Streptococcus pneumoniae:: Epidemiology and patterns of resistance

被引:82
作者
Jacobs, MR
机构
[1] Univ Hosp Cleveland, Div Clin Microbiol, Cleveland, OH 44106 USA
[2] Case Western Reserve Univ, Dept Pathol, Cleveland, OH 44106 USA
关键词
D O I
10.1016/j.amjmed.2004.07.003
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Streptococcus pneumoniae is a leading cause of bacterial pneumonia, meningitis, otitis media, and sinusitis; it results in significant morbidity and mortality in patients with pneumonia and meningitis. The pneumococcus is a common colonizing bacterium in the respiratory tract; it is especially common in the respiratory tracts of children, where it is frequently exposed to antimicrobial agents. This exposure can lead to resistance. Penicillin nonsusceptibility is found in nearly 40% of strains causing disease in adults, although often these cases are treatable with appropriate dosing regimens of many oral and parenteral beta-lactam agents. In the United States resistance to macrolides is widespread-averaging approximately 28% - but geographically variable, ranging from 23% in the northwest to 30% in the northeast. Resistance to tetracyclines and trimethoprim-sulfamethoxazole are reported in approximately 20% and 35% of isolates, respectively, and resistance to multiple classes of agents is increasingly common. Amoxicillin, amoxicillin-clavulanate, respiratory fluoroquinolones, and clindamycin are currently the most effective agents for treatment of respiratory tract infections caused by S pneumoniae, with > 90% of isolates in the United States being susceptible. Vancomycin is the only agent against which resistance has not emerged. Patient groups that are at increased risk for developing resistant pneumococcal infections have been identified and include patients with malignancies, human immunodeficiency virus infection, and sickle-cell disease. Judicious use of antimicrobials is the key to preventing the emergence of further resistance, particularly as few new classes of agents are likely to become available for clinical use in the short term. (C) 2004 by Elsevier Inc.
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页码:3 / 15
页数:13
相关论文
共 73 条
[1]   Pneumococcal macrolide resistance - myth or reality? [J].
Amsden, GW .
JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY, 1999, 44 (01) :1-6
[2]   COMMUNITY-ACQUIRED PNEUMONIA [J].
BARTLETT, JG ;
MUNDY, LM .
NEW ENGLAND JOURNAL OF MEDICINE, 1995, 333 (24) :1618-1624
[3]   Antimicrobial resistance trends in community-acquired respiratory tract pathogens in the Western Pacific Region and South Africa: report from the SENTRY antimicrobial surveillance program, (1998-1999) including an in vitro evaluation of BMS284756 [J].
Bell, JM ;
Turnidge, JD ;
Jones, RN .
INTERNATIONAL JOURNAL OF ANTIMICROBIAL AGENTS, 2002, 19 (02) :125-132
[4]   The in vivo-in vitro paradox in pneumococcal respiratory tract infections [J].
Bishai, W .
JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY, 2002, 49 (03) :433-436
[5]   Tetracycline antibiotics: Mode of action, applications, molecular biology, and epidemiology of bacterial resistance [J].
Chopra, I ;
Roberts, M .
MICROBIOLOGY AND MOLECULAR BIOLOGY REVIEWS, 2001, 65 (02) :232-+
[6]   Pneumococcal nasopharyngeal colonization in young South Indian infants [J].
Coles, CL ;
Kanungo, R ;
Rahmathullah, L ;
Thulasiraj, RD ;
Katz, J ;
Santosham, M ;
Tielsch, JM .
PEDIATRIC INFECTIOUS DISEASE JOURNAL, 2001, 20 (03) :289-295
[7]   Pharmacokinetic/pharmacodynamic parameters: Rationale for antibacterial dosing of mice and men [J].
Craig, WA .
CLINICAL INFECTIOUS DISEASES, 1998, 26 (01) :1-10
[8]   Bacteriologic efficacies of oral azithromycin and oral cefaclor in treatment of acute otitis media in infants and young children [J].
Dagan, R ;
Leibovitz, E ;
Fliss, DM ;
Leiberman, A ;
Jacobs, MR ;
Craig, W ;
Yagupsky, P .
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, 2000, 44 (01) :43-50
[9]   Bacteriologic and clinical efficacy of amoxicillin/clavulanate vs. azithromycin in acute otitis media [J].
Dagan, R ;
Johnson, CE ;
McLinn, S ;
Abughali, N ;
Feris, J ;
Leibovitz, E ;
Burch, DJ ;
Jacobs, MR .
PEDIATRIC INFECTIOUS DISEASE JOURNAL, 2000, 19 (02) :95-104
[10]   Bacteriologic response to oral cephalosporins: Are established susceptibility breakpoints appropriate in the case of acute otitis media? [J].
Dagan, R ;
Abramson, O ;
Leibovitz, E ;
Greenberg, D ;
Lang, R ;
Goshen, S ;
Yagupsky, P ;
Leiberman, A ;
Fliss, DM .
JOURNAL OF INFECTIOUS DISEASES, 1997, 176 (05) :1253-1259