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Five of seven serotypes in the pneumococcal conjugate vaccine, introduced for infants in the US in 2000, are responsible for most penicillin-resistant infection thus a study is conducted to examine the effect of this vaccine on invasive disease caused by resistant strains. The examination revealed that rate of antibiotic-resistant invasive pneumococcal infections decreased in young children and older persons after the introduction of the conjugate vaccine, while there is an increase in infections caused by serotypes not included in the vaccine.

After increasing from 1995 to 1999, invasive erythromycin-nonsusceptible Streptococcus pneumoniae rates per 100,000 decreased 53.6% in children from Baltimore, Maryland (USA) from 1999 to 2001, which was partially attributed to [...]

The Africans in the United States are more prone to invasive pneumococcal disease than the Americans. There is a decline in invasive disease among the younger children because of the introduction of a new protein polysaccharide pneumococcal conjugate vaccine.

A pneumococcal vaccine introduced in 2000 has reduced the number of cases of pneumococcal infection in the US in children and adults. Since 1998, the number of cases of pneumococcal infection decreased 69% in children under two, 32% in adults 20 to 39 years old, 8% in adults 40 to 64 years old, and 18% in adults 65 years and older. Pneumococcal infection is a bacterial infection that can be very serious.

A total of 698 students at Dartmouth College in New Hampshire developed an eye infection called conjunctivitis between January and April, 2002. The infection was caused by a bacterium called Streptococcus pneumoniae. The specific strain was found to be the same one that caused outbreaks of conjunctivitis in the US in 1980. Risk factors included contact lens use, contact with an infected student, being on a sports team, and living in a fraternity or sorority house or attending parties at one.

Serological typing of opacity-factor-positive group A streptococci (GAS) and emm (M protein gene) and sof gene sequence variation are discussed. Strong correlation of certain M serotypes with certain emm sequences exists without regard to strain background. Strong association of specific anti-opacity-factor types and gene sequence types has been found.

Research findings show that pneumococcal capsular polysaccharide vaccines are effective in protecting 94% of the vaccinated preschool-age children with pneumococcal disease., To estimate the effectiveness of pneumococcal polysaccharide vaccine, we serotyped isolates submitted to the Pneumococcal Sentinel Surveillance System from 1984 to 1996 from 48 vaccinated and 125 unvaccinated children 2 [...]

The incidence of drug-resistant pneumococcal infection appears to be increasing in Franklin County, Ohio. Pneumococcal infections are caused by the bacterium Streptococcus pneumoniae. A total of 590 cases of pneumococcal infection occurred between January 1991 and April 1994. The overall incidence was 18.9 per 100,000, but the incidence in the elderly was 83 per 100,000. Overall mortality was approximately 19% each year, but mortality varied by age group. Mortality was 11% in those younger than 65, 22% in those between 65 and 84 and 38% in those over 84. In 1994, 14% of bacterial strains isolated from patients' blood were resistant to penicillin, up from 4% in 1991. Mortality was not significantly higher in patients infected with penicillin-resistant pneumococcus, but these patients spent 3.7 more days in the hospital on average. Most of the penicillin-resistant strains would be covered by the pneumococcal vaccine., Objective.--To determine the incidence and mortality rates of patients with bacteremic infections with Streptococcus pneumoniae, and to determine the serotypes and antimicrobial susceptibilities of the pneumococcal isolates. Design.--Prospective case ascertainment and procurement of S pneumoniae isolates between January 1991 and April 1994. Setting.--Ten adult care hospitals in Franklin County, Ohio. Patients.--Patients (N=590) in whom S pneumoniae was isolated from blood cultures. Measurements.--Demographic data from patients with pneumococcal bacteremia were obtained by chart review. Pneumococcal serotyping and antimicrobial susceptibility testing were performed on 499 bacteremic isolates. Results.--Among residents of Franklin County, the annual incidence of pneumococcal bacteremia was higher in patients at least 65 years old (83.0 per 100 000 population) compared with younger adults (9.6 per 100 000 population) (odds ratio [OR], 8.74; 95% confidence interval [CI], 7.19 to 10.62) and more common among African Americans than whites (OR, 1.36; 95% CI, 1.06 to 1.75). The relative risk of pneumococcal bacteremia among persons infected with the human immunodeficiency virus was 41.8 times (CI,19.0 to 92.0) that of county residents 18 to 64 years of age. The overall mortality rate was 19% and was age-dependent, reaching 38% in patients at least 85 years old. The distribution of pneumococcal serotypes causing bacteremia was remarkably consistent over time. The incidence of drug-resistant strains increased during the study period; by 1994 14% were resistant to penicillin, 12% to ceftazidime, and 24% to trimethoprim-sulfamethoxazole. The resistant strains included several serotypes of S pneumoniae. Most serotypes (89.8%) of S pneumoniae causing bacteremia are contained in the pneumococcal vaccine. Conclusions.--Increased use of pneumococcal vaccine and recognition of antimicrobial resistance patterns may assist physicians in treating patients with S pneumoniae bacteremia. Educational programs to discourage unnecessary antimicrobial drug use should be developed for patients and physicians. (JAMA. 1990-?75:194-198)

Strains of Streptococcus pneumoniae that are resistant to drugs are becoming more common. Researchers performed laboratory tests on bacteria isolated from 431 patients with pneumococcal diseases in Atlanta. During 1994, the overall incidence of invasive pneumococcal infection was 30 cases per 100,000 people. Twenty-five percent of the isolated bacteria were resistant to penicillin, 26% were resistant to trimethoprim-sulfamethoxazole, 9% were resistant to cefotaxime, and 15% were resistant to erythromycin. Children under 6 years old were more likely than older patients to have infections resistant to cefotaxime or multiple drugs. Whites were more likely than blacks to have drug-resistant infections. For instance, penicillin-resistant bacteria were isolated from 32% of whites and 19% of blacks. However, pneumococcal infections in general were more common in blacks. Prevention of drug-resistant infections requires more careful antibiotic prescription and greater use of the 23-valent pneumococcal vaccine.

An epidemic of pneumococcal disease in a Houston, Texas jail was most likely caused by overcrowding and poor ventilation. Pneumococcal infections can result in pneumonia or other complications, but have become rare as living conditions in crowded areas have improved and antibiotics have become more widely available. Prisoners at the jail in which the outbreak occurred were most likely to become infected if they lived in small, shared cells in areas with high carbon dioxide levels and inadequate outside air available through the ventilation system. Intravenous drug use was found to be the only other significant risk factor. The jail at which the outbreak occurred was built to house 3,500 inmates, but held 6,700 at the time of the outbreak.

The incidence of drug-resistant pneumococcal pneumonia infections appears to be increasing nationwide. Drug resistance occurs when an organism is no longer susceptible to a drug once able to eradicate it. Thirteen hospitals from 12 states submitted pneumococcal isolates from 544 patients between Oct 1, 1991, and Sep 30, 1992. More than 5% of all isolates showed resistance to penicillin, erythromycin and trimethoprim-sulfamethoxazole. High-level penicillin resistance was detected in 1.3% of the isolates. A total of 16.4% of the isolates were resistant to one or more of the following antimicrobials: penicillin, erythromycin, trimethoprim-sulfamethoxazole and chloramphenicol. Eighty-five percent of the drug-resistant strains were members of six serotypes. The growing incidence of drug-resistant pneumonia has created the need for new conjugate pneumococcal vaccines and for effective use of currently available vaccines., Objective. - To estimate drug susceptibility patterns of Streptococcus pneumoniae in selected hospitals in the United States and to characterize the epidemiology of invasive drug-resistant pneumococcal infections. Design. - Minimum inhibitory concentrations (MICS) for a variety of commonly used antimicrobial drugs were determined for pneumococcal isolates submitted to the Centers for Disease Control and Prevention (CDC). Risk factors for drug-resistant pneumococcal infection were evaluated. Setting. - Hospital laboratories in the United States submitting pneumococcal isolates to the CDC between October 1, 1991, and September 30, 1992. Participants. - A total of 544 persons with pneumococci isolated from normally sterile sites. Results. - A total of 13 hospitals in 12 states actively participated in an ongoing pneumococcal surveilliance study. Resistance to penicillin was detected in 6.6% of isolates, including 1.3% of isolates with MICs of 2.0 [micro]g/ml or more (compared with

The pneumococcal polysaccharide vaccine may be more effective in certain patient populations than in others. The pneumococcal vaccine is given to at-risk individuals to prevent community-acquired pneumonia and meningitis. Researchers examined the the effectiveness of the vaccine in 2,837 patients over five years old with an infection of the blood or cerebrospinal fluid between May 1978 and Apr 1992. The vaccine was 57% effective in preventing infections caused by the serotypes of Streptococcus pneumoniae included in the vaccine. It was 84% effective for patients with diabetes mellitus, 73% for those with coronary vascular disease, 69% for those congestive heart failure and 65% for those with chronic pulmonary diseases. The time since vaccination did not affect efficacy of the vaccine significantly.

An outbreak of surgical wound infections as a result of infection by the beta-hemolytic streptococcal bacteria led to an epidemiologic investigation. In 10 of the previously reported outbreaks of this serious infection of wounds, a hospital worker directly involved with patient-care in the operating room was identified as the source. Twenty cases were identified during this outbreak, which represented an attack rate of 1 surgical wound infection for each 1,097 surgical procedures, which is about 5 to 10 times the expected frequency. Operating room staff were examined to see if they were carriers of beta-hemolytic strep, but none could be detected. Sterile plates were placed at strategic locations in the operating suites and a log of individuals entering various areas was kept. As a result of these detection methods, one individual was identified. The subject had a history of intermittent eczema since childhood. Although on her four previous examinations, no source of the organism could be found, close examination revealed areas of scaling on her scalp, ears, under her breasts and at skin folds. Her condition was diagnosed as psoriasis (a chronic skin condition resulting in a redness of the affected skin and scaling) and seborrhea (scalp infection of oil glands). She was treated with topical medications and systemic antibiotics, and was transferred away from the operating suite and other patient-care areas. Tests of other family members of this individual also revealed infections, which were similarly treated. Following the isolation of this individual, no further cases of surgical wound infection related to this subgroup of organism occurred at the hospital. In other cases of wound infection, the organism was usually located in the rectum or vagina of the infected worker. The present report identifies another possible source of infection the scalp. (Consumer Summary produced by Reliance Medical Information, Inc.)