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Streptococcus pneumoniae, Drug-Resistant
Invasive Disease (DRSP)
1995 Case Definition
Clinical description
Pneumococci may cause many clinical syndromes depending
on the site of infection (e.g. otitis media, pneumonia, bacteremia,
or meningitis). For the purposes of national surveillance, "invasive" pneumococcal
disease refers only to bacteremia and/or meningitis. Although S. pneumoniae infections
involving other normally sterile sites such as joint, pleural,
or peritoneal fluid are sometimes considered invasive, these
infections are not intended for inclusion under this surveillance
system.
Laboratory Criteria for Diagnosis
- Isolation of S. pneumoniae from blood
or cerebrospinal fluid
- Intermediate and high level resistance (defined
by National Committee for Clinical Laboratory Standards [NCCLS]
approved methods and interpretive minimum inhibitory concentration
[MIC] breakpoints) of the S. pneumoniae isolate
to at least one antimicrobial agent currently approved for
use in treating pneumococcal infection*
Case classification
Probable: A clinically
compatible case caused by laboratory-confirmed culture of S.
pneumoniae identified as "non-susceptible" (i.e., an
oxacillin zone size of less than 20mm) when oxacillin screening
is the only method of antimicrobial susceptibility testing performed
Confirmed: A clinically compatible case
caused by laboratory-confirmed S. pneumoniae identified
as "non-susceptible" according to MIC interpretive
breakpoints as outlined in NCCLS guidelines for susceptibility
testing to any antimicrobial agent currently approved for use
in treating pneumococcal infection*
Comment
NCCLS recommends that all invasive S. pneumoniae
isolates that are found to be "possibly resistent" to
beta-lactams (i.e., an oxacillin zone size of less than 20mm)
by oxacillin screening should undergo further susceptibility
testing using a quantitative MIC method acceptable for penicillin,
extended spectrum cephalosporins, and other drugs as clinically
indicated.
* Minimum Inhibitory Concentration (MIC) Interpretive
Standard (µg/ml) for S. pneumoniae; NCCLS Guidelines
1994.
See also:
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