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Previous Volume 333:481-486 August 24, 1995 Number 8 Next

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ABSTRACT

Background Streptococcus pneumoniae is a major cause of illness, and the emergence of drug-resistant strains threatens to complicate the management of pneumococcal infections. We conducted a laboratory-based surveillance for drug-resistant S. pneumoniae among patients with invasive pneumococcal infections in Atlanta.

Methods From January through October 1994, pneumococcal isolates from 431 patients with invasive disease in metropolitan Atlanta were serotyped and tested to determine their susceptibility to various antimicrobial agents. Susceptibility to the antimicrobial agents was defined according to guidelines established by the National Committee for Clinical Laboratory Standards.

Results The annual incidence of invasive pneumococcal infection was 30 cases per 100,000 population. Isolates from 25 percent of the patients were resistant to penicillin (7 percent were highly resistant), and isolates from 26 percent were resistant to trimethoprim–sulfamethoxazole (7 percent highly resistant). Fifteen percent of the isolates were resistant to erythromycin, 9 percent to cefotaxime (4 percent were highly resistant), and 25 percent to multiple drugs. Drug-resistant pneumococci were found in both children and adults. Children under six years of age were more likely than older children and adults to have isolates resistant to multiple drugs or cefotaxime. Whites were more likely than blacks to have invasive pneumococcal infections caused by drug-resistant organisms. Among white children younger than six years, 41 percent of the S. pneumoniae isolates were resistant to penicillin.

Conclusions Drug-resistant strains of S. pneumoniae are common among both children and adults in Atlanta. Although blacks had a higher incidence of invasive pneumococcal infections than whites, whites were more likely to be infected with a drug-resistant isolate. Control of drug-resistant pneumococci will require more judicious use of antimicrobial agents and wider use of the pneumococcal polysaccharide vaccine. .

Source Information

From the Childhood and Respiratory Diseases Branch, National Center for Infectious Diseases, Centers for Disease Control and Prevention (J.H., M.S.C., R.R.F., J.A.E., K.A.D., R.F.B.), and the Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine and Veterans Affairs Medical Center (M.M.F., W.S.B.) — all in Atlanta.

Address reprint requests to Dr. Breiman at the Childhood and Respiratory Diseases Branch, Mailstop C09, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA 30333.

Full Text of this Article

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