S. pneumoniae Grows Even More Resistant

Abstract

Article| January 01 1999 S. pneumoniae Grows Even More Resistant AAP Grand Rounds (1999) 1 (1): 1–2. https://doi.org/10.1542/gr.1-1-1 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation S. pneumoniae Grows Even More Resistant. AAP Grand Rounds January 1999; 1 (1): 1–2. https://doi.org/10.1542/gr.1-1-1 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: drug resistance, microbial, respiratory system, streptococcus pneumoniae, amoxicillin, penicillin, pneumococcal infections, pneumococcal vaccine, antimicrobial susceptibility, antimicrobials, bacteremia Source: Doern GV, Pfaller MA, Kugler K, Freeman J, Jones RN. Prevalence of antimicrobial resistance among respiratory tract isolates of Streptococcus pneumoniae in North America: 1997. Results from the SENTRY Antimicrobial Surveillance Program. Clin Inf Dis. 1998;27:764–770. In 1997, Doern and colleagues collected 1 047 respiratory tract isolates of Streptococcus pneumoniae from 27 US and 7 Canadian centers and tested them in a centralized laboratory for antibiotic susceptibility. Only 56% of US and 70% of Canadian isolates were fully sensitive to penicillin, with minimal inhibitory concentrations (MICs) < 0.06 μg/ml. Twenty-eight percent of US isolates showed intermediate level resistance (0.12 – 1 μg/ml) and an additional 16% manifested high-level resistance (2 μg/ml) to penicillin. These numbers confirm the inexorable increase in resistance rates over the past decade, from 3.8% intermediate-level resistance and no high-level resistance in the late 1980s. This phenomenon occurred to almost the same degree in all regions of the US. Resistance rates to other beta-lactam agents, including amoxicillin and amoxicillin/elavulanate, and to all 7 cephalosporins studied (cefepime, cefotaxime, cefuroxime, cefpodoxime, cefaclor, cefadroxil, and cefixime) were also shown to be increasing steadily. Overall rates of resistance to macrolides and clindamycin changed little from 3 years earlier, and all 1 047 S. pneumoniae strains remained sensitive to vancomycin. Streptococcus pneumoniae is an exceedingly important pediatric pathogen, both as an agent of common respiratory infections (otitis, sinusitis, etc) and of invasive infections (bacteremia, meningitis, etc). These data are the most current available to document the alarming increase in antibiotic resistance among pneumococci. The trend is serious—combined intermediate and highly resistant strains totaled: 1992–17.8%; 1993–22.3%; 1994–24.6%; 1995–27.2%; 1996–34.6%; and now 1997–44%. These recent data likely underestimate the degree of resistance as it applies to children, as the institutions surveyed by Doern et al are dominated by those that primarily or exclusively serve adults. Previous studies have demonstrated that pediatric isolates of pneumococci generally show higher rates of resistance than adult isolates and that respiratory tract (eg, nasopharynx, middle ear) isolates as a group are more antibiotic-resistant than are isolates from normally sterile sites.1 Antibiotic usage patterns appear to contribute substantially to the increasing resistance among S. pneumoniae as well as among other important pediatric pathogens.2 We need to minimize unnecessary antibiotic usage, monitor resistance trends, develop new classes of antibiotics, adhere to good infection control practices, utilize the existing pneumococcal vaccine as appropriate, and continue to work toward approval of conjugate pneumococcal vaccines that are effective in younger children.3,4 Like the rapid changes in beak size among Darwin’s Galapagos finches in response to drought, the rapid emergence of pneumococcal antimicrobial resistance represents evolution in real time. While marveling at the biologic adaptability of these microorganisms and birds, we wonder if an ability to perceive and respond appropriately to the biologic and environmental consequences of our behaviors will be comparable. You do not currently have access to this content.