Skip to main content

Advertisement

SpringerLink
Log in

Pneumonia Due to Drug-Resistant Streptococcus pneumoniae

  • Pleuropulmonary and Bronchial Infections (FW Arnold, Section Editor)
  • Published:
Current Infectious Disease Reports Aims and scope Submit manuscript

Abstract

Pneumonia is a major infectious disease associated with significant morbidity and mortality, with Streptococcus pneumoniae the predominant pathogen in community-acquired cases, accounting for 20% to 50% of bacterial cases. Although pneumococcal resistance to β-lactams is now common worldwide, high-dose parental penicillin G, many other parental β-lactams and some oral β-lactams continue to be efficacious. The new Clinical and Laboratory Standards Institute susceptibility breakpoints for parental penicillin G for nonmeningeal infections (≤2 μg/mL, susceptible; 4 μg/mL, intermediate; ≥8 μg/mL, resistant) introduced in 2008 facilitate appropriate reporting and use of penicillin G. Pneumococcal vaccine usage in children from 2000 has led to significant decreases in morbidity and mortality due to S. pneumoniae in all age groups, and the increase in resistant serotypes, such as 19A, appears to be decreasing following the introduction of an expanded valence vaccine in 2010. Judicious use of antimicrobial agents is the best long-term approach in order to reduce S. pneumoniae resistance.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Aspa J, Rajas O, Rodriguez de Castro F, et al. Impact of initial antibiotic choice on mortality from pneumococcal pneumonia. Eur Respir J. 2006;27(5):1010–9.

    PubMed  CAS  Google Scholar 

  2. Baddour LM, Yu VL, Klugman KP, et al. Combination antibiotic therapy lowers mortality among severely ill patients with pneumococcal bacteremia. Am J Respir Crit Care Med. 2004;170(4):440–4.

    Article  PubMed  Google Scholar 

  3. Potgieter PD, Hammond JM. The intensive care management, mortality and prognostic indicators in severe community-acquired pneumococcal pneumonia. Intensive Care Med. 1996;22(12):1301–6.

    Article  PubMed  CAS  Google Scholar 

  4. Tleyjeh IM, Tlaygeh HM, Hejal R, Montori VM, Baddour LM. The impact of penicillin resistance on short-term mortality in hospitalized adults with pneumococcal pneumonia: a systematic review and meta-analysis. Clin Infect Dis. 2006;42(6):788–97.

    Article  PubMed  Google Scholar 

  5. Paladino JA, Adelman MH, Schentag JJ, Iannini PB. Direct costs in patients hospitalised with community-acquired pneumonia after non-response to outpatient treatment with macrolide antibacterials in the US. Pharmacoeconomics. 2007;25(8):677–83.

    Article  PubMed  Google Scholar 

  6. Whitney CG, Pilishvili T, Farley MM, et al. Effectiveness of seven-valent pneumococcal conjugate vaccine against invasive pneumococcal disease: a matched case–control study. Lancet. 2006;368(9546):1495–502.

    Article  PubMed  CAS  Google Scholar 

  7. Jacobs MR. Antimicrobial-resistant Streptococcus pneumoniae: trends and management. Expert Rev Anti Infect Ther. 2008;6(5):619–35.

    Article  PubMed  Google Scholar 

  8. Widdowson CA, Klugman KP. Molecular mechanisms of resistance to commonly used non-betalactam drugs in Streptococcus pneumoniae. Semin Respir Infect. 1999;14(3):255–68.

    PubMed  CAS  Google Scholar 

  9. Hakenbeck R, Kaminski K, Konig A, et al. Penicillin-binding proteins in beta-lactam-resistant streptococcus pneumoniae. Microb Drug Resist. 1999;5(2):91–9.

    Article  PubMed  CAS  Google Scholar 

  10. Fuller JD, McGeer A, Low DE. Drug-resistant pneumococcal pneumonia: clinical relevance and approach to management. Eur J Clin Microbiol Infect Dis. 2005;24(12):780–8.

    Article  PubMed  CAS  Google Scholar 

  11. Klugman KP, Yu VL. No impact of penicillin resistance on mortality. Clin Infect Dis 2006 Jul 15;43(2):261; author reply −2.

  12. Weinstein MP, Klugman KP, Jones RN. Rationale for revised penicillin susceptibility breakpoints versus Streptococcus pneumoniae: coping with antimicrobial susceptibility in an era of resistance. Clin Infect Dis. 2009;48(11):1596–600.

    Article  PubMed  CAS  Google Scholar 

  13. Daneman N, McGeer A, Green K, Low DE. Macrolide resistance in bacteremic pneumococcal disease: implications for patient management. Clin Infect Dis. 2006;43(4):432–8.

    Article  PubMed  CAS  Google Scholar 

  14. Fasola EL, Bajaksouzian S, Appelbaum PC, Jacobs MR. Variation in erythromycin and clindamycin susceptibilities of Streptococcus pneumoniae by four test methods. Antimicrob Agents Chemother. 1997;41(1):129–34.

    PubMed  CAS  Google Scholar 

  15. Jacobs MR, Good CE, Beall B, Bajaksouzian S, Windau AR, Whitney CG. Changes in serotypes and antimicrobial susceptibility of invasive Streptococcus pneumoniae strains in Cleveland: a quarter century of experience. J Clin Microbiol. 2008;46(3):982–90.

    Article  PubMed  Google Scholar 

  16. Farrell DJ, Couturier C, Hryniewicz W. Distribution and antibacterial susceptibility of macrolide resistance genotypes in Streptococcus pneumoniae: PROTEKT Year 5 (2003–2004). Int J Antimicrob Agents. 2008;31(3):245–9.

    Article  PubMed  CAS  Google Scholar 

  17. Jenkins SG, Brown SD, Farrell DJ. Trends in antibacterial resistance among Streptococcus pneumoniae isolated in the USA: update from PROTEKT US Years 1–4. Ann Clin Microbiol Antimicrob. 2008;7:1.

    Article  PubMed  Google Scholar 

  18. Janoir C, Zeller V, Kitzis MD, Moreau NJ, Gutmann L. High-level fluoroquinolone resistance in Streptococcus pneumoniae requires mutations in parC and gyrA. Antimicrob Agents Chemother. 1996;40(12):2760–4.

    PubMed  CAS  Google Scholar 

  19. Piddock LJ, Johnson MM, Simjee S, Pumbwe L. Expression of efflux pump gene pmrA in fluoroquinolone-resistant and -susceptible clinical isolates of Streptococcus pneumoniae. Antimicrob Agents Chemother. 2002;46(3):808–12.

    Article  PubMed  CAS  Google Scholar 

  20. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44 Suppl 2:S27–72.

    Article  PubMed  CAS  Google Scholar 

  21. Buckingham SC, Brown SP, Joaquin VH. Breakthrough bacteremia and meningitis during treatment with cephalosporins parenterally for pneumococcal pneumonia. J Pediatr. 1998;132(1):174–6.

    Article  PubMed  CAS  Google Scholar 

  22. Daum RS, Nachman JP, Leitch CD, Tenover FC. Nosocomial epiglottitis associated with penicillin- and cephalosporin-resistant Streptococcus pneumoniae bacteremia. J Clin Microbiol. 1994;32(1):246–8.

    PubMed  CAS  Google Scholar 

  23. Dowell SF, Smith T, Leversedge K, Snitzer J. Failure of treatment of pneumonia associated with highly resistant pneumococci in a child. Clin Infect Dis. 1999;29(2):462–3.

    Article  PubMed  CAS  Google Scholar 

  24. Pallares R, Linares J, Vadillo M, et al. Resistance to penicillin and cephalosporin and mortality from severe pneumococcal pneumonia in Barcelona, Spain. N Engl J Med. 1995;333(8):474–80.

    Article  PubMed  CAS  Google Scholar 

  25. Sacho H, Klugman KP, Koornhof HJ, Ruff P. Community-acquired pneumonia in an adult due to a multiply-resistant pneumococcus. J Infect. 1987;14(2):188–9.

    Article  PubMed  CAS  Google Scholar 

  26. Farrell DJ, Jenkins SG, Brown SD, Patel M, Lavin BS, Klugman KP. Emergence and spread of Streptococcus pneumoniae with erm(B) and mef(A) resistance. Emerg Infect Dis. 2005;11(6):851–8.

    Article  PubMed  CAS  Google Scholar 

  27. Jenkins SG, Farrell DJ. Increase in pneumococcus macrolide resistance, United States. Emerg Infect Dis. 2009;15(8):1260–4.

    Article  PubMed  Google Scholar 

  28. Klugman KP, Lonks JR. Hidden epidemic of macrolide-resistant pneumococci. Emerg Infect Dis. 2005;11(6):802–7.

    Article  PubMed  CAS  Google Scholar 

  29. Powis J, McGeer A, Green K, et al. In vitro antimicrobial susceptibilities of Streptococcus pneumoniae clinical isolates obtained in Canada in 2002. Antimicrob Agents Chemother. 2004;48(9):3305–11.

    Article  PubMed  CAS  Google Scholar 

  30. Richter SS, Heilmann KP, Beekmann SE, Miller NJ, Rice CL, Doern GV. The molecular epidemiology of Streptococcus pneumoniae with quinolone resistance mutations. Clin Infect Dis. 2005;40(2):225–35.

    Article  PubMed  CAS  Google Scholar 

  31. Weiss K, Restieri C, Gauthier R, et al. A nosocomial outbreak of fluoroquinolone-resistant Streptococcus pneumoniae. Clin Infect Dis. 2001;33(4):517–22.

    Article  PubMed  CAS  Google Scholar 

  32. Davidson R, Cavalcanti R, Brunton JL, et al. Resistance to levofloxacin and failure of treatment of pneumococcal pneumonia. N Engl J Med. 2002;346(10):747–50.

    Article  PubMed  Google Scholar 

  33. Fuller JD, Low DE. A review of Streptococcus pneumoniae infection treatment failures associated with fluoroquinolone resistance. Clin Infect Dis. 2005;41(1):118–21.

    Article  PubMed  Google Scholar 

  34. Ho PL, Tse WS, Tsang KW, et al. Risk factors for acquisition of levofloxacin-resistant Streptococcus pneumoniae: a case–control study. Clin Infect Dis. 2001;32(5):701–7.

    Article  PubMed  CAS  Google Scholar 

  35. Kupronis BA, Richards CL, Whitney CG. Invasive pneumococcal disease in older adults residing in long-term care facilities and in the community. J Am Geriatr Soc. 2003;51(11):1520–5.

    Article  PubMed  Google Scholar 

  36. Jacobs MR, Good CE, Windau AR, et al. Activity of ceftaroline against recent emerging serotypes of Streptococcus pneumoniae in the United States. Antimicrob Agents Chemother. 2010;54(6):2716–9.

    Article  PubMed  CAS  Google Scholar 

  37. Malhotra-Kumar S, Lammens C, Coenen S, Van Herck K, Goossens H. Effect of azithromycin and clarithromycin therapy on pharyngeal carriage of macrolide-resistant streptococci in healthy volunteers: a randomised, double-blind, placebo-controlled study. Lancet. 2007;369(9560):482–90.

    Article  PubMed  CAS  Google Scholar 

  38. Bronzwaer SL, Cars O, Buchholz U, et al. A European study on the relationship between antimicrobial use and antimicrobial resistance. Emerg Infect Dis. 2002;8(3):278–82.

    Article  PubMed  Google Scholar 

  39. van de Sande-Bruinsma N, Grundmann H, Verloo D, et al. Antimicrobial drug use and resistance in Europe. Emerg Infect Dis. 2008;14(11):1722–30.

    Article  PubMed  Google Scholar 

  40. Hicks LA, Chien YW, Taylor Jr TH, Haber M, Klugman KP. Outpatient antibiotic prescribing and nonsusceptible Streptococcus pneumoniae in the United States, 1996–2003. Clin Infect Dis Oct. 2011;53(7):631–9.

    Article  Google Scholar 

  41. Shields B. Prevnar (heptavalent pneumococcal conjugate vaccine): disease prevention in infants and children. J Pediatr Health Care. 2001;15(4):203–8. quiz 9–10.

    PubMed  CAS  Google Scholar 

  42. Jacobs MR, Bajaksouzian S, Bonomo RA, et al. Occurrence, distribution, and origins of Streptococcus pneumoniae Serotype 6 C, a recently recognized serotype. J Clin Microbiol. 2009;47(1):64–72.

    Article  PubMed  CAS  Google Scholar 

  43. Nahm MH, Lin J, Finkelstein JA, Pelton SI. Increase in the prevalence of the newly discovered pneumococcal serotype 6 C in the nasopharynx after introduction of pneumococcal conjugate vaccine. J Infect Dis. 2009;199(3):320–5.

    Article  PubMed  Google Scholar 

  44. Jacobs MR, Good CE, Bajaksouzian S, Windau AR. Emergence of Streptococcus pneumoniae serotypes 19A, 6 C, and 22 F and serogroup 15 in Cleveland, Ohio, in relation to introduction of the protein-conjugated pneumococcal vaccine. Clin Infect Dis. 2008;47(11):1388–95.

    Article  PubMed  Google Scholar 

  45. Reynolds TA. Update on emerging infections: news from the Centers for Disease Control and Prevention. Emergence of antimicrobial-resistant serotype 19A Streptococcus pneumoniae–Massachusetts, 2001–2006. Ann Emerg Med. 2008;51(3):312–5.

    Article  PubMed  Google Scholar 

  46. Moore MR, Gertz Jr RE, Woodbury RL, et al. Population snapshot of emergent Streptococcus pneumoniae serotype 19A in the United States, 2005. J Infect Dis. 2008;197(7):1016–27.

    Article  PubMed  Google Scholar 

  47. Messina AF, Katz-Gaynor K, Barton T, et al. Impact of the pneumococcal conjugate vaccine on serotype distribution and antimicrobial resistance of invasive Streptococcus pneumoniae isolates in Dallas, TX, children from 1999 through 2005. Pediatr Infect Dis J. 2007;26(6):461–7.

    Article  PubMed  Google Scholar 

  48. Dagan R, Klugman KP. Impact of conjugate pneumococcal vaccines on antibiotic resistance. Lancet Infect Dis. 2008;8(12):785–95.

    Article  PubMed  Google Scholar 

Download references

Disclosure

Dr. M Jacobs has received grant support, consulting fees, travel support, and payment for development of educational presentations from Abbott Pharmaceuticals, ARPIDA Pharmaceuticals, Aventis Pharmaceuticals, Basilea Pharmaceuticals, Bristol-Myers Squibb Pharmaceuticals, Bayer Pharmaceuticals, Cerexa Pharmaceuticals, Daiichi Pharmaceuticals, Dr Reddy’s Laboratory, Eli Lilly & Co., GlaxoSmithKline Pharmaceuticals, Meiji Pharmaceuticals, Ortho-McNeil Pharmaceutical, Pfizer Inc., Ranbaxy Laboratories, Roche Pharmaceuticals, TAP Pharmaceuticals, Warner-Lambert Pharmaceuticals, Wockhardt Pharmaceuticals and Wyeth-Ayerst/Lederle Pharmaceuticals; Dr. S. Jinno reported no potential conflicts of interest relevant to this article.

Author information

Authors and Affiliations

  1. Department of Medicine, AIDS Healthcare Foundation, 1300 N Vermont Avenue, Suite 407, Los Angeles, CA, 90027, USA

    Sadao Jinno

  2. Department of Pathology, University Hospitals Case Medical Center and Case Western Reserve University, Cleveland, OH, USA

    Michael R. Jacobs

Authors
  1. Sadao Jinno
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael R. Jacobs
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sadao Jinno.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jinno, S., Jacobs, M.R. Pneumonia Due to Drug-Resistant Streptococcus pneumoniae . Curr Infect Dis Rep 14, 292–299 (2012). https://doi.org/10.1007/s11908-012-0260-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11908-012-0260-x

Keywords

Search

Navigation