Invasive Pneumococcal Disease Page 13 INVASIVE PNEUMOCOCCAL DISEASE AND ANTIMICROBIAL SUSCEPTIBILITY PATTERNS FOR STREPTOCOCCUS PNEUMONIAE

Pneumococcal infections continue to be a leading cause of morbidity and mortality in persons of all ages. The etiologic agent, Streptococcus pneumoniae is the most common cause of acute otitis media, bacteremia, pneumonia, and purulent meningitis, particularly in young children, the elderly, and the immunocompromised. While a recently published Centers for Disease Control and Prevention (CDC) survey on pneumococcal vaccine coverage1 found increasing vaccine coverage levels for persons 65 years (36.5%), disparities in coverage levels were found among Hispanics (24.2%) and non-Hispanic Blacks (19.7%). The currently licensed vaccine is nonimmunogenic in the most vulnerable population, infants and children under age two years. Since the beginning of the antibiotic era in the 1940's, penicillin has been the drug of choice for treating these infections. Beginning in the 1990's, penicillin-resistant strains began to appear and data from the CDC Pneumococcal Sentinel Surveillance System for 1993-19942 showed that the prevalence of both penicillin nonsusceptible S. pneumoniae (PNSP; MIC> 0.1)g/mL) and multiple-drug nonsusceptible (MDNSP) strains were steadily increasing, posing a serious therapeutic dilemma for clinicians. CDC active surveillance data for 1995 from eight metropolitan areas showed that prevalence of PNSP varied widely, ranging from 10 % to>30 % between areas and between hospital