Changes in the proportion of penicillin-non-susceptible Streptococcus pneumoniae (PNSP) isolates during an intervention programme were evaluated by phenotypic analysis of all initial isolates with penicillin MIC > or =0.5 microg/ml (n=1248) collected 1995-2004. During the study period, the proportion of such isolates was fairly constant (12-19%), and there was no statistically significant variation in the proportion of total PNSP cases (MIC > or =0.12 microg/ml) or PNSP with MIC > or =0.5 microg/ml, with the exception of an increase in 2004. Analysis restricted to clinical cases revealed no statistically significant changes. 23 different serogroups were found, and serogroup 9 isolates accounted for almost half of the PNSP cases. Only minor changes in phenotypic characteristics occurred in the other serogroups, which indicates that the increase in PNSP in 2004 was not due to import of a new resistant clone. Antibiotic consumption is considered to be an important risk factor for penicillin resistance in S. pneumoniae. After initiation of the intervention programme in Malmö, overall prescribing of antibiotics decreased 28%, and the reduction was even greater among children (52%). In conclusion, the proportion of PNSP isolates in Malmö has remained stable, despite the intervention programme and decreased consumption of antibiotics.
To study the aetiology of bloodstream infections (BSI) in children 0-17 years, the influence of age and underlying co-morbidity on BSI rate, distribution of pathogens and outcome; and to provide data on antimicrobial susceptibility patterns.
A retrospective population-based study. Data on blood cultures were collected at yearly intervals during 1998-2008. Information about risk factors, focal infection and outcome was retrieved from the patient charts.
We identified 1097 BSI. The incidence of BSI was 0.4/1000. The age-specific incidence was 2.3/1000 in neonates (0-28 days old) and 0.2/1000 in the age group 6-17 years. Staphylococcus aureus was the most common pathogen. The number of species causing BSI in previously healthy children was lower compared with children with co-morbidity. Most children requiring intensive care had a serious underlying illness. Antimicrobial resistance was rare and did not influence outcome. The case-fatality rate was 14.4% in neonates, 5.4% in children with co-morbidity and 1.7% in previously healthy children.
Mortality from BSI is low, and a limited spectrum of pathogens is isolated from previously healthy children compared with children with co-morbidity. When choosing empirical therapy for suspected BSI, age and presence of risk factors should be taken into account.
Streptococcus pneumoniae infections belong to the leading worldwide causes of illness and death among young children, people with underlying debilitating medical conditions, and the elderly. Following early documentation of infections due to pneumococcal strains with reduced penicillin susceptibility in Australia in 1967, and of infections due to penicillin-resistant strains in South Africa in 1978, pneumococcal resistance to penicillin and other antibiotics has progressed rapidly and is now a global problem. In Sweden, notification of the occurrence of pneumococci with a minimum inhibitory concentration (MIC) > or = 0.5 mg/L for penicillin G (PcG) has been mandatory for general practitioners (GPs) and clinical microbiological laboratories since 1 January 1996. In 1996, 1,057 cases of infection by such pneumococci were reported by microbiological laboratories, but only 262 cases by GPs. With a view to minimising the impact of pneumococci with reduced penicillin susceptibility in Sweden, the National Board of Health and Welfare set up a working group of experts in November 1994. To reduce the transmission of such bacteria in the community, the working group introduced a control programme which includes the isolation of day-care children under six years of age carrying pneumococci with PcG-MICs > or = 0.5 mg/L. An enquiry among the 25 regional centres for infectious disease control in the country to ascertain compliance in the different counties of Sweden showed the programme to have been adhered to in a majority of counties, although many had chosen alternative measures to deal with the problem.
Pneumococci are a leading cause of bacterial meningitis and bacteraemia, as well as pneumonia, otitis media and sinusitis in childhood. These organisms recently have shown a dramatic increase in antibiotic resistance. Penicillin-resistant pneumococci are of special concern as they are often resistant to other unrelated antibiotics. This is of particular significance to Aboriginal children who have among the highest rates of pneumococcal infection in the world. Laboratories should now test all invasive pneumococcal isolates for penicillin and third generation cephalosporin resistance. Local treatment guidelines are required for pneumococcal infections, especially for meningitis, taking into account the prevalence of resistant strains within the community. At present, penicillin and amoxycillin remain the drugs of choice for pneumococcal infections, with the exception of meningitis where initial empirical therapy must be with a third generation cephalosporin. Judicious antibiotic use, which avoids over-prescribing and unnecessary use of broad-spectrum agents, improved living standards in underprivileged communities and introduction of an effective conjugate vaccine, able to reduce the rates of pneumococcal infection and hopefully colonization, may limit the spread of resistant strains.
In 1875, 7 years prior to the description of the Koch bacillus, Klebs visualized the first Streptococcus pneumoniae in pleural fluid. Since then, this organism has played a decisive role in biomedical science. From a biological point of view, it was extensively involved in the development of passive and active immunization by serotherapy and vaccination respectively. Genetic transformation was also first observed in S. pneumoniae, leading to the discovery of DNA. From a clinical point of view, S. pneumoniae is today still a prime cause of otitis media in children and of pneumonia in all age groups, as well as a predominant cause of meningitis and bacteremia. In adults, bacteremia still has a mortality of over 25%. Although S. pneumoniae remained very sensitive to penicillin for many years, penicillin-resistant strains have emerged and increased dramatically over the last 15 years. During this period the frequency of penicillin-resistant isolates has increased from or = 10%. The increase in penicillin-resistant pneumococci correlates with the intensive use of beta-lactam antibiotics. The mechanism of resistance is not due to bacterial production of penicillinase but to an alteration of the bacterial target of penicillin, the so-called penicillin-binding proteins. Resistance is subdivided into (1) intermediate level resistance (minimal inhibitory concentration [MIC] of penicillin of 0.1-1 mg/l) and (2) high level resistance (MCI > or = 2 mg/l). The clinical significance of intermediate resistance remains poorly defined. On the other hand, highly resistant strains have been responsible for numerous therapeutic failures, especially in cases of meningitis. Antibiotics recommended against penicillin-resistant pneumococci include cefotaxime, ceftriaxone, imipenem and in some instances vancomycin. However, penicillin-resistant pneumococci tend to present cross-resistances to all the antibiotics of the beta-lactam family and could even become resistant to the last resort drugs mentioned above. Thus, the explosion of resistance to penicillin in pneumococci is a ubiquitous phenomenon which must be fought against by (1) avoiding excessive use of antibiotics, (2) the practice of microbiological sampling of infected foci before treatment, (3) the systematic surveillance of resistance profiles of pneumococci against antibiotics and (4) adequate vaccination of populations at risk.
To review the definition and prevalence of antibiotic-resistant Streptococcus pneumoniae, its links with antibiotic prescribing, data on antibiotic prescribing and prescribing appropriateness, and evidence-based treatment guidelines for common respiratory tract syndromes.
Primary studies consist of cross-sectional surveys and case-control studies. Treatment guidelines are based on clinical trials, meta-analyses, and cohort studies. Study designs were appropriate for the specific study questions.
The increasing prevalence of penicillin-resistant S pneumoniae is concurrent with increasing antibiotic prescribing. Individual patients show a twofold to ninefold increase in nasopharyngeal carriage of resistant bacteria or invasion with resistant bacteria (among those who have received antibiotics in the preceding 3 months). Cross-sectional data as well as data from medicaid and drug databases attest to overprescribing of antibiotics for respiratory tract infections. Physician surveys and focus groups blame this on parental pressure for antibiotic prescriptions. However, parents in focus groups and surveys deny they pressure their physicians and indicate their main purpose for office visits is to obtain a diagnosis and to seek reassurance that their children are not seriously ill. Evidence-based guidelines suggest treatment strategies that would reduce antibiotic prescribing.
The few antibiotics that can be used with resistant organisms are expensive and are increasingly being needed. To control the rise of antibiotic resistance, it is important to limit antibiotic overprescribing.
This article addresses antimicrobial resistance and the threat it poses to an individual's health and the health care system. Diseases, such as pneumococcus have gained an overabundance of antimicrobial resistance. In addition, previously unknown diseases are surging and sounding alarm bells worldwide. The history and causes of this surge are examined globally. One such cause is the overuse of antibiotics in long-term care facilities. International strategies that have been implemented by organizations, such as the World Health Organization, to control the spread of infectious diseases, are also reviewed. The prevalence, causes and consequences of antibiotic resistant organisms, are found in long-term care facilities and hospitals specifically in Canada, are reviewed. Recommendations are made.
Invasive disease caused by antibiotic resistant pneumococci is a worldwide problem. All invasive pneumococcal strains in an area of south-west Sweden with 1.7 million inhabitants were collected prospectively during 1998-2001. Minimum inhibitory concentrations (MICs) were determined by E-test and correlated to serotypes and clinical characteristics. Of 827 strains, 744 (90%) were susceptible (S) to all agents tested and 83 (10%) were indeterminate (I) or resistant (R) to at least 1 agent. 22 isolates (2.7%) were I to penicillin (MIC >0.06 to 1.0 mg/l). Numbers and proportions of decreased susceptibility against other agents tested were as follows: erythromycin R: 30 (3.6%), clindamycin R: 6 (0.7%), tetracycline R: 16 (1.9%), moxifloxacin R: 1 (0.1%), cotrimoxazole I: 17 (2%) and R: 31(4%). Non-susceptibility to at least 1 agent was not correlated with age, clinical manifestation, underlying diseases and outcome. The serotype distribution differed between non-susceptible and susceptible strains. The serotypes in the 7-valent pneumococcal conjugate vaccine covered 42% of all infections and 73% of those caused by non-susceptible strains. In conclusion, the impact of antibiotic resistance in invasive pneumococcal disease remains limited in south-west Sweden.
To investigate the serotype distribution and antibiotic susceptibility patterns 204 isolates of Streptococcus pneumoniae obtained from blood or cerebrospinal fluid (CSF) of children or = 2 y of age or older, but was not found among children