title: Invasive pneumococcal disease in central Oklahoma: emergence of high-level penicillin resistance and multiple antibiotic resistance. Pneumococcus Study Group.
abstract: Relatively penicillin-resistant pneumococci have caused 10% of invasive pneumococcal disease in central Oklahoma during the last decade, but almost no high-level penicillin or other antibiotic resistance has been described. This study evaluated antibiotic susceptibility and serotype distribution in invasive pneumococcal disease in the Oklahoma City metropolitan area (1990 population 848,000). A total of 144 cases of invasive infection was collected in 1 year (17 with meningitis, 120 with other bacteremic infections, and 7 with other invasive infections), for a rate of 16.9/100,000 (95% confidence interval [CI], 14.0-19.5). For the population aged > or = 60, invasive pneumococcal disease rates were higher among nursing home residents (352/100,000) than among nonresidents (25.6/100,000; relative risk, 13.7; 95% CI, 7.7-24.7). Antibiotic-resistant organisms caused 19.4% of the cases: relative penicillin resistance, 7.6%; high-level penicillin resistance, 1.4% (2 cases), and 11% resistance to erythromycin, trimethoprim-sulfamethoxazole, or both, with 5% sharing both resistances plus a MIC of penicillin of 0.06 microgram/mL.
authors.affiliation: Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City.
authors.forename: L A
authors.initials: LA
authors.lastname: Haglund
authors.forename: G R
authors.initials: GR
authors.lastname: Istre
authors.forename: D A
authors.initials: DA
authors.lastname: Pickett
authors.forename: D F
authors.initials: DF
authors.lastname: Welch
authors.forename: D P
authors.initials: DP
authors.lastname: Fine
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004352:Drug Resistance, Microbial; D004917:Erythromycin / Q000494:pharmacology; D006801:Humans; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009825:Oklahoma / Q000453:epidemiology; D010403:Penicillin Resistance; D011008:Pneumococcal Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification / Q000187:drug effects; D013420:Sulfamethoxazole / Q000494:pharmacology; D014296:Trimethoprim Resistance
chemical_list: D004917:Erythromycin; D013420:Sulfamethoxazole