Risk Factors for Multidrug-Resistant Invasive Pneumococcal Disease in South Africa, a Setting with High HIV Prevalence, in the Prevaccine Era from 2003 to 2008

• Type of Material: Article
• Authors: Penny Crowther-Gibson, National Health Laboratory Service; Cheryl Cohen, University of Witwatersrand; Keith Klugman, Emory University; Linda de Gouveia, National Health Laboratory Service; Anne von Gottberg, National Health Laboratory Service
• Language: English
• Date: 2012-10-01
• Publisher: American Society for Microbiology
• Publication Version: Final Published Version
• Copyright Statement: © 2012, American Society for Microbiology. All Rights Reserved.
• Final Published Version (URL): http://dx.doi.org/10.1128/AAC.06463-11
• Title of Journal or Parent Work: Antimicrobial Agents and Chemotherapy
• ISSN: 0066-4804
• Volume: 56
• Issue: 10
• Start Page: 5088
• End Page: 5095
• Grant/Funding Information: This study received funding from the National Institute for Communicable Diseases of the National Health Laboratory Service and was supported in part by funds from the U.S. Agency for International Development's Antimicrobial Resistance Initiative, transferred via a cooperative agreement (number U60/CCU022088) from the Centers for Disease Control and Prevention (CDC), Atlanta, GA, and cooperative agreement U62/CCU022901 from the CDC.
• Keywords: CONJUGATE VACCINE; PHARMACOLOGY & PHARMACY; ANTIBIOTIC-RESISTANCE; ANTIMICROBIAL RESISTANCE; MICROBIOLOGY; PENICILLIN-RESISTANT; STREPTOCOCCUS-PNEUMONIAE; 10-YEAR PERIOD; Life Sciences & Biomedicine; Science & Technology; INCREASING PREVALENCE; UNITED-STATES; Microbiology; NASOPHARYNGEAL CARRIAGE; PEDIATRIC POPULATION; Pharmacology & Pharmacy
• Research Categories: Health Sciences, Public Health; Health Sciences, Pathology

Abstract

The emergence of multidrug-resistant (MDR) Streptococcus pneumoniae complicates disease management. We aimed to determine risk factors associated with MDR invasive pneumococcal disease (IPD) in South Africa and evaluate the potential for vaccination to reduce disease burden. IPD data collected by laboratory-based surveillance from 2003 through 2008 were analyzed. Multidrug resistance was defined as nonsusceptibility to any three or more different antibiotic classes. Risk factors for multidrug resistance were evaluated using multivariable logistic regression. Of 20,100 cases of IPD identified, 3,708 (18%) had MDR isolates, with the proportion increasing from 16% (461/2,891) to 20% (648/3,326) (P < 0.001) over the study period. Serotypes included in the 13-valent pneumococcal conjugate vaccine (PCV13) accounted for 94% of MDR strains. Significant risk factors for MDR IPD included PCV13 (1,486/6,407; odds ratio [OR] of 6.3; 95% confidence interval [CI] of 5.0 to 7.9) and pediatric (3,382/9,980; OR of 12.8; 95% CI of 10.6 to 15.4) serotypes, age of < 5 (802/3,110; OR of 2.0; 95% CI of 1.8 to 2.3) or ≥65 (39/239; OR of 1.5; 95% CI of 1.0 to 2.2) years versus age of 15 to 64 years, HIV infection (975/4,636; OR of 1.5; 95% CI of 1.2 to 1.8), previous antibiotic use (242/803; OR of 1.7; 95% CI of 1.4 to 2.1), previous hospital admissions (579/2,450; OR of 1.2; 95% CI of 1.03 to 1.4), urban location (883/4,375; OR of 2.0; 95% CI of 1.1 to 3.5), and tuberculosis treatment (246/1,021; OR of 1.2; 95% CI of 1.03 to 1.5). MDR IPD prevalence increased over the study period. The effect of many of the MDR risk factors could be reduced by more judicious use of antibiotics. Because PCV13 serotypes account for most MDR infections, pneumococcal vaccination may reduce the prevalence of multidrug resistance.