Penicillin-resistant pneumococci in southern Sweden, 1993-1997

In Malmohus County, Southern Sweden, the frequency of penicillin-resistant pneumococci in nasopharyngeal specimens of outpatients with respiratory tract infections increased from 3.1% in 1993 to 7.6% in 1995, and was thereafter rather stable. Over the period, 82-85% of the patients with penicillin-resistant strains were children 0-6 years of age. Ten groups/types constituted 96-100% of the penicillin-resistant isolates. Grouping/typing of 200 consecutive isolates in October and November each year indicated that the distribution of groups/types amongst patients with respiratory tract infections was rather constant over the period. The frequency of penicillin-resistant pneumococci of groups/types 6, 14, and 19 roughly corresponded to the occurrence of these groups/types amongst the consecutive isolates. Other groups/types 9, 15, 21, and 23 either showed a pronounced increase or decrease, which could not be related to the prevalence of these groups/types among the consecutive isolates or degree of antibiotic resistance. Penicillin-resistant group 9, introduced in the area in 1993, consisted of one single clone, 9V. The stabilized level of penicillin resistance since 1995 may be related to the preventive measures implemented in the area, including day-care interventions, and measures to reduce the prescription rate of antibiotics to outpatients with respiratory tract infections.