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.
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
Cates KL, Gerrard JM, Geibink GS, et al. A
penicillin-resistant
pneumococcus. J Pediatr 1978;93:624-6.
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.
Appelbaum PC, Bhamjee A, Scragg JN, Hallett AF, Bowen AJ,
Cooper
RC. Streptococcus pneumoniae resistant to penicillin and
chloramphenicol. Lancet 1977;ii:995-7.
Jacobs MR, Koornhof HJ, Robins-Browne RM, et al. Emergence of
multiply resistant pneumococci. N Engl J Med 1978;299:735-40.
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.
Thornsberry C, Swenson JM. Antimicrobial susceptibility
testing
of Streptococcus pneumoniae. Lab Med 1980;11:83-6.
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