A Multicenter Evaluation of Trends in Antimicrobial Resistance Among Streptococcus pneumoniae Isolates From Adults in the United States

Abstract

Background Management of pneumococcal disease is complicated by high rates of antimicrobial resistance (AMR). This study assessed AMR trends for Streptococcus pneumoniae isolates from adults with pneumococcal disease. Methods From January 2011 to February 2020, we evaluated 30-day non-duplicate S. pneumoniae isolates from 290 US hospitals (BD Insights Research Database) from adults (≥ 18 years) in inpatient and outpatient settings. Isolates were required to have at least one AMR result for invasive (blood, cerebrospinal fluid/neurologic) or non-invasive (respiratory or ear/nose/throat) pneumococcal disease samples. Determination of AMR was based on facility reports of intermediate or resistant. Descriptive statistics and generalized estimated equations were used to assess variations over time. Results Over the study period, 34,039 S. pneumoniae isolates were analyzed (20,749 [61%] from non-invasive sources and 13,290 [39%] from invasive sources). Almost half (46.6%) of the isolates were resistant to ≥ 1 drug and non-invasive isolates had higher rates of AMR than invasive isolates. Total S. pneumoniae isolates had high rates of resistance to macrolides (37.7%), penicillin (22.1%), and tetracyclines (16.1%). Multivariate modeling identified a significant increasing trend in resistance to macrolides (+1.8%/year; P < 0.001). Significant decreasing trends were observed for penicillin (-1.6%/year; P < 0.001), extended-spectrum cephalosporins (ESCs) (-0.35%/year; P < 0.001), and ≥3 drugs (-0.5%/year; P < 0.001). Conclusions Despite decreasing trends for penicillin, ESCs, and resistance to ≥3 drugs, AMR rates are persistently high in S. pneumoniae isolates among US adults. Increasing macrolide resistance suggests that efforts to address AMR in S. pneumoniae may require antimicrobial stewardship efforts and higher-valent pneumococcal conjugate vaccines.

Trends inStreptococcus pneumoniaeAntimicrobial Resistance in US Children: A Multicenter Evaluation

“…A notable result from this study was higher resistance rates in noninvasive PD isolates compared with IPD isolates, regardless of the drug category evaluated. A similar observation has also been made in adults [ 17 ]. Although noninvasive PD cases are generally less severe, they contribute to widespread antibiotic use [ 18–20 ] and exert a heavy burden on the healthcare system, including an estimated 382 182 pneumonia hospitalizations and 93 million office visits for otitis media in US children between 1997 and 2019 [ 2 ].…”

“…The magnitudes of increasing resistance to ≥2 drug classes (+1.8%/year) and macrolides (+5.0%/year) were particularly alarming. High and increasing S pneumoniae resistance to macrolides has also been documented in adults with PD [ 16 , 17 ]. More encouraging results were observed with penicillin resistance, which showed a significant decreasing trend, although the approximately 35% resistance rate for total isolates in the most recent data (2019–2020) is still quite substantial.…”

“…Reporting institutions consisted of US hospitals in the BD Insights Research Database (Becton, Dickinson and Company, Franklin Lakes, New Jersey), which includes small and large hospitals in urban and rural areas and provides geographical representation across the US [ 16 , 17 ]. The study was approved as involving use of a limited retrospective data set for an epidemiology study and deemed exempt from consent by the New England Institutional Review Board/Human Subjects Research Committee (Wellesley, Massachusetts) and conducted in compliance with Health Insurance Portability and Accountability Act requirements.…”