High prevalence of penicillin-nonsusceptible Streptococcus pneumoniae at aCommunity Hospital in Oklahoma

During 1997, Oklahoma City's Hospital A reported penicillin-nonsusceptible Streptococcus pneumoniae in almost 67% of isolates. To confirm this finding , all Hospital A S. pneumoniae isolates from October 23, 1997, through Febr uary 19, 1998, were tested for antibiotic susceptibility and repeat-tested at two other hospital laboratories. Medical records of Hospital A patients with invasive S. pneumoniae infections during 1994 through 1997 were also r eviewed. These data were compared with 1998 statewide sentinel hospital sur veillance data for invasive S, pneumoniae. Of 48 S, pneumoniae isolates fro m Hospital A during October 23, 1997, through February 19, 1998, 31 (65%) w ere penicillin-nonsusceptible S. pneumoniae, and 23 (48%) were highly penic illin resistant. Similar prevalences were confirmed at the other hospital l aboratories; however, significant interlaboratory differences were noted in the determination of third-generation cephalosporin susceptibility. During 1994 through 1997, a trend toward increasing penicillin nonsusceptibility (p <0.05) was noted among S. pneumoniae isolates from nursing home patients . During 1998, 85 (30%) of 282 invasive isolates reported to the state surv eillance system were penicillin-nonsusceptible S. pneumoniae; 33 (12%) were highly resistant. The increase in resistance observed is notable; the inte rlaboratory discrepancies are unexplained. To respond, a vaccination progra m was implemented at Hospital A, and vaccination efforts were initiated at nursing homes.