title: Association between antimicrobial resistance among pneumococcal isolates and burden of invasive pneumococcal disease in the community.
abstract: Treatment of infections with drug-resistant strains of Streptococcus pneumoniae (pneumococcus) may fail; whether drug resistance is associated with an increase in the number of serious infections in the community is unknown. We evaluated the relationship between the proportion of antimicrobial-resistant S. pneumoniae isolates and the number of cases of invasive pneumococcal disease. Linear regression models included 1996 county-level data from 38 counties participating in the US Centers for Disease Control and Prevention's Active Bacterial Core Surveillance. Separate models evaluated hospitalized children aged <5 years, nonhospitalized children aged <5 years, adults aged 18-64 years, and adults aged >64 years. The proportion of isolates resistant to > or =3 drug classes was associated with invasive disease in both hospitalized (P=.06) and nonhospitalized (P=.001) children. The proportion of multidrug-resistant pneumococcal isolates did not predict invasive cases among adults. The increasing prevalence of multidrug-resistant pneumococci among children may be leading to an increase in invasive disease.
authors.affiliation: Division of Bacterial and Mycotic Diseases, National Centers for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Julia Y
authors.initials: JY
authors.lastname: Morita
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Zell
authors.forename: Richard
authors.initials: R
authors.lastname: Danila
authors.forename: Monica M
authors.initials: MM
authors.lastname: Farley
authors.forename: James
authors.initials: J
authors.lastname: Hadler
authors.forename: Lee H
authors.initials: LH
authors.lastname: Harrison
authors.forename: Lewis
authors.initials: L
authors.lastname: Lefkowitz
authors.forename: Arthur
authors.initials: A
authors.lastname: Reingold
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Kupronis
authors.forename: Anne
authors.initials: A
authors.lastname: Schuchat
authors.forename: Cynthia G
authors.initials: CG
authors.lastname: Whitney
mesh_terms: D000293:Adolescent; D000328:Adult; D002675:Child, Preschool; D003153:Community Health Services / Q000191:economics*; D017281:Cost of Illness; D024881:Drug Resistance, Bacterial / Q000502:physiology*; D006801:Humans; D016014:Linear Models; D011008:Pneumococcal Infections / Q000191:economics*; D013223:Statistics as Topic; D013296:Streptococcus pneumoniae / Q000187:drug effects