title: Biological and Epidemiological Features of Antibiotic-Resistant Streptococcus pneumoniae in Pre- and Post-Conjugate Vaccine Eras: a United States Perspective.
abstract: Streptococcus pneumoniae inflicts a huge disease burden as the leading cause of community-acquired pneumonia and meningitis. Soon after mainstream antibiotic usage, multiresistant pneumococcal clones emerged and disseminated worldwide. Resistant clones are generated through adaptation to antibiotic pressures imposed while naturally residing within the human upper respiratory tract. Here, a huge array of related commensal streptococcal strains transfers core genomic and accessory resistance determinants to the highly transformable pneumococcus. β-Lactam resistance is the hallmark of pneumococcal adaptability, requiring multiple independent recombination events that are traceable to nonpneumococcal origins and stably perpetuated in multiresistant clonal complexes. Pneumococcal strains with elevated MICs of β-lactams are most often resistant to additional antibiotics. Basic underlying mechanisms of most pneumococcal resistances have been identified, although new insights that increase our understanding are continually provided. Although all pneumococcal infections can be successfully treated with antibiotics, the available choices are limited for some strains. Invasive pneumococcal disease data compiled during 1998 to 2013 through the population-based Active Bacterial Core surveillance program (U.S. population base of 30,600,000) demonstrate that targeting prevalent capsular serotypes with conjugate vaccines (7-valent and 13-valent vaccines implemented in 2000 and 2010, respectively) is extremely effective in reducing resistant infections. Nonetheless, resistant non-vaccine-serotype clones continue to emerge and expand.
authors.affiliation: Epidemiology Section, Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Kim
authors.affiliation: Streptococcus Laboratory, Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Lesley
authors.initials: L
authors.lastname: McGee
authors.affiliation: Epidemiology Section, Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Tomczyk
authors.affiliation: Streptococcus Laboratory, Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA bbeall@cdc.gov.
authors.forename: Bernard
authors.initials: B
authors.lastname: Beall
mesh_terms: D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects; D006801:Humans; D011008:Pneumococcal Infections / Q000453:epidemiology / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000494:pharmacology / Q000627:therapeutic use*; D015995:Prevalence; D013296:Streptococcus pneumoniae / Q000187:drug effects*; D014481:United States / Q000453:epidemiology; D018074:Vaccines, Conjugate / Q000494:pharmacology / Q000627:therapeutic use*; D047090:beta-Lactams / Q000627:therapeutic use
chemical_list: D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate; D047090:beta-Lactams