An Outbreak of Multidrug-Resistant Pneumococcal Pneumonia and Bacteremia among Unvaccinated Nursing Home Residents

• Published in: The New England journal of medicine Vol. 338; no. 26; pp. 1861 - 1868
• Main Authors: Nuorti, J. Pekka, Butler, Jay C, Crutcher, James M, Guevara, Ramon, Welch, David, Holder, Patricia, Elliott, John A
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 25-06-1998
• Subjects: Adult; Aged; Aged, 80 and over; Antimicrobial agents; Bacteremia - epidemiology; Bacteremia - microbiology; Bacterial diseases; Bacterial Vaccines; Biological and medical sciences; Cohort Studies; Confidence intervals; Disease Outbreaks; Drug Resistance, Multiple; Fatalities; Female; Human bacterial diseases; Humans; Infectious diseases; Male; Medical sciences; Microbial Sensitivity Tests; Middle Aged; Nasopharynx - microbiology; Nursing; Nursing Homes; Pneumococcal Infections - epidemiology; Pneumococcal Infections - microbiology; Pneumonia; Pneumonia, Pneumococcal - epidemiology; Pneumonia, Pneumococcal - microbiology; Retrospective Studies; Risk Factors; Staphylococcal infections, streptococcal infections, pneumococcal infections; Streptococcus infections; Streptococcus pneumoniae; Streptococcus pneumoniae - classification; Streptococcus pneumoniae - drug effects; Streptococcus pneumoniae - isolation & purification; United States; North America; America; United States > US; Epidemic; Lung disease; Pneumonia; Prevalence; Respiratory disease; Vaccination; Streptococcus pneumoniae; Infection; Prevention; Immunoprophylaxis; Streptococcaceae; Chemotherapy; Cohort study; Multiple resistance; Bacteriosis; Bacteria; Micrococcales; Homes for the aged
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJM199806253382601

Pneumococcal disease accounts for more deaths than any other vaccine-preventable bacterial disease.
1
Among the elderly, the case fatality rates for bacteremia approach 40 percent.
2
,
3
Most cases are sporadic, and during the antibiotic era outbreaks caused by a single pneumococcal serotype have been rare, occurring mainly in institutions such as hospitals,
4
military camps,
5
,
6
shelters,
7
,
8
jails,
9
day-care centers,
10
,
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and nursing homes.
12
,
13
Since 1990, drug-resistant pneumococcal strains have become increasingly common in the United States,
14
–
18
making the selection of empirical treatment for pneumococcal infections difficult.
15
,
18
–
20
Drug-resistant infections have also been associated with certain institutional settings, . . .