Prevalence of antibiotic resistance and serotypes in pneumococci in England and Wales: results of observational surveys in 1990 and 1995

Objective : To assess the prevalence of antibiotic resistance and serotype distribution among pneumococci in England and Wales in 1990 and 1995. Design : Observational surveys in March 1990 and March 1995. During two weeks in each survey period all pneumococci isolated in public health laboratories in England and Wales were collected and assessed for sensitivity to antibiotics and the distribution of serogroups or serotypes. Setting : The network of public health laboratories throughout England and Wales. Subjects : 1127 individual patient isolates of Streptococcus pneumoniae obtained during the two surveys. Main outcome measures : Sensitivity or resistance to a range of antibiotics; serogroup or serotype. Results : The prevalence of intermediate or full resistance to penicillin increased from 1.5% in 1990 to 3.9% in 1995 and resistance to erythromycin increased from 2.8% to 8.6%. About 92% of isolates belonged to serogroups or serotypes included in the currently available pneumococcal vaccine. Conclusion : Resistance to penicillin and erythromycin has increased among pneumococci in England and Wales. Continued surveillance to assess further increases in the prevalence of pneumococcal resistance to antibiotics is essential. Key messages Resistance to cefotaxime or ceftriaxone, which may be the drugs of choice for pneumococcal meningitis caused by penicillin resistant pneumo- cocci, is still fairly rare Roughly 92% of pneumococcal isolates in England and Wales belong to serogroups or serotypes included in the currently available 23 valent vaccine Between 65.1% and 73.9% of pneumococcal isolates from children aged 2 or less belong to sero- groups or serotypes included in the five, seven, or nine valent conjugate vaccines under development for use in children of this age group Continued surveillance of pneumococcal resist- ance to antibiotics is essential if clinicians are to make rational decisions concerning the treatment of pneumococcal infections