Drug-resistant Streptococcus pneumoniae infections: clinical importance, drug treatment, and prevention.

Drug-resistant Streptococcus pneumoniae (DRSP) have complicated the management of pneumococcal infections throughout the world in recent years. Important risk factors for the development of a DRSP infection include recent antibiotic use, young age, immunosuppression, daycare center attendance, and recent hospitalizations. Although intermediate resistance to beta-lactam antibodies does not appear to have an impact on the mortality of S. pneumoniae infections, evidence is accumulating to suggest that more highly resistant isolates may increase mortality. Clinical and bacteriologic failures are more common in DRSP meningitis and otitis media. To select appropriate therapy, one must consider whether a patient has risk factors for resistance, the site and severity of the infection, and antibiotic susceptibility data. Reducing the impact of DRSP may be achieved through reducing antibiotic use in communities and increased understanding of other factors that contribute to the development and transmission of resistance. The most important way to reduce all S. pneumoniae infections is to increase the use of existing polysaccharide vaccines and to begin to use new polysaccharide-protein conjugate vaccines in young children.