| Clinical
Features |
Pneumonia, bacteremia, otitis media
(OM), meningitis, peritonitis and sinusitis |
| Etiologic
Agent |
Streptococcus pneumoniae.
Resistant to one or more commonly used antibiotics. Seven
sero-types (6A, 6B, 9V, 14, 19A, 19F, and 23F) account for
most DRSP. |
| Incidence |
Until 2000, S. pneumoniae
infections caused 60,000 cases of invasive disease each year
and up to 40% of these were caused by pneumococci non-susceptible
to at least one drug. These figures have decreased substantially
following the introduction of the pneumococcal conjugate vaccine
for children. In the year 2002, there were 37,000 cases of
invasive pneumococcal disease. Of these, 34% were caused by
pneumococci non-susceptible to at least one drug and 17% were
due to a strain non-susceptible to 3 or more drugs. Prevalence
of DRSP shows geographic variation. |
| Sequelae |
Death occurs in 14% of hospitalized
adults with invasive disease. Neurologic sequelae occur in
meningitis patients. Hearing impairment can result from recurrent
otitis media. Resistance has led to treatment failures. |
| Costs |
DRSP is associated with increased
costs due to use of antimicrobial agents, recurrent disease,
surveillance, education, and new antimicrobial drug development.
|
| Transmission |
Person-to-person. |
| Risk
Groups |
Persons who attend or work at child-care
centers and persons who recently used antimicrobial agents
are at increased risk for infection with DRSP. |
| Surveillance |
CDC sponsors active, population-based
surveillance in ten states. Laboratory-based reporting of
DRSP has been mandated in several states. Several private-sector
systems also track DRSP. |
| Trends |
The new pneumococcal conjugate vaccine
is preventing many infections due to drug-resistant pneumococci.
Outbreaks of DRSP have been reported in nursing homes, institutions
for HIV-infected persons, and child-care centers. |
| Challenges |
Widespread overuse of antimicrobial
agents and the spread of resistant strains has contributed
to emerging resistance. The 23-valent vaccine is underused.
Supplies of the new conjugate vaccine for children are inadequate.
Some clinical laboratories have not adopted standard methods
(NCCLS guidelines) for identifying and defining DRSP. |
| Opportunities |
Campaigns for more judicious use
of antibiotics and use of the new conjugate vaccine may slow
or reverse emerging drug resistance. Prevention of infections
could improve through expanded use of 23-valent polysaccharide
vaccine and the new conjugate vaccine. Among children 5 years
of age, the conjugate vaccine elicits protection against ~80%
of invasive pneumococcal isolates that are not susceptible
to penicillin. |
|
December 2003
|
