Mohanty Salini, Johnson Kelly D, Yu Kalvin C, Watts Janet A, Gupta Vikas
Center for Observational and Real World Evidence (CORE), Merck & Co., Inc., Rahway, New Jersey, USA.
Becton, Dickinson & Company, Franklin Lakes, New Jersey, USA.
Open Forum Infect Dis. 2022 Sep 2;9(9):ofac420. doi: 10.1093/ofid/ofac420. eCollection 2022 Sep.
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.
From January 2011 to February 2020, we evaluated 30-day nonduplicate isolates from 290 US hospitals (BD Insights Research Database) from adults (≥18 years) in inpatient and outpatient settings. Isolates were required to have ≥1 AMR result for invasive (blood, cerebrospinal fluid/neurologic) or noninvasive (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.
Over the study period, 34 039 isolates were analyzed (20 749 [61%] from noninvasive sources and 13 290 [39%] from invasive sources). Almost half (46.6%) of the isolates were resistant to ≥1 drug, and noninvasive isolates had higher rates of AMR than invasive isolates. Total 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; < .001). Significant decreasing trends were observed for penicillin (-1.6%/year; < .001), extended-spectrum cephalosporins (ESCs; -0.35%/year; < .001), and ≥3 drugs (-0.5%/year; < .001).
Despite decreasing trends for penicillin, ESCs, and resistance to ≥3 drugs, AMR rates are persistently high in isolates among US adults. Increasing macrolide resistance suggests that efforts to address AMR in may require antimicrobial stewardship efforts and higher-valent pneumococcal conjugate vaccines.
肺炎球菌疾病的管理因高抗菌药物耐药率（AMR）而变得复杂。本研究评估了肺炎球菌疾病成年患者中肺炎链球菌分离株的AMR趋势。
2011年1月至2020年2月，我们评估了来自美国290家医院（BD洞察研究数据库）住院和门诊成年患者（≥18岁）的30天内非重复分离株。分离株需有侵袭性（血液、脑脊液/神经系统）或非侵袭性（呼吸道或耳鼻喉）肺炎球菌疾病样本的≥1个AMR结果。AMR的判定基于机构报告的中介或耐药情况。采用描述性统计和广义估计方程评估随时间的变化。
在研究期间，共分析了34039株分离株（20749株[61%]来自非侵袭性来源，13290株[39%]来自侵袭性来源）。几乎一半（46.6%）的分离株对≥1种药物耐药，非侵袭性分离株的AMR率高于侵袭性分离株。分离株对大环内酯类（37.7%）、青霉素（22.1%）和四环素（16.1%）的耐药率较高。多变量建模确定大环内酯类耐药呈显著上升趋势（+1.8%/年；P<0.001）。观察到青霉素（-1.6%/年；P<0.001）、广谱头孢菌素（ESCs；-0.35%/年；P<0.001）和≥3种药物（-0.5%/年；P<0.001）的显著下降趋势。
尽管青霉素、ESCs以及对≥3种药物的耐药呈下降趋势，但美国成年患者分离株中的AMR率仍然居高不下。大环内酯类耐药增加表明，应对AMR的努力可能需要抗菌药物管理措施和更高价的肺炎球菌结合疫苗。
