Antimicrobial resistance in Streptococcus pneumoniae: implications for patients with community-acquired pneumonia.
Streptococcus pneumoniae is the leading cause of community-acquired pneumonia. During the past decade, the prevalence of penicillin resistance in S pneumoniae has increased dramatically, with resistance rates approaching 45% in some areas of the United States. Streptococcus pneumoniae has also acquired resistance to other commonly used antimicrobials, including cephalosporins, macrolides, and trimethoprim-sulfamethoxazole. While vancomycin and the newer quinolones are currently highly active against most strains of S pneumoniae, reduced susceptibilities to these agents have been identified in some strains. Prior use of antimicrobial agents is the major risk factor for colonization and infection with antibiotic-resistant strains. beta-Lactam antibiotics remain the treatment of choice for infections caused by susceptible S pneumoniae. The optimum therapy for penicillin-resistant strains remains unclear. Appropriate empirical therapy for patients with community-acquired pneumonia depends in part on the community-specific resistance patterns of S pneumoniae to various antibiotics. In this article, we provide an overview of the development of S pneumoniae resistance to commonly used antibiotics and discuss the implications of the development of resistance on treatment decisions.
Chenoweth
C E
CE
Department of Internal Medicine, University of Michigan Health System, Ann Arbor 48109-0378, USA. cchenow@umich.edu
Saint
S
S
Martinez
F
F
Lynch
J P
JP
Fendrick
A M
AM
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000188:drug therapy; D004352:Drug Resistance, Microbial; D006801:Humans; D007769:Lactams; D010403:Penicillin Resistance; D018410:Pneumonia, Bacterial / Q000188:drug therapy*; D011379:Prognosis; D013296:Streptococcus pneumoniae / Q000187:drug effects*; D014774:Virulence
D000900:Anti-Bacterial Agents; D007769:Lactams