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Streptococcus pneumoniae, Drug-Resistant
Invasive Disease (DRSP)
2007 Case Definition*
Clinical description
Streptococcus pneumoniae causes many clinical syndromes, depending on the site of
infection (e.g., acute otitis media, pneumonia, bacteremia, or meningitis).
Laboratory criteria for diagnosis
- Isolation of S. pneumoniae from a normally sterile site (e.g., blood, cerebrospinal
fluid, or, less commonly, joint, pleural, or pericardial fluid) and
- "Nonsusceptible" isolate (i.e., intermediate- or high-level resistance of the S.
pneumoniae isolate to at least one antimicrobial agent currently approved for use in
treating pneumococcal infection (12,
13)+
+Resistance defined by National Committee for Clinical Laboratory Standards
(NCCLS)-approved methods and NCCLS-approved interpretive minimum inhibitory concentration (MIC)
standards (µg/mL) for S. pneumoniae. NCCLS recommends that all invasive S. pneumoniae
isolates found to be “possibly resistant”to beta-lactams (i.e., an oxacillin zone size of less than 20
mm) by oxacillin screening should undergo further susceptibility testing by using a quantitative MIC
method acceptable for penicillin, extended-spectrum cephalosporins, and other drugs as clinically
indicated (12).
Case classification
Probable: a clinically compatible case caused by laboratory-confirmed culture of S.
pneumoniae identified as "nonsusceptible" (i.e., an oxacillin zone size of less than 20 mm) when
oxacillin screening is the only method of antimicrobial susceptibility testing performed
Confirmed: a clinically compatible case that is laboratory confirmed
*Comment
The difference between this case definition and the previous case definition for this condition
is the inclusion of new case classifications for reporting purposes.
Case classifications for Drug Resistant Streptococcus pneumoniae (DRSP) and Invasive
Pneumococcal Disease (IPD) are modified as listed below:
- Isolates causing IPD from children less than five years of age for which antibacterial susceptibilities
are available and determined to be DRSP should be reported only as DRSP (event code 11720).
- Isolates causing IPD from children less than five years of age which are susceptible, or for which
susceptibilities are not available should be reported ONLY as IPD in children less than five years of age
(event code 11717).
References
12. National Committee for Clinical
Laboratory Standards. Performance standards for antimicrobial susceptibility
testing. Villanova, PA: National Committee for Clinical Laboratory
Standards, 1994;14(16); NCCLS document M100-S5.
13. CDC. Defining the public health impact of drug-resistant Streptococcus pneumoniae:
report of a working group. MMWR 1996;45(No. RR-1).
See also:
Printable Version
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