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ISSN: 2161-1165
Epidemiology: Open Access

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Antibiotic Resistance in Streptococcus pneumonia: A Disaster in the making

Mirza Shaper*

Division of Epidemiology, University of Texas Houston Health Sciences Center, USA

*Corresponding Author:
Dr. Mirza Shaper
Division of Epidemiology
University of Texas Houston Health Sciences Center, USA
Tel: 956-882-1560
E-mail: [email protected]

Received date: July 22, 2011; Accepted date: July 24, 2011; Published date: July 28, 2011

Citation: Shaper M (2011) Antibiotic Resistance in Streptococcus pneumonia: A Disaster in the making. Epidemiol 1:102e. doi:10.4172/2161-1165.1000102e

Copyright: © 2011 Shaper M. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

Sir William Osler once called S. pneumoniae "the Captain of the men of death". Streptococcus pneumonia, the most common cause of community acquired pneumoniae, otitis media and meningitis is the sixth leading cause of death in the world. Children under the age of 5, elderly individuals and individuals with co-morbidities such as cardiovascular disease, diabetes, and immuncompromised individuals are at the highest risk of acquiring pneumococcal infections. The World Health Organization (WHO) estimates between 11 and 18 million cases of pneumococcal infection in children under the age of 5 and approximately 826,000 deaths globally. Pneumococcal infections account for approximately 11% of all deaths that occur in children under the age of 5 yrs. S. pneumoniae is also the most frequent cause of community acquired pneumonia (CAP) accounting for 20-60% cases of CAP and 11-20% of CAP associated mortality.

Sir William Osler once called S. pneumoniae "the Captain of the men of death". Streptococcus pneumonia, the most common cause of community acquired pneumoniae, otitis media and meningitis is the sixth leading cause of death in the world. Children under the age of 5, elderly individuals and individuals with co-morbidities such as cardiovascular disease, diabetes, and immuncompromised individuals are at the highest risk of acquiring pneumococcal infections. The World Health Organization (WHO) estimates between 11 and 18 million cases of pneumococcal infection in children under the age of 5 and approximately 826,000 deaths globally. Pneumococcal infections account for approximately 11% of all deaths that occur in children under the age of 5 yrs. S. pneumoniae is also the most frequent cause of community acquired pneumonia (CAP) accounting for 20-60% cases of CAP and 11-20% of CAP associated mortality.

The emergence of drug resistance has been a significant clinical and public health problem. Penicillin was the drug of choice for the treatment of pneumococcal infections, however, as a result of the transition from the penicillin susceptibility to resistance, the management of pneumococcal infections changed drastically. Management of pneumococcal infections caused by drug resistant strains, places a significant burden on medical and economic resources. Health care costs associated with treatment of both health-care associated pneumoniae and CAP is estimated to be 10 million each year.

The first clinical isolate with depidemioleased susceptibility to penicillin was identified in 1960s in New Guinea and Australia, followed by isolation of similar strains in South Africa and Spain in 1970s. By the 1980s several incidences of drug resistance was reported worldwide. Resistance to penicillin was not reported in United States until 1991, thus penicillin remained the drug of choice for the treatment of pneumoniae. However, in 1991 resistance to penicillin was reported in the United States, with 1.3% of strains submitted to Center for Disease Control were resistant to penicillin. The proportion continued to increase between 1993 and 1994. Currently reported incidence of penicillin resistance is 14.7% in Europe, 12.7% in Latin America and 15.9% in North America. Furthermore penicillin resistant strains are more likely to be resistant to other classes of antimicrobials giving rise to multi drug resistance. This was first reported in 1977, when isolates of pneumococci, were first seen to be resistant to several other classes of drugs such as macrolides, lincosamides, tetracyclines, phenicols and folates inhibitors. Since then multi drug resistance has been increasingly reported worldwide. The projected increase in incidence of multi drug resistance in United States was 11% between 1995 and 2005. Currently 30% of clinical isolates are considered MDR worldwide. Although there are 90 different serotypes of pneumococci most common isolates with high level ß-lactam resistance belong to serotype 6b, 9V, 14, 19F, 23F these isolates have acquired resistance to multiple antibiotics

The most common cause of resistance is thought to be due to the increase in the community wide utilization of these medicines for upper-respiratory tract infections. For example in United States alone 75% of prescriptions are for upper respiratory infections in ambulatory patients. Many of these prescriptions are unnecessary due to the viral etiology of cold and acute bronchitis. Center of Disease Control and prevention estimates that appropriate use of antibiotics would cause a 40% decline in the prescription of antibiotics.

Interventions to reduce prescription of antibiotics and prevent carriage in particular by drug resistance strains have been shown to reduce the transmissions and infections by drug resistance strains. Nationwide initiatives to reduce prescription of antibiotics were implemented in both Finland and Iceland resulting in a remarkable 48% decline in the drug resistance strains. Additionally use of conjugate vaccine have reduced the rate of carriage by the vaccine serotypes, to approximately 60%. Furthermore the rate of infections caused by penicillin non-susceptible strains dropped by 35%. Introduction of conjugate vaccine also resulted in depidemiolease in the rate of invasive disease by 69% in children age <2 years. The 23 valent polysaccharide vaccines is also available and has been successful in reducing the incidence of diseases upto 60-70% however, the efficacy of the vaccine varies significantly with age and is not effective against preventing carriage.

With the discovery of penicillin in 1928, the health-care professionals in developed world considered the battle of infectious diseases, to be won. To their surprise and chagrin the battle is far from over. Bacterial infections continue to plague our lives. The battle has intensified with the increasing emergence and spread of MDR strains of pathological bacteria. Treatment options are being limited and treatment failures are increase further exacerbating the cost of management of S. pneumoniae associated diseases.

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