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August 1992, Vol 146, No. 8 >
Article | August 1992

The Escalating Problem of Antimicrobial Resistance in Streptococcus pneumoniae FREE

P. JOAN CHESNEY, MD
Am J Dis Child. 1992;146(8):912-916. doi:10.1001/archpedi.1992.02160200034022.
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The use of DNA from killed organisms to transform colonies of Streptococcus pneumoniae from rough to smooth and from penicillin-susceptible to penicillin-resistant organisms by Oswald Avery, Colin MacLeod, Maclyn McCarty, and Rollin Hotchkiss in the 1940s established DNA as the molecule responsible for the transfer of genetic information.1 The same ease and indiscriminate acceptance of foreign DNA by pneumococcal species in vivo appears to be an important mechanism whereby an increasing number of strains of pneumococci isolated from infected and colonized individuals have become resistant to penicillin and other antimicrobials, including erythromycin, trimethoprim-sulfamethoxazole (TMP-SMX), and chloramphenicol. What is the extent and significance of this problem for pediatricians for whom S pneumoniae species are among the most common bacterial pathogens of the middle ear, paranasal sinuses, lower respiratory tract, and bloodstream in children younger than 24 months without an obvious focus of infection? As well, S

REFERENCES

1 +
Freifeldu D. Molecular Biology . Portola, Calif: Jones & Bartlett Publishers Inc; 1987;:210-212.
2 +
Breiman RF, Spika JS, Navarro VJ, Darden PM, Darby CP.  Pneumococcal bacteremia in Charleston County, South Carolina: a decade later . Arch Intern Med . 1990;;150:1401-1405.
3 +
Kennedy WA, Hoyt MJ, McCracken GH.  The role of corticosteroid therapy in children with pneumococcal meningitis . AJDC . 1991;;145: 1374-1378.
4 +
Ward J.  Antibiotic-resistant Streptococcus pneumoniae: clinical and epidemiologic aspects . Rev Infect Dis . 1981;;3:254-266.
5 +
Gray BM, Converse GM III, Dillon HC Jr.  Epidemiologic studies of Streptococcus pneumoniae in infants: acquisition, carriage, and infection during the first 24 months of life . J Infect Dis . 1980;;142:923-933.
6 +
Gray BM, Converse GM III, Dillion HC Jr.  Serotypes of Streptococcus pneumoniae causing disease . J Infect Dis . 1979;;140:979-983.
7 +
Anderson B, Beachey EH, Tomasz A, Tuomanen E, Svanborg-Eden C, Eden C.  A sandwich adhesion on Streptococcus pneumoniae attaching to human oropharyngeal epithelial cells in vitro . Microb Pathog . 1988;;4:267-278.
8 +
Gray BM, Converse GM III, Huhta N, et al.  Epidemiologic studies of Streptococcus pneumoniae in infants: antibody response to nasopharyngeal carriage of types 3,19 and 23 . J Infect Dis . 1981;;144:312-318.
9 +
Douglas RM, Paton JC, Duncan SJ, Hansman DJ.  Antibody response to pneumococcal vaccination in children younger than five years of age . J Infect Dis . 1983;;148:131-137.
10 +
Jacobs MR, Koornhof HJ, Robins-Browne RM.  Emergence of multiply resistant pneumococci . N Engl J Med . 1978;;299:735-740.
11 +
Klugman KP.  Pneumococcal resistance to antibiotics . Clin Microbiol Rev . 1990;;3:171-196.
12 +
Friedland IR, Klugman KP.  Antibiotic-resistant pneumococcal disease in South African children . AJDC . 1992;;146:920-923.
13 +
Berkowitz FE.  Bacteremia in hospitalized black South African children: a one-year study emphasizing nosocomial bacteremia and bacteremia in severely malnourished children . AJDC . 1984;;138:551-556.
14 +
Oppenheim B, Korrnhof HJ, Austrian R.  Antibiotic resistant pneumococcal disease in children at Baragwanath Hospital , Johannesburg. Pediatr Infect Dis 1986;;5:520-524.
15 +
Marton A, Gulyas M, Munoz R, Tomasz A.  Extremely high incidence of antibiotic resistance in clinical isolates of Streptococcus pneumoniae in Hungary . J Infect Dis . 1991;;163:542-548.
16 +
Latorre C, Juncosa T, Sanfeliu I.  Antibiotic resistance and serotypes of 100 Streptococcus pneumoniae isolated in a children's hospital in Barcelona, Spain . Antimicrob Agents Chemother . 1985;;28:357-359.
17 +
Mastro TD, Ghafoor A, Nomani NK.  Antimicrobial resistance of pneumococci in children with acute lower respiratory tract infection in Pakistan . Lancet . 1991;;337:156-159.
18 +
Schwartz RH, Khan WN.  Penicillin and trimethoprim-sulfamethoxazole—resistant pneumococci isolated from blood cultures of three infants in metropolitan Washington, DC: a harbinger of serious future problems? Pediatr Infect Dis J . 1991;;10:782-783.
19 +
Ford KL, Mason EO, Kaplan SL, Lamberth LB, Tillman J.  Factors associated with middle ear isolates of Streptococcus pneumoniae resistant to penicillin in a children's hospital . J Pediatr . 1991;;119:941-944.
20 +
Jackson MA, Shelton S, Nelson JD, McCracken GH.  Relatively penicillin-resistant pneumococcal infections in pediatric patients . Pediatr Infect Dis . 1984;;3:129-184.
21 +
Tinkelman DG, Silk HJ.  Clinical and bacteriologic features of chronic sinusitis in children . AJDC . 1989;;143:938-941.
22 +
Spika JS, Facklam RR, Plikaytis BD, Oxtoby MJ, Pneumococcal Surveillance Working Group.  Antimicrobial resistance of Streptococcus pneumoniae in the United States: 1979-1987 . J Infect Dis . 1991;;163:1273-1278.
23 +
Henderson FW, Gilligan PH, Wait K, Goff DA.  Nasopharyngeal carriage of antibiotic resistant pneumococci by children in group day care . J Infect Dis . 1988;;157:256-263.
24 +
Rauch AM, O'Ryan M, Van R, Pickering LK.  Invasive disease due to multiply resistant Streptococcus pneumoniae in a Houston, Tex, day-care center . AJDC . 1990;;144:923-927.
25 +
Radetsky MS, Istre GR, Johansen TL, et al.  Multiply resistant pneumococcus causing meningitis: its epidemiology within a daycare center . Lancet . 1981;;2:771-773.
26 +
Tomasz A.  Penicillin-binding proteins and the antibacterial effectiveness of β-lactam antibiotics . Rev Infect Dis . 1986;;8( (suppl 3) ):S260-S278.
27 +
Dowson CG, Hutchison A, Brannigan JA, et al.  Horizontal transfer of penicillin-binding protein genes in penicillin-resistant clinical isolates of Streptococcus pneumoniae . Proc Natl Acad Sci U S A . 1989;;86:8842-8846.
28 +
Dowson CG, Hutchison A, Woodford N, et al.  Penicillin-resistant viridans streptococci have obtained altered penicillin-binding protein genes from penicillin-resistant strains of Streptococcus pneumoniae . Proc Natl Acad Sci U S A . 1990;;87:5858-5862.
29 +
Munoz R, Coffey TJ, Daniels M.  Intercontinental spread of a multiresistant clone of serotype 23F Streptococcus pneumoniae . J Infect Dis . 1991;;164:302-306.
30 +
Severin A, Cottagnoud P, Tomasz A. Penicillin resistant pneumococcal isolates belonging to distinct PBP families have unique and different cell wall stem peptide composition. In: Abstracts of the 31st Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC); September 29-October 3, 1991; Chicago, Ill. Abstract 1431.
31 +
Bradley JS, Connor JD.  Ceftriaxone failure in meningitis caused by Streptococcus pneumoniae with reduced susceptibility to beta lactam antibiotics . Pediatr Infect Dis J . 1991;;10:871-873.
32 +
Sloas MM, Barrett FF, Chesney PJ, et al. Cephalosporin treatment failure in penicillin and cephalosporin resistant Streptococcus pneumoniae meningitis. Pediatr Infect Dis. In press.
33 +
Figueiredo AM, Connor JD, Tomasz A. Evidence for a unique mechanism of beta lactam antibiotic resistance in a ceftriaxone-resistant clinical isolate of Streptococcus pneumoniae. In: Abstracts of the 31st Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC); September 29-October 3, 1991; Chicago, Ill. Abstract 1430.
34 +
Shoemaker NB, Smith MD, Guild WR.  Organization and transfer of heterologous chloramphenicol and tetracycline resistance genes in pneumococcus . J Bacteriol . 1979;;139:432-441.
35 +
Cooksey RC, Swenson JM, Clark NC, Thornsberry C.  DNA hybridization studies of a nucleotide sequence homologous to transposon Tn 1545 in the "Minnesota" strain of multiresistant Streptococcus pneumoniae isolated in 1977 . Diagn Microbiol Infect Dis . 1989;;12:13-16.
36 +
Hieber JP, Nelson JD.  A pharmacologic evaluation of penicillin in children with purulent meningitis . N Engl J Med . 1977;;297:410-413.
37 +
McCracken GH, Sakata Y.  Antimicrobial therapy of experimental meningitis caused by Streptococcus pneumoniae strains with different resceptibilities to penicillin . Antimicrob Agents Chemother . 1985;;27:141-145.
38 +
Viladrich PF, Gudiol F, Linares J, et al.  Evaluation of vancomycin for therapy in adult pneumococcal meningitis . Antimicrob Agents Chemother . 1991;;35:2467-2472.
39 +
Friedland IR, Klugman KP.  Failure of chloramphenicol therapy in penicillin resistant pneumococcal meningitis . Lancet . 1992;;1:405-408.
40 +
Asensi F, Perez-Tamarit D, Otero MS, et al.  Imipenem-cilastatin therapy in a child with meningitis caused by a multiply resistant pneumococcus . Pediatr Infect Dis J . 1989;;8:895.
41 +
Wong VK, Wright HT, Ross LA, Mason WH, Inderlied CB, Sikkim K.  Imipenem/cilastatin treatment of bacterial meningitis in children . Pediatr Infect Dis J . 1991;;10:122-125.
42 +
Friedland IR, Istre GR.  Management of penicillin-resistant pneumococcal infections . Pediatr Infect Dis J . 1992;;11:433-435.
43 +
Kennedy DJ, Belshe RB, Anderson EL. Safety and immunogenicity of type 6B pneumococcal meningococcal protein conjugate vaccine (6B-OMPC) in children and infants. In: Abstracts of the 31st Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC); September 29-October 3, 1991; Chicago, Ill. Abstract 59.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

References

1 +
Freifeldu D. Molecular Biology . Portola, Calif: Jones & Bartlett Publishers Inc; 1987;:210-212.
2 +
Breiman RF, Spika JS, Navarro VJ, Darden PM, Darby CP.  Pneumococcal bacteremia in Charleston County, South Carolina: a decade later . Arch Intern Med . 1990;;150:1401-1405.
3 +
Kennedy WA, Hoyt MJ, McCracken GH.  The role of corticosteroid therapy in children with pneumococcal meningitis . AJDC . 1991;;145: 1374-1378.
4 +
Ward J.  Antibiotic-resistant Streptococcus pneumoniae: clinical and epidemiologic aspects . Rev Infect Dis . 1981;;3:254-266.
5 +
Gray BM, Converse GM III, Dillon HC Jr.  Epidemiologic studies of Streptococcus pneumoniae in infants: acquisition, carriage, and infection during the first 24 months of life . J Infect Dis . 1980;;142:923-933.
6 +
Gray BM, Converse GM III, Dillion HC Jr.  Serotypes of Streptococcus pneumoniae causing disease . J Infect Dis . 1979;;140:979-983.
7 +
Anderson B, Beachey EH, Tomasz A, Tuomanen E, Svanborg-Eden C, Eden C.  A sandwich adhesion on Streptococcus pneumoniae attaching to human oropharyngeal epithelial cells in vitro . Microb Pathog . 1988;;4:267-278.
8 +
Gray BM, Converse GM III, Huhta N, et al.  Epidemiologic studies of Streptococcus pneumoniae in infants: antibody response to nasopharyngeal carriage of types 3,19 and 23 . J Infect Dis . 1981;;144:312-318.
9 +
Douglas RM, Paton JC, Duncan SJ, Hansman DJ.  Antibody response to pneumococcal vaccination in children younger than five years of age . J Infect Dis . 1983;;148:131-137.
10 +
Jacobs MR, Koornhof HJ, Robins-Browne RM.  Emergence of multiply resistant pneumococci . N Engl J Med . 1978;;299:735-740.
11 +
Klugman KP.  Pneumococcal resistance to antibiotics . Clin Microbiol Rev . 1990;;3:171-196.
12 +
Friedland IR, Klugman KP.  Antibiotic-resistant pneumococcal disease in South African children . AJDC . 1992;;146:920-923.
13 +
Berkowitz FE.  Bacteremia in hospitalized black South African children: a one-year study emphasizing nosocomial bacteremia and bacteremia in severely malnourished children . AJDC . 1984;;138:551-556.
14 +
Oppenheim B, Korrnhof HJ, Austrian R.  Antibiotic resistant pneumococcal disease in children at Baragwanath Hospital , Johannesburg. Pediatr Infect Dis 1986;;5:520-524.
15 +
Marton A, Gulyas M, Munoz R, Tomasz A.  Extremely high incidence of antibiotic resistance in clinical isolates of Streptococcus pneumoniae in Hungary . J Infect Dis . 1991;;163:542-548.
16 +
Latorre C, Juncosa T, Sanfeliu I.  Antibiotic resistance and serotypes of 100 Streptococcus pneumoniae isolated in a children's hospital in Barcelona, Spain . Antimicrob Agents Chemother . 1985;;28:357-359.
17 +
Mastro TD, Ghafoor A, Nomani NK.  Antimicrobial resistance of pneumococci in children with acute lower respiratory tract infection in Pakistan . Lancet . 1991;;337:156-159.
18 +
Schwartz RH, Khan WN.  Penicillin and trimethoprim-sulfamethoxazole—resistant pneumococci isolated from blood cultures of three infants in metropolitan Washington, DC: a harbinger of serious future problems? Pediatr Infect Dis J . 1991;;10:782-783.
19 +
Ford KL, Mason EO, Kaplan SL, Lamberth LB, Tillman J.  Factors associated with middle ear isolates of Streptococcus pneumoniae resistant to penicillin in a children's hospital . J Pediatr . 1991;;119:941-944.
20 +
Jackson MA, Shelton S, Nelson JD, McCracken GH.  Relatively penicillin-resistant pneumococcal infections in pediatric patients . Pediatr Infect Dis . 1984;;3:129-184.
21 +
Tinkelman DG, Silk HJ.  Clinical and bacteriologic features of chronic sinusitis in children . AJDC . 1989;;143:938-941.
22 +
Spika JS, Facklam RR, Plikaytis BD, Oxtoby MJ, Pneumococcal Surveillance Working Group.  Antimicrobial resistance of Streptococcus pneumoniae in the United States: 1979-1987 . J Infect Dis . 1991;;163:1273-1278.
23 +
Henderson FW, Gilligan PH, Wait K, Goff DA.  Nasopharyngeal carriage of antibiotic resistant pneumococci by children in group day care . J Infect Dis . 1988;;157:256-263.
24 +
Rauch AM, O'Ryan M, Van R, Pickering LK.  Invasive disease due to multiply resistant Streptococcus pneumoniae in a Houston, Tex, day-care center . AJDC . 1990;;144:923-927.
25 +
Radetsky MS, Istre GR, Johansen TL, et al.  Multiply resistant pneumococcus causing meningitis: its epidemiology within a daycare center . Lancet . 1981;;2:771-773.
26 +
Tomasz A.  Penicillin-binding proteins and the antibacterial effectiveness of β-lactam antibiotics . Rev Infect Dis . 1986;;8( (suppl 3) ):S260-S278.
27 +
Dowson CG, Hutchison A, Brannigan JA, et al.  Horizontal transfer of penicillin-binding protein genes in penicillin-resistant clinical isolates of Streptococcus pneumoniae . Proc Natl Acad Sci U S A . 1989;;86:8842-8846.
28 +
Dowson CG, Hutchison A, Woodford N, et al.  Penicillin-resistant viridans streptococci have obtained altered penicillin-binding protein genes from penicillin-resistant strains of Streptococcus pneumoniae . Proc Natl Acad Sci U S A . 1990;;87:5858-5862.
29 +
Munoz R, Coffey TJ, Daniels M.  Intercontinental spread of a multiresistant clone of serotype 23F Streptococcus pneumoniae . J Infect Dis . 1991;;164:302-306.
30 +
Severin A, Cottagnoud P, Tomasz A. Penicillin resistant pneumococcal isolates belonging to distinct PBP families have unique and different cell wall stem peptide composition. In: Abstracts of the 31st Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC); September 29-October 3, 1991; Chicago, Ill. Abstract 1431.
31 +
Bradley JS, Connor JD.  Ceftriaxone failure in meningitis caused by Streptococcus pneumoniae with reduced susceptibility to beta lactam antibiotics . Pediatr Infect Dis J . 1991;;10:871-873.
32 +
Sloas MM, Barrett FF, Chesney PJ, et al. Cephalosporin treatment failure in penicillin and cephalosporin resistant Streptococcus pneumoniae meningitis. Pediatr Infect Dis. In press.
33 +
Figueiredo AM, Connor JD, Tomasz A. Evidence for a unique mechanism of beta lactam antibiotic resistance in a ceftriaxone-resistant clinical isolate of Streptococcus pneumoniae. In: Abstracts of the 31st Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC); September 29-October 3, 1991; Chicago, Ill. Abstract 1430.
34 +
Shoemaker NB, Smith MD, Guild WR.  Organization and transfer of heterologous chloramphenicol and tetracycline resistance genes in pneumococcus . J Bacteriol . 1979;;139:432-441.
35 +
Cooksey RC, Swenson JM, Clark NC, Thornsberry C.  DNA hybridization studies of a nucleotide sequence homologous to transposon Tn 1545 in the "Minnesota" strain of multiresistant Streptococcus pneumoniae isolated in 1977 . Diagn Microbiol Infect Dis . 1989;;12:13-16.
36 +
Hieber JP, Nelson JD.  A pharmacologic evaluation of penicillin in children with purulent meningitis . N Engl J Med . 1977;;297:410-413.
37 +
McCracken GH, Sakata Y.  Antimicrobial therapy of experimental meningitis caused by Streptococcus pneumoniae strains with different resceptibilities to penicillin . Antimicrob Agents Chemother . 1985;;27:141-145.
38 +
Viladrich PF, Gudiol F, Linares J, et al.  Evaluation of vancomycin for therapy in adult pneumococcal meningitis . Antimicrob Agents Chemother . 1991;;35:2467-2472.
39 +
Friedland IR, Klugman KP.  Failure of chloramphenicol therapy in penicillin resistant pneumococcal meningitis . Lancet . 1992;;1:405-408.
40 +
Asensi F, Perez-Tamarit D, Otero MS, et al.  Imipenem-cilastatin therapy in a child with meningitis caused by a multiply resistant pneumococcus . Pediatr Infect Dis J . 1989;;8:895.
41 +
Wong VK, Wright HT, Ross LA, Mason WH, Inderlied CB, Sikkim K.  Imipenem/cilastatin treatment of bacterial meningitis in children . Pediatr Infect Dis J . 1991;;10:122-125.
42 +
Friedland IR, Istre GR.  Management of penicillin-resistant pneumococcal infections . Pediatr Infect Dis J . 1992;;11:433-435.
43 +
Kennedy DJ, Belshe RB, Anderson EL. Safety and immunogenicity of type 6B pneumococcal meningococcal protein conjugate vaccine (6B-OMPC) in children and infants. In: Abstracts of the 31st Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC); September 29-October 3, 1991; Chicago, Ill. Abstract 59.

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