THE PREVALENCE OF DRUG-RESISTANT STREPTOCOCCUS-PNEUMONIAE IN ATLANTA

Background. Streptococcus pneumoniae is a major cause of illness, and the emergence of drug-resistant strains threatens to complicate the ma nagement of pneumococcal infections. We conducted a laboratory-based s urveillance for drug-resistant S. pneumoniae among patients with invas ive pneumococcal infections in Atlanta. Methods. From January through October 1994, pneumococcal isolates from 431 patients with invasive di sease in metropolitan Atlanta were serotyped and tested to determine t heir susceptibility to various antimicrobial agents. Susceptibility to the antimicrobial agents was defined according to guidelines establis hed by the National Committee for Clinical Laboratory Standards. Resul ts. The annual incidence of invasive pneumococcal infection was 30 cas es per 100,000 population, Isolates from 25 percent of the patients we re resistant to penicillin (7 percent were highly resistant), and isol ates from 26 percent were resistant to trimethoprim-sulfamethoxazole ( 7 percent highly resistant). Fifteen percent of the isolates were resi stant to erythromycin, 9 percent to cefotaxime (4 percent were highly resistant), and 25 percent to multiple drugs. Drug-resistant pneumococ ci were found in bath children and adults. Children under six years of age were more likely than older children and adults to have isolates resistant to multiple drugs or cefotaxime, Whites were more likely tha n blacks to have invasive pneumococcal infections caused by drug-resis tant organisms. Among white children younger than six years, 41 percen t of the S. pneumoniae isolates were resistant to penicillin. Conclusi ons. Drug-resistant strains of S. pneumoniae are common among both chi ldren and adults in Atlanta, Although blacks had a higher incidence of invasive pneumococcal infections than whites, whites were more likely to be infected with a drug-resistant isolate. Control of drug-resista nt pneumococci will require more judicious use of antimicrobial agents and wider use of the pneumococcal polysaccharide vaccine.