Key points
- Some Streptococcus pneumoniae isolates are resistant to one or more antibiotics.
- S. pneumoniae resistance can lead to treatment failures.
- Learn how vaccination helps prevent resistant pneumococcal infections.
Trends
How common antibiotic-resistantA S. pneumoniae is varies throughout the United States.
Today, S. pneumoniae that is non-susceptible to at least one antibiotic causes about 2 in 5 infections. New pneumococcal vaccines will be critical to reduce the remaining burden of antibiotic-resistant S. pneumoniae infections.
CDC's ABCs Bact Facts Interactive Data Dashboard shows the proportion of invasive pneumococcal disease (IPD) resistant to select antibiotics by year.
Threats report
CDC's Antibiotic Resistance Threats in the United States, 2019 identifies antibiotic-resistant S. pneumoniae as a serious threat. The report includes the latest national death and infection estimates that underscore the continued threat of antibiotic resistance.
Vaccine impact
Pneumococcal vaccines provide serotype-specific protection. Pneumococcal conjugate vaccines (PCVs) include protection against serotypes that cause the majority of antibiotic-resistant IPD. As a result, introduction of PCVs caused a significant reduction in resistant IPD in the United States.
The number of antibiotic-resistant IPD cases also decreased greatly following a change in definition of resistance to penicillin in 2008.
PCVs have reduced pneumococcal infections caused by vaccine serotypes, most of which were resistant to antibiotics. IPD cases caused by vaccine serotypes have decreased by 90% in children and 60% in adults.
Before 2000: Seven serotypes caused most antibiotic-resistant S. pneumoniae IPD cases in the United States. They were 6A, 6B, 9V, 14, 19A, 19F, and 23F.
Between 2000 and 2009: Rates of disease caused by these serotypes (except 19A) decreased after the introduction of PCV7. PCV7 included six of the seven (not 19A) serotypes. Rates of overall and antibiotic-resistant IPD cases caused by serotype 19A increased.
Between 2010 and 2019: Rates of IPD caused by serotype 19A greatly decreased due to use of PCV13 (includes 19A). No new serotype causing most antibiotic-resistant IPD emerged in its place in the United States.
2020 to present: The impact PCV15, PCV20, and PCV21 will have on antibiotic-resistant infections due to vaccine-covered pneumococcal serotypes is yet to be determined.
Surveillance
CDC uses U.S. surveillance data to estimate how many cases of IPD (including resistant cases) occur each year.
Outbreaks
State and local health departments have reported outbreaks of antibiotic-resistant S. pneumoniae in long-term care settings and childcare centers.
Risk groups
People with pneumococcal infections who recently used antibiotics are more likely to have a resistant infection than those who haven't.
People who attend or work at childcare centers are at increased risk for infection with antibiotic-resistant S. pneumoniae.
Other risk factors for having a resistant S. pneumoniae infection include hospitalization and immunosuppression.
Costs
Antibiotic-resistant S. pneumoniae is associated with increased costs compared to infections caused by non-resistant S. pneumoniae. This is because of
- More expensive antibiotics needed
- Costs associated with antibiotic drug development
- Surveillance costs to track resistance patterns
- Repeat disease due to treatment failures
- Educational requirements for patients, clinicians, and microbiologists
Challenges and opportunities
Challenges
There are several factors that create challenges for preventing emerging antibiotic resistance of S. pneumoniae, including:
- Unnecessary use of antibiotics
- Nonuniversal adoption of standard methods (CLSI guidelines) to identify and define antibiotic-resistant S. pneumoniae
- Spread of resistant serotypes
- Lack of a vaccine that can protect against all serotypes of S. pneumoniae
Opportunities
Improving appropriate antibiotic use and expanding use of pneumococcal vaccines may slow or reverse emerging antibiotic resistance. Expanded use of recommended vaccines could also prevent more infections.
- Antibiotic-resistance refers to Streptococcus pneumoniae that are intermediate or resistant to the antibiotics tested.