Limiting the spread of resistant pneumococci: Biological and epidemiologicevidence for the effectiveness of alternative interventions

Citation
Sj. Schrag et al., Limiting the spread of resistant pneumococci: Biological and epidemiologicevidence for the effectiveness of alternative interventions, CLIN MICROB, 13(4), 2000, pp. 588
Citations number
89
Language
INGLESE
art.tipo
Review
Categorie Soggetti
Microbiology
Journal title
CLINICAL MICROBIOLOGY REVIEWS
ISSN journal
0893-8512 → ACNP
Volume
13
Issue
4
Year of publication
2000
Database
ISI
SICI code
0893-8512(200010)13:4<588:LTSORP>2.0.ZU;2-#
Abstract
Strepzococcus pneumoniae infections are a leading cause of respiratory illn ess in young children, the elderly, and persons with chronic medical condit ions. The emergence of multidrug-resistant pneumococci has compromised the effectiveness of antibiotic therapy for pneumococcal infections. As antibio tic-resistant strains increase in prevalence, there is a need for intervent ions that minimize the spread of resistant pneumococci. In this review we p rovide a framework for understanding the spread of pneumococcal resistance and evaluate proposed interventions to reduce this spread. Pneumococci diff er from many drug-resistant pathogens because asymptomatic carriers play a key role in transmission of resistant strains and the genes encoding resist ance are spread primarily by transformation and conjugative transposons. Ev idence suggests that modifications of treatment regimens that have proved e ffective at limiting resistance in other pathogens may not prevent the spre ad of pneumococcal resistance. In contrast, programs encouraging more judic ious antibiotic use have been shown to be effective. Additionally, a newly developed conjugate pneumococcal vaccine holds great potential as an "antir esistance vaccine" that simultaneously reduces the burden of invasive disea se and the prevalence of resistant strains. Several areas of future epidemi ologic and laboratory research hold promise to contribute to the reduced sp read of pneumococcal resistance.