Antibiotic-Resistant Streptococcus pneumoniae in US Adult Respiratory Infections
Overview
Antibiotic-nonsusceptible Streptococcus pneumoniae causes a significant burden of nonbacteremic pneumonia and sinusitis in US adults, with 16.4% of pneumonia and 19.0% of sinusitis cases resistant to three or more antibiotic classes. New pneumococcal conjugate vaccines (PCV15/20/21) target serotypes responsible for a substantial proportion of these resistant infections, highlighting opportunities for prevention.
Background
Streptococcus pneumoniae is a major cause of acute respiratory infections (ARIs) such as nonbacteremic pneumonia and sinusitis in adults. Antibiotic resistance in pneumococcal strains complicates treatment and is associated with increased morbidity and mortality. Resistance patterns vary by serotype, and vaccines targeting prevalent serotypes have historically reduced antibiotic-nonsusceptible infections. Newly licensed PCVs covering additional serotypes offer potential to further reduce resistant pneumococcal disease burden.
Data Highlights
Measure
Estimate (95% CI)
Annual Cases/Visits
Nonbacteremic pneumococcal pneumonia nonsusceptible to ≥3 antibiotic classes
Approximately 16.4% of nonbacteremic pneumococcal pneumonia and 19.0% of pneumococcal sinusitis cases in US adults are resistant to three or more antibiotic classes.
Over 31% of pneumonia and 10.5% of sinusitis cases are nonsusceptible to at least one first-line outpatient antibiotic agent.
Serotypes targeted by PCV15, PCV20, and PCV21 account for increasing proportions of antibiotic-nonsusceptible pneumococcal pneumonia and sinusitis cases.
Antibiotic-nonsusceptible pneumococcal infections result in substantial outpatient visits and hospitalizations annually.
Historical use of PCVs has reduced antibiotic-nonsusceptible pneumococcal infections, and newer vaccines may further mitigate this burden.
Clinical Implications
Clinicians should consider the high prevalence of antibiotic-nonsusceptible pneumococcal strains when selecting empiric therapy for adult patients with pneumonia or sinusitis. Incorporation of PCV15, PCV20, or PCV21 vaccination in eligible adults may reduce the incidence of resistant pneumococcal infections. Continued antibiotic stewardship is essential to limit further resistance development.
Conclusion
Antibiotic-nonsusceptible Streptococcus pneumoniae contributes substantially to the burden of adult nonbacteremic pneumonia and sinusitis in the US. Expanded pneumococcal vaccination and prudent antibiotic use are key strategies to mitigate this public health challenge.
References
CDC/WHO -- Recognition of antibiotic-nonsusceptible pneumococcal infections as health threats
Active Bacterial Core surveillance data 2016-2019 -- Serotype-specific antibiotic nonsusceptibility
US Pneumococcal Vaccination Recommendations 2023 -- PCV15/20/21 use in adults
