Resistance in Streptococcus pneumoniae

  • Mathias W. R. Pletz
  • Tobias Welte
  • Lesley McGee
Part of the Birkhäuser Advances in Infectious Diseases book series (BAID)


Streptococcus pneumoniae is a leading cause of community-acquired lower respiratory tract infections, sinusitis, meningitis, and bloodstream infections. Pneumococci are Gram positive, encapsulated bacteria and exhibit more than 90 different capsular serotypes.

Resistance to penicillin in clinical isolates was reported anecdotally as early as 1965, but was not considered a major concern until the mid-1990s. In the 1990s, there was a tremendous global increase in resistance to penicillins and this led to the increased use of macrolides and tetracyclines to treat infections. After several years, the resistance rates to these antibiotics began to increase as well. Currently, fluoroquinolones are used most frequently to treat community-acquired respiratory infections in adults and resistance rates globally are still low.

Pneumococci are naturally competent bacteria and frequently acquire resistance by intraspecies or interspecies gene transfer. Resistance to β-lactams is due to the acquisition of different mutations within the pencillin-binding proteins that have been demonstrated to originate from the less pathogenic viridans streptococci. Other mechanisms of antibiotic resistance include enzymes and efflux pumps on mobile genetic elements (e.g. erm and mef), or resistance arising through spontaneous mutations. Clinical studies show that resistance, particularly to penicillins, is not always related to clinical failure.

The global increase in resistance rates in pneumococci is in part due to the spread of a limited number of highly sucessful multiresistant pneumococcal clones. Isolates belonging to a specific clone, defined by sequence types according to multilocus sequencing, often exhibit the same serotype. However, capsular switching due to genetic rearrangements within the same clone has been observed. The recently introduced seven-valent conjugated pneumococcal vaccine has been shown to decrease disease and carrier rates of the included serotypes. Since some of the multiresistant clones exhibit vaccine serotypes, resistance rates to penicillin, macrolides and fluoroquinolones have been decreasing since the introduction of this vaccine.


Streptococcus Pneumoniae Antimicrob Agent Pneumococcal Pneumonia Macrolide Resistance Fluoroquinolone Resistance 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Birkhäuser Verlag Basel/Switzerland 2007

Authors and Affiliations

  • Mathias W. R. Pletz
    • 1
  • Tobias Welte
    • 1
  • Lesley McGee
    • 2
  1. 1.Department of Respiratory MedicineHannover Medical SchoolHannoverGermany
  2. 2.Hubert Department of Global HealthEmory UniversityAtlantaUSA

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