Streptococcus pneumoniae non-susceptibility and outpatient antimicrobial prescribing rates at the Alaska Native Medical Center

Abstract

BackgroundAmerican Indian/Alaska Native (AI/AN) people suffer substantially higher rates of invasive pneumococcal disease (IPD) than the general US population. We evaluated antimicrobial prescribing data and their association with non-susceptibility in Streptococcus pneumoniae causing IPD in AI/AN people between 1992 and 2009.MethodsAntimicrobial use data were gathered from the electronic patient management system and included all prescriptions dispensed to Alaska Native patients aged 5 years and older from outpatient pharmacies at the Alaska Native Medical Center (ANMC). Antimicrobial susceptibility data were gathered from pneumococcal isolates causing IPD among Anchorage Service Unit AI/AN residents aged 5 years and older. Data were restricted to serotypes not contained in the pneumococcal vaccine (PCV7).ResultsOver the study period, overall antimicrobial prescribing increased 59% (285/1,000 persons/year in 1992 to 454/1,000 persons per year in 2009, p<0.001). Trimethoprim/sulfamethoxazole prescribing increased (43/1,000 persons/year in 1992 to 108/1,000 persons/year in 2009, p<0.001) and non-susceptibility to trimethoprim/sulfamethoxazole in AI/AN patients ≥5 years of age increased in non-PCV7 serotypes (0–12%, p<0.05). Similarly, prescribing rates increased for macrolide antibiotics (46/1,000 persons/year in 1992 to 84/1,000 persons/year in 2009, p<0.05). We observed no statistically significant change over time in erythromycin non-susceptibility among non-PCV7 serotypes in AI/AN patients aged 5 years or greater (0–7%, p=0.087).ConclusionAntimicrobial prescribing patterns of some antibiotics in the AI/AN population corresponded to increased antimicrobial resistance in clinical isolates. This study highlights the on-going threat of antimicrobial resistance, the critical importance of judicious prescribing of antibiotics and the potential utility of prescribing data for addressing this issue.

Antimicrobial Susceptibility/Resistance of Streptococcus Pneumoniae

“…S. pneumoniae is associated with a high degree of morbidity and mortality in many countries around the world and is considered the main cause of death of millions children in the transition countries ( 1 ), which account for up to 70% of deaths ( 2 ). It is also considered the leading cause of significant mortality and morbidity in children in developed countries, emphasizing the age of less than two years ( 3 ), which resulted in placing of this bacteria in the unenviable first place within morbidity hierarchy in transition countries ( 1 ).…”

Resistance Maintained in Digital Organisms Despite Guanine/Cytosine-Based Fitness Cost and Extended De-Selection: Implications to Microbial Antibiotics Resistance

“…This is supported by recent studies showing direct relationship between emergence of antibiotic resistant strains and amount of prescribed antibiotics. [29][30][31][32][33] The average population fitness score under selective pressure in this study (generation 1 to 200) is not significantly different ( 0.05) pairedt testp value − − > from the corresponding results study by Castillo & Ling, 18 where identical selective pressure and simulation setup are used for comparability of results. All 25 populations were subjected to 5000 generations of selective pressure withdrawal to mimic the disuse of specific antibiotics after increased antibiotic resistance.…”

Impact of previous macrolide use on invasive pneumococcal disease due to erythromycin-resistant serotypes in adults over 59 years of age

“…Pathological history and previous vaccination were also analyzed in the present study [ 5 , 6 , 33 , 34 ]. We did not find the presence of a pathological history as a risk factor for IPD due to resistant serotypes.…”