Drug-Resistant Streptococcus Pneumoniae (DRSP) Disease

Clinical Features

Pneumonia, bacteremia, otitis media, meningitis, sinusitis, arthritis.

Etiologic Agent

Streptococcus pneumoniae.
While 90 serotypes exist, four serotypes (6B, 14, 19, 23F) account for most disease and drug-resistant Streptococcus pneumoniae (DRSP) strains.

Incidence

Increasing in United States since 1987.
Drug-resistant pneumococci cause at least 15000 cases of meningitis, 7,000 cases of sepsis/bacteremia, 150,000 cases of pneumonia, and over 1,000,000 cases of otitis media annually. Between 3-to-35% of pneumococcal illness is due to drug-resistant strains and this proportion shows wide geographic and temporal variation.

Sequelae

Deafness and other neurologic sequelae (after meningitis).
Hearing impairment, developmental delay in children with recurrent otitis Death.

Costs

Costs of therapy, prolonged hospitalization, recurrent disease, surveillance, education, and development of new drugs are all expected to increase substantially

Transmission

Person-to-person transmission.

Risk Groups

The elderly, children greater than or equal to 2 years of age, blacks, American Indians/HIV-infected persons are at increased for serious pneumococcal infections, as are persons with underlying medical conditions interfering with immune responses.
DRSP infections are likely to increase when there is excessive use of antimicrobial drugs.

Surveillance

NCID Pneumococcal Sentinel Surveillance System; Active CDC-sponsored population-based surveillance is ongoing in 9 U.S. communities; DRSP nationwide lab-based surveillance will soon be added by CSTE to the notifiable disease list requiring mandatory reporting to state health departments and CDC.

Trends

Recent emergence of multidrug resistant strains including strains resistant to antimicrobial drugs commonly used for respiratory infections.
Appearance of an increasing number DRSP serotypes.
Outbreaks in nursing homes and among HIV-infected persons in nosocomial and correctional facilities, in rural and urban metropolitan areas, among pediatric and adult populations.

Challenges

Laboratory testing for drug-resistant pneumococci not routinely done.
Methods for identifying and defining drug-resistant isolates not fully standardized; NCCLS guidelines are available to assist with standardization.
Systematic, regional surveillance not yet done but is urgently needed.
Treatment guidelines are being developed.
Irrational use of antimicrobial drugs.

Opportunities

Education of clinicians about the need to evaluate pneumococcal strains for resistance and about the importance of rationalizing use of therapeutic and prophylactic antimicrobial drugs, particularly in institutional settings.
New pneumococcal conjugate vaccines for use in children to prevent spread.
Campaign to promote existing 23-valent pneumococcal vaccine to persons at increased risk for pneumoccocal disease according to ACIP recommendations.
Widen surveillance for pneumococcal infections; add DRSP to reportable disease list.

Research Priorities

Develop and evaluate improved pneumococcal vaccines.
Develop improved diagnostic tests for pneumococcal disease.
Expand nationwide surveillance for DRSP infections.
Evaluate use of nasopharyngeal isolates as an inexpensive means to expand surveillance.
Initiate nationwide educational efforts to promote rational antibiotic use.

April 1996
Courtesy of the Centers for Disease Control and Prevention