Increasing Prevalence of Multidrug-ResistantStreptococcus pneumoniaein the United States

作者：Cynthia G. Whitney, Monica M. Farley, James L. Hadler, Lee H. Harrison, Catherine Lexau, Arthur Lawrence Reingold, Lewis B. Lefkowitz, Paul R. Cieslak, Martín S. Cetron, Elizabeth R. Zell, James H. Jorgensen, Anne Schuchat · 发表于：New England Journal of Medicine · 年份：2000 · DOI：10.1056/nejm200012283432603 · 被引用次数：898 · 研究领域：Pneumonia and Respiratory Infections、Antibiotics Pharmacokinetics and Efficacy、Antibiotic Use and Resistance

BACKGROUND: The emergence of drug-resistant strains of bacteria has complicated treatment decisions and may lead to treatment failures. METHODS: We examined data on invasive pneumococcal disease in patients identified from 1995 to 1998 in the Active Bacterial Core Surveillance program of the Centers for Disease Control and Prevention. Pneumococci that had a high level of resistance or had intermediate resistance according to the definitions of the National Committee for Clinical Laboratory Standards were defined as "resistant" for this analysis. RESULTS: During 1998, 4013 cases of invasive Streptococcus pneumoniae disease were reported (23 cases per 100,000 population); isolates were available for 3475 (87 percent). Overall, 24 percent of isolates from 1998 were resistant to penicillin. The proportion of isolates that were resistant to penicillin was highest in Georgia (33 percent) and Tennessee (35 percent), in children under five years of age (32 percent, vs. 21 percent for persons five or more years of age), and in whites (26 percent, vs. 22 percent for blacks). Penicillin-resistant isolates were more likely than susceptible isolates to have a high level of resistance to other antimicrobial agents. Serotypes included in the 7-valent conjugate and 23-valent pneumococcal polysaccharide vaccines accounted for 78 percent and 88 percent of penicillin-resistant strains, respectively. Between 1995 and 1998 (during which period 12,045 isolates were collected), the proportion of is...