Abstract
Prolonged outbreaks of multidrug-resistant Streptococcus pneumoniae in health care facilities are uncommon. We found persistent transmission of a fluroquinolone-resistant S. pneumoniae clone during 2006-2011 in a post-acute care facility in Israel, despite mandatory vaccination and fluoroquinolone restriction. Capsular switch and multiple antimicrobial nonsusceptibility mutations occurred within this single clone. The persistent transmission of fluoroquinolone-resistant S. pneumoniae during a 5-year period underscores the importance of long-term care facilities as potential reservoirs of multidrug-resistant streptococci.
Highlights
Institutionalized persons, those >65 years of age, are at high risk for pneumococcal infections [1,2,3]
The selective plates were compared with tryptic soy agar–5% sheep blood and had similar ability to support the growth of S. pneumoniae
Clinical Cases of fluoroquinoloneresistant Streptococcus pneumoniae (FQRSP) during the Baseline Period Before November 2008, pneumococcal vaccine was not administered at admission to the facility
Summary
Institutionalized persons, those >65 years of age, are at high risk for pneumococcal infections [1,2,3]. The rate of sporadic pneumococcal diseases for nursing home residents is almost 20 times higher than for elderly persons living in the community [1]. In September 2008 in Israel, after report of an invasive pneumococcal disease caused by a fluoroquinoloneresistant Streptococcus pneumoniae (FQRSP) strain in a patient who had been transferred from a post–acute care facility, an investigation led to discovery that this phenotype had been endemic in the facility for at least 2 years. In the index case-patient, an 81-year-old woman with dementia, bilateral pneumonia and acute respiratory failure developed while she was in a post-acute care facility.
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