Prevalence of antimicrobial drug-resistant Streptococcus pneumoniae in Washington State

We conducted a survey to assess the prevalence and geographic distribution of antimicrobial drug resistance among invasive isolates of Streptococcus p neumoniae in Washington State. Sequential sterile-site pneumococcal isolate s were submitted from 13 hospital laboratories between 1 October 1995 and 3 0 January 1997. We serotyped 275 isolates from adults and children and dete rmined minimum inhibitory concentrations (MIC) for commonly used antimicrob ial drugs. Data were abstracted from medical records to compare differences in outcome and risk factors for infection. Of the 275 isolates, 73 (26.5%) were nonsusceptible to one or more antimicrobial drugs. Penicillin-nonsusc eptible pneumococci (PNSP, MIC greater than or equal to 0.1 mu g/ml) accoun ted for 42 (15.3%) of the 275 isolates including 4 (1.5%) resistant strains (MIC greater than or equal to 2 mu g/ml). The 42 PNSP included serogroups 6, 9, 14 19, and 23, all of which are represented in the 23-valent pneumoco ccal vaccine. PNSP were also nonsusceptible to trimethoprim/sulfamethoxazol e (92.9%), erythromycin (38.1%), imipenem (28.6%), and ceftriaxone (23.8%). Forty-seven (17.1%) of the 275 isolates were multiple drug-nonsusceptible pneumococci (MDNSP). A significantly greater number of patients less than o r equal to 12 years of age were infected with MDNSP compared with those >12 years. Prior use of antimicrobial drugs and an immunosuppressive disorder were risk factors for infection with PNSP. In summary, pneumococci nonsusce ptible to penicillin and other antimicrobial drugs are prevalent among adul ts with invasive pneumococcal disease in Washington State. A large proporti on of PNSP are resistant to other commonly used antimicrobial drugs. Local antibiotic susceptibility data should be considered when designing empiric treatment regimens.