumoniae and That in Haemophilus influenzae: Evidence for Common Selective Pressure , 2002, Antimicrobial Agents and Chemotherapy.

[24]  S. Schrag,et al.  Limiting the spread of resistant pneumococci: biological and epidemiologic evidence for the effectiveness of alternative interventions. , 2000, Clinical microbiology reviews.

[25]  G. Stefánsdóttir,et al.  Do antimicrobials increase the carriage rate of penicillin resistant pneumococci in children? Cross sectional prevalence study , 1996, BMJ.

[26]  G. Siber,et al.  Which pneumococcal serogroups cause the most invasive disease: implications for conjugate vaccine formulation and use, part I. , 2000, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[27]  B. Lowe,et al.  Serotype distribution and prevalence of resistance to benzylpenicillin in three representative populations of Streptococcus pneumoniae isolates from the coast of Kenya. , 1998, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[28]  T. Klaukka,et al.  Macrolide-resistant Streptococcus pneumoniae and use of antimicrobial agents. , 2001, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.