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| Home > Disease Listing > Drug-resistant Streptococcus pneumoniae Disease |
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Drug-resistant Streptococcus pneumoniae Disease
| 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.
Streptococcus pneumoniae. Resistant to one or more commonly used antibiotics. Seven sero-types (6A, 6B, 9V, 14, 19A, 19F, and 23F) accounted for most DRSP before the introduction of 7-valent pneumococcal conjugate vaccine (PCV7, Prevnar®, Wyeth) in the U.S. in 2000). Most antibiotic resistance today is found in serotype 19A. |
| 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 2006, there were 41,400 cases of invasive pneumococcal disease. Of these, 38% were caused by pneumococci non-susceptible to at least one drug and 15% 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. |
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Date: April 13, 2008
Content source: National Center for Immunization and Respiratory Diseases: Division of Bacterial Diseases |
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