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Isolation of Multiply Antibiotic-Resistant Pneumococci -- New York

From March 1983 to November 1984, nine serotype 19A Streptococcus pneumoniae strains were isolated from patients enrolled at the Brooklyn, New York, Veterans Administration Medical Center (VAMC) in a Veterans Administration Cooperative Studies Program trial of pneumococcal vaccine efficacy (Table 2). Six of these organisms were recovered from single throat cultures obtained during routine follow-up visits. Because these patients had no symptoms and were given no treatment, and subsequent cultures did not yield pneumococci, they were thought to have been asymptomatically colonized. The remaining three isolates were from diagnostic sputum specimens. Two of the patients had bronchitis, and one had pneumonia. Each of these three patients had been previously treated with antibiotics. However, the intervals between prior treatment and 19A pneumococcal isolates were 2, 24, and 19 months, respectively. Two of the three patients were treated with erythromycin, and one, with trimethoprim/sulfamethoxazole. All three responded to antibiotic therapy.

The serotype 19A isolates were found to be resistant to penicillin G, ampicillin, oxacillin, mezlocillin, cefazolin, ceftriaxone, tetracycline, chloramphenicol, and trimethoprim/sulfamethoxazole. They were sensitive to erythromycin, clindamycin, and rifampin.

The nine patients had limited contact with each other in the Cooperative Studies Clinic, and they were not followed by any common physicians outside the study. Throat cultures of Cooperative Studies personnel failed to yield pneumococci. However, the similarity of their susceptibility patterns suggests that these 19A pneumococci were serially passed among the patients or that these subjects were colonized or infected from a common focus. All the patients were ambulatory at the time these isolates were obtained. Thus, a focus of antibiotic-resistant serotype 19A pneumococci may be present in Brooklyn, New York. Reported by Veterans Administration Cooperative Study Group on Pneumococcal Vaccine Efficacy: MS Simberkoff, MD, A Richmond, MD, New York Veterans Administration Medical Center, M Lukaszewski, AP Cross, A Baltch, MD, Albany Veterans Administration Medical Center, J Nadler, MD, Brooklyn Veterans Administration Medical Center, New York; M Al-Ibrahim, MD, Baltimore Veterans Administration Medical Center, Maryland; PJ Geiseler, MD, Chicago (WS) Veterans Administration Medical Center, Illinois; Antimicrobics and Infection Mechanisms Br, Hospital Infections Program, Meningitis and Special Pathogens Br, Div of Bacterial Diseases, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: Pneumococci fully resistant to penicillin (minimal inhibitory concentration (MIC)

1 ug/ml) have been rarely reported in the United States. A 5-year-old female has been reported with penicillin-resistant type 14 pneumococcal bacteremia (1). Six other cases of pneumococcal disease in this country, apparently caused by fully resistant pneumococci, have been confirmed by antimicrobial susceptibility testing at CDC (Table 3). Isolates 1-5 were sent to CDC for confirmatory testing; isolate 6 was obtained from CDC's national laboratory surveillance system. This system involves serotyping all pneumococcal isolates--which are submitted by selected hospitals across the United States--from normally sterile sites so that serotype distribution and antimicrobial resistance patterns can be monitored. From 1979 through 1984, only one isolate of the 3,400 isolates tested was fully resistant to penicillin; 3.7% of the isolates were partially resistant to penicillin (MIC 0.1-1 ug/ml). Outside the United States, penicillin-resistant pneumococci have been a more serious problem (2-4). In South Africa, many of these infections have been caused by serotype 19A pneumococci resistant to multiple antibiotics.

Antimicrobial susceptibility testing of all invasive pneumococcal isolates is recommended (5). Use of an oxacillin disc is a simple and effective method for screening penicillin antimicrobial susceptibility of pneumococci (6).

References

  1. Cates KL, Gerrard JM, Geibink GS, et al. A penicillin-resistant pneumococcus. J Pediatr 1978;93:624-6.

  2. Hansman D, Glasgow H, Sturt J, et al. Increased resistance to penicillin of pneumococci isolated from man. N Engl J Med 1971;284:175-7.

  3. Appelbaum PC, Bhamjee A, Scragg JN, Hallett AF, Bowen AJ, Cooper RC. Streptococcus pneumoniae resistant to penicillin and chloramphenicol. Lancet 1977;ii:995-7.

  4. Jacobs MR, Koornhof HJ, Robins-Browne RM, et al. Emergence of multiply resistant pneumococci. N Engl J Med 1978;299:735-40.

  5. Facklam R. Streptococci and aerococci. In: Lennette EH, Balows A, Hausler WJ, Truant JP, eds. Manual of clinical microbiology. Third edition. Washington, D.C.: American Society for Microbiology, 1980;85-110.

  6. Thornsberry C, Swenson JM. Antimicrobial susceptibility testing of Streptococcus pneumoniae. Lab Med 1980;11:83-6.

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