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Geographic diversity and temporal trends of antimicrobial resistance in Streptococcus pneumoniae in the United States

Nature Medicine volume 9, pages 424–430 (2003)Cite this article

Abstract

Resistance of Streptococcus pneumoniae to antibiotics is increasing throughout the United States, with substantial variation among geographic regions. We show that patterns of geographic variation are best explained by the intensity of selection for resistance, which is reflected by differences between the proportions of resistance within individual serotypes, rather than by differences between the frequencies of particular serotypes. Using a mathematical transmission model, we analyzed temporal trends in the proportions of singly and dually resistant organisms and found that pneumococcal strains resistant to both penicillin and erythromycin are increasing faster than strains singly resistant to either. Using the model, we predict that by 1 July 2004, in the absence of a vaccine, 41% of pneumococci at the Centers for Disease Control and Prevention (CDC)'s Active Bacterial Core surveillance (ABCs) sites, taken together, will be dually resistant, with 5% resistant to penicillin only and 5% to erythromycin only.

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Figure 1: Model of pneumococcal transmission (described in Methods).
Figure 2: Actual and predicted proportions of resistance.

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Acknowledgements

This work was supported by a National Institutes of Health grant AI48935 to M.L. and by an Ellison Foundation New Scholar Award in Global Infectious Diseases to M.L. We thank S. McCoy and E. Zell for compiling antimicrobial use data and J. Robins for helpful suggestions.

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Authors and Affiliations

  1. Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA

    Althea W. McCormick & Marc Lipsitch

  2. Active Bacterial Core surveillance and Emerging Infections Program Network, Centers for Disease Control and Prevention, Atlanta, Georgia, USA

    Cynthia G. Whitney

  3. Emory Department of Medicine, Emory University, Atlanta, Georgia, USA

    Monica M. Farley

  4. Minnesota Department of Health, Minnesota Emerging Infections Program, Minneapolis, Minnesota, USA

    Ruth Lynfield

  5. Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA

    Lee H. Harrison

  6. Monroe County Health Department,, Rochester, New York, USA

    Nancy M. Bennett

  7. Vanderbilt University School of Medicine, Vanderbilt Medical Center, Nashville, Tennessee, USA

    William Schaffner

  8. School of Public Health, University of California, Berkeley, California, USA

    Arthur Reingold

  9. Connecticut Department of Public Health, Connecticut Emerging Infections Program, Hartford, Connecticut, USA

    James Hadler

  10. Department of Human Services, Oregon Emerging Infections Program, Health Services, Office of Disease Prevention and Epidemiology, Portland, Oregon, USA

    Paul Cieslak

  11. Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA

    Matthew H. Samore

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  1. Althea W. McCormick
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Correspondence to Marc Lipsitch.

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McCormick, A., Whitney, C., Farley, M. et al. Geographic diversity and temporal trends of antimicrobial resistance in Streptococcus pneumoniae in the United States. Nat Med 9, 424–430 (2003). https://doi.org/10.1038/nm839

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