Evaluation of innovative surveillance for drug-resistant Streptococcus pneumoniae

To monitor disease incidence and antibiotic resistance, effective, practica l surveillance strategies are needed at the local level for drug-resistant Streptococcus pneumoniae (DRSP). Knox County Tennessee, participates in thr ee forms of DRSP surveillance: an active system sponsored by the Centers fo r Disease Control and Prevention (CDC; Atlanta, Georgia); a novel county-sp onsored system; and conventional state-mandated reporting. Ascertainment of invasive S. pneumoniae infection cases by each system in 1998 was evaluate d, and completeness of reporting, antibiotic resistance patterns, costs, an d other attributes were compared. The county-sponsored system collects pati ent identifiers and drug susceptibility data directly from hospital laborat ories, whereas the CDC-sponsored system performs medical chart abstractions and reference laboratory susceptibility testing. Similar numbers of invasi ve S. pneumoniae cases were detected by the county-sponsored (n = 127) and CDC-sponsored (n = 123) systems; these systems held > 75% of all cases in c ommon, and each system achieved > 85% sensitivity. Conventional reporting c ontained 88% and 76% of the DRSP cases identified by the county- and CDC-sp onsored systems, respectively, but did not capture infections produced by s usceptible isolates. Both the county- and CDC-sponsored systems indicated t hat large proportions of isolates were resistant to penicillin and extended -spectrum cephalosporins. The county-sponsored DRSP surveillance system was inexpensive, simple to execute, and relevant to local needs.