Penicillin-Nonsusceptible Pneumococcal Bacteremia
Penicillin-Nonsusceptible Pneumococcal Bacteremia
Background. Although the first reports of infection due to penicillin-nonsusceptible Streptococcus pneumoniae in the United States were in children, these strains have circulated widely in recent years, with the prevalence increasing dramatically among the elderly. Regional surveillance of pneumococcal susceptibility profiles may assist clinicians in management decisions, increase awareness of this microbial threat, and target potential areas of intervention.
Methods. As part of ongoing surveillance, we surveyed single-patient pneumococcal blood isolates in our 440-bed Staten Island community teaching hospital from June 1, 1996, through May 31, 1998.
Results. Overall, of 47 single-patient isolates, 16 (35%) were penicillin nonsusceptible. Of 35 isolates from adults, 15 (44%) were nonsusceptible, compared with 1 of 12 (8%) from children. Seven of the nonsusceptible isolates (44%) were from persons ≥65 years old and represented 47% of the isolates from this age group.
Conclusions. Community-acquired penicillin-nonsusceptible pneumococcal bacteremia is not simply a pediatric problem, but also a threat to the elderly.
Recent surveillance data reflect the increasing prevalence of penicillin-nonsusceptible Streptococcus pneumoniae strains in the United States. The Centers for Disease Control and Prevention (CDC) reported that 25% of pneumococcal isolates from 3,237 cases of invasive disease were not susceptible to penicillin during 1997 active surveillance, which included seven US regions with a population of 16 million. In national surveillance from 1993-1994, 14.1% of 740 sterile body site pneumococcal isolates recovered from 12 hospitals in 11 states were penicillin nonsusceptible.
During the first 6 months of 1998, the prevalence rate of penicillin-nonsusceptible invasive S pneumoniae in New York City was 17.7%, up from 16% in 1997 (Marcelle Layton, MD, New York City Department of Health Update). Data from 11 metropolitan New York City hospitals during the first 4 months of 1998 revealed that of 477 consecutive, single-patient pneumococcal isolates, 113 (24%) from all sites were penicillin nonsusceptible (Roberts RB, et al: Molecular epidemiology of penicillin-nonsusceptible Streptococcus pneumoniae from metropolitan New York hospitals. Manuscript in preparation).
In addition to varying regionally, the prevalence of penicillin-nonsusceptible pneumococcal isolates also varies substantially by hospital within a region. To further define prevalence and epidemiology of penicillin nonsusceptible S pneumoniae strains in Staten Island, NY, we recently surveyed pneumococcal blood isolates identified in our 440-bed community teaching hospital located on the north shore of this New York City borough with a population of 400,000.
Background. Although the first reports of infection due to penicillin-nonsusceptible Streptococcus pneumoniae in the United States were in children, these strains have circulated widely in recent years, with the prevalence increasing dramatically among the elderly. Regional surveillance of pneumococcal susceptibility profiles may assist clinicians in management decisions, increase awareness of this microbial threat, and target potential areas of intervention.
Methods. As part of ongoing surveillance, we surveyed single-patient pneumococcal blood isolates in our 440-bed Staten Island community teaching hospital from June 1, 1996, through May 31, 1998.
Results. Overall, of 47 single-patient isolates, 16 (35%) were penicillin nonsusceptible. Of 35 isolates from adults, 15 (44%) were nonsusceptible, compared with 1 of 12 (8%) from children. Seven of the nonsusceptible isolates (44%) were from persons ≥65 years old and represented 47% of the isolates from this age group.
Conclusions. Community-acquired penicillin-nonsusceptible pneumococcal bacteremia is not simply a pediatric problem, but also a threat to the elderly.
Recent surveillance data reflect the increasing prevalence of penicillin-nonsusceptible Streptococcus pneumoniae strains in the United States. The Centers for Disease Control and Prevention (CDC) reported that 25% of pneumococcal isolates from 3,237 cases of invasive disease were not susceptible to penicillin during 1997 active surveillance, which included seven US regions with a population of 16 million. In national surveillance from 1993-1994, 14.1% of 740 sterile body site pneumococcal isolates recovered from 12 hospitals in 11 states were penicillin nonsusceptible.
During the first 6 months of 1998, the prevalence rate of penicillin-nonsusceptible invasive S pneumoniae in New York City was 17.7%, up from 16% in 1997 (Marcelle Layton, MD, New York City Department of Health Update). Data from 11 metropolitan New York City hospitals during the first 4 months of 1998 revealed that of 477 consecutive, single-patient pneumococcal isolates, 113 (24%) from all sites were penicillin nonsusceptible (Roberts RB, et al: Molecular epidemiology of penicillin-nonsusceptible Streptococcus pneumoniae from metropolitan New York hospitals. Manuscript in preparation).
In addition to varying regionally, the prevalence of penicillin-nonsusceptible pneumococcal isolates also varies substantially by hospital within a region. To further define prevalence and epidemiology of penicillin nonsusceptible S pneumoniae strains in Staten Island, NY, we recently surveyed pneumococcal blood isolates identified in our 440-bed community teaching hospital located on the north shore of this New York City borough with a population of 400,000.
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