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Streptococcus pneumoniae, Drug-Resistant
Invasive Disease (DRSP)
1996 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)*
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
*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).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:
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