Association between antimicrobial resistance among pneumococcal isolates and burden of invasive pneumococcal disease in the community.

Treatment of infections with drug-resistant strains of Streptococcus pneumoniae (pneumococcus) may fail; whether drug resistance is associated with an increase in the number of serious infections in the community is unknown. We evaluated the relationship between the proportion of antimicrobial-resistant S. pneumoniae isolates and the number of cases of invasive pneumococcal disease. Linear regression models included 1996 county-level data from 38 counties participating in the US Centers for Disease Control and Prevention's Active Bacterial Core Surveillance. Separate models evaluated hospitalized children aged <5 years, nonhospitalized children aged <5 years, adults aged 18-64 years, and adults aged >64 years. The proportion of isolates resistant to > or =3 drug classes was associated with invasive disease in both hospitalized (P=.06) and nonhospitalized (P=.001) children. The proportion of multidrug-resistant pneumococcal isolates did not predict invasive cases among adults. The increasing prevalence of multidrug-resistant pneumococci among children may be leading to an increase in invasive disease.

[1]  J. Hedrick,et al.  Pneumococcal serotypes from acute otitis media in rural Kentucky , 2002, The Pediatric infectious disease journal.

[2]  S. Lockhart,et al.  Efficacy of a pneumococcal conjugate vaccine against acute otitis media. , 2001, The New England journal of medicine.

[3]  M. Ferraro.  Performance standards for antimicrobial susceptibility testing , 2001 .

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

[5]  L. McCaig,et al.  National Hospital Ambulatory Medical Care Survey: 1998 outpatient department summary. , 2000, Advance data.

[6]  L. McCaig.  National Hospital Ambulatory Medical Care Survey: 1998 emergency department summary. , 2000, Advance data.

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

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

[9]  Lisa B. Gelling,et al.  Epidemiologic Relation between HIV and Invasive Pneumococcal Disease in San Francisco County, California , 2000, Annals of Internal Medicine.

[10]  A. Schuchat,et al.  Mortality from invasive pneumococcal pneumonia in the era of antibiotic resistance, 1995-1997. , 2000, American journal of public health.

[11]  A. Schuchat,et al.  Invasive pneumococcal infection in Baltimore, Md: implications for immunization policy. , 2000, Archives of internal medicine.

[12]  S. Pelton.  Risk factors for invasive pneumococcal disease in children: a population-based case-control study in North America. , 2000, Pediatrics.

[13]  R. Gaynes,et al.  Biological and chemical terrorism: strategic plan for preparedness and response. , 2000 .

[14]  J. Koplan.  Preventing pneumococcal disease among infants and young children. Recommendations of the Advisory Committee on Immunization Practices (ACIP). , 2000, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[15]  G. Doern,et al.  Antimicrobial resistance with Streptococcus pneumoniae in the United States, 1997 98. , 1999, Emerging infectious diseases.

[16]  S. Dowell.  ANTIBIOTIC THERAPY FOR OTITIS MEDIA , 1999 .

[17]  J. Justman,et al.  Penicillin resistance and other predictors of mortality in pneumococcal bacteremia in a population with high human immunodeficiency virus seroprevalence. , 1999, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[18]  S. Dowell,et al.  Failure of treatment of pneumonia associated with highly resistant pneumococci in a child. , 1999, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[19]  D. Woodwell.  National Ambulatory Medical Care Survey: 1997 summary. , 1999, Advance data.

[20]  S. Dowell,et al.  Acute otitis media: management and surveillance in an era of pneumococcal resistance--a report from the Drug-resistant Streptococcus pneumoniae Therapeutic Working Group. , 1999, The Pediatric infectious disease journal.

[21]  Paterick Bd,et al.  Geographic variation in penicillin resistance in Streptococcus pneumoniae--selected sites, United States, 1997. , 1999, MMWR. Morbidity and mortality weekly report.

[22]  N. Andrews,et al.  Invasive pneumococcal infection in South and West England , 1998, Epidemiology and Infection.

[23]  F. Baquero-Artigao,et al.  Influence of recent antibiotic therapy on antimicrobial resistance of Streptococcus pneumoniae in children with acute otitis media in Spain. , 1998, The Pediatric infectious disease journal.

[24]  S. Dowell,et al.  Principles of Judicious Use of Antimicrobial Agents for Pediatric Upper Respiratory Tract Infections , 1998, Pediatrics.

[25]  S. Dowell,et al.  Otitis Media—Principles of Judicious Use of Antimicrobial Agents , 1998, Pediatrics.

[26]  S. Buckingham,et al.  Breakthrough bacteremia and meningitis during treatment with cephalosporins parenterally for pneumococcal pneumonia. , 1998, The Journal of pediatrics.

[27]  D. Cherry,et al.  National Ambulatory Medical Care Survey: 1999 Summary , 2001 .

[28]  D. Greenberg,et al.  Bacteriologic response to oral cephalosporins: are established susceptibility breakpoints appropriate in the case of acute otitis media? , 1997, The Journal of infectious diseases.

[29]  A. Schuchat,et al.  Bacterial Meningitis in the United States in 1995 , 1997 .

[30]  S. Dowell,et al.  Resistant pneumococci: protecting patients through judicious use of antibiotics. , 1997, American family physician.

[31]  B. Schwartz,et al.  Therapy for children with invasive pneumococcal infections , 1997 .

[32]  D. Greenberg,et al.  Impaired bacteriologic response to oral cephalosporins in acute otitis media caused by pneumococci with intermediate resistance to penicillin. , 1996, The Pediatric infectious disease journal.

[33]  M. Jacobs.  Increasing importance of antibiotic-resistant Streptococcus pneumoniae in acute otitis media. , 1996, The Pediatric infectious disease journal.

[34]  J. R. Parsons,et al.  Bacteremia With Streptococcus pneumoniae: Implications for Therapy and Prevention , 1996 .

[35]  M. Cetron,et al.  Minimizing the impact of drug-resistant Streptococcus pneumoniae (DRSP). A strategy from the DRSP Working Group. , 1996, JAMA.

[36]  R. Breiman,et al.  Bacteremia with Streptococcus pneumoniae. Implications for therapy and prevention. Franklin County Pneumonia Study Group. , 1996, JAMA.

[37]  J. Hedrick,et al.  High prevalence of multidrug-resistant Streptococcus pneumoniae among children in a rural Kentucky community. , 1995, The Pediatric Infectious Disease Journal.

[38]  M. Cetron,et al.  The prevalence of drug-resistant Streptococcus pneumoniae in Atlanta. , 1995, The New England journal of medicine.

[39]  J. Eskola,et al.  Risk factors for primary invasive pneumococcal disease among children in Finland. , 1995, JAMA.

[40]  B. Gessner,et al.  Risk factors for invasive disease caused by Streptococcus pneumoniae among Alaska native children younger than two years of age. , 1995, The Pediatric infectious disease journal.

[41]  F. Tenover,et al.  Emergence of drug-resistant pneumococcal infections in the United States. , 1994, JAMA.

[42]  N. Bennett,et al.  Pneumococcal bacteremia in Monroe County, New York. , 1992, American journal of public health.

[43]  Schappert Sm.  Office visits for otitis media: United States, 1975-90. , 1992 .

[44]  J. Connor,et al.  Ceftriaxone failure in meningitis caused by Streptococcus pneumoniae with reduced susceptibility to beta-lactam antibiotics. , 1991, The Pediatric infectious disease journal.

[45]  A. Schuchat,et al.  Use of surveillance for invasive pneumococcal disease to estimate the size of the immunosuppressed HIV-infected population. , 1991, JAMA.

[46]  B. Plikaytis,et al.  Antimicrobial resistance of Streptococcus pneumoniae in the United States, 1979-1987. The Pneumococcal Surveillance Working Group. , 1991, The Journal of infectious diseases.

[47]  G. Rutherford,et al.  The role of human immunodeficiency virus infection in pneumococcal bacteremia in San Francisco residents. , 1990, The Journal of infectious diseases.

[48]  R. Breiman,et al.  Pneumococcal bacteremia in Charleston County, South Carolina. A decade later. , 1990, Archives of internal medicine.

[49]  J. Waitz.  Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically , 1990 .

[50]  D. Gilbert,et al.  Meningitis due to penicillin-resistant Streptococcus pneumoniae in adults. , 1990, Reviews of infectious diseases.

[51]  B Rosner,et al.  Epidemiology of otitis media during the first seven years of life in children in greater Boston: a prospective, cohort study. , 1989, The Journal of infectious diseases.

[52]  J. Ariza,et al.  Characteristics and antibiotic therapy of adult meningitis due to penicillin-resistant pneumococci. , 1988, The American journal of medicine.

[53]  R. Facklam,et al.  Antimicrobial resistance in pneumococci from the USA: Are there trends? , 1988 .

[54]  J. Bigby.  Harrison's Principles of Internal Medicine , 1988 .

[55]  G. Istre,et al.  Invasive disease due to Streptococcus pneumoniae in an area with a high rate of relative penicillin resistance. , 1987, The Journal of infectious diseases.

[56]  J. Gruber.  Bacterial meningitis in the United States, 1978 through 1981: The national bacterial meningitis surveillance study , 1985 .

[57]  G. Mccracken,et al.  Relatively penicillin‐resistant pneumococcal infections in pediatric patients , 1984, Pediatric infectious disease.

[58]  G. Istre,et al.  Chloramphenicol and penicillin resistance in pneumococci isolated from blood and cerebrospinal fluid: a prevalence study in metropolitan Denver , 1983, Journal of clinical microbiology.

[59]  E. Bruck,et al.  National Committee for Clinical Laboratory Standards. , 1980, Pediatrics.

[60]  R. Michaels,et al.  Meningitis from a pneumococcus moderately resistant to penicillin. , 1979, JAMA.

[61]  John E. Bennett,et al.  Principles and practice of infectious diseases. Vols 1 and 2. , 1979 .

[62]  W. Krivit,et al.  A penicillin-resistant pneumococcus. , 1978, The Journal of pediatrics.

[63]  L. Taber,et al.  Prolonged pneumococcal meningitis due to an organism with increased resistance to penicillin. , 1976, Pediatrics.

[64]  W. Kup.  [Infections of the upper respiratory tract]. , 1976, Zeitschrift fur arztliche Fortbildung.

[65]  S. Naraqi,et al.  Relapsing pneumococcal meningitis: isolation of an organism with decreased susceptibility to penicillin G. , 1974, The Journal of pediatrics.

[66]  Jerry H. Johnson.  Infections of the Upper Respiratory Tract , 1973 .