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Rapidly Increasing Prevalence of Penicillin-Resistant Streptococcus pneumoniae in Middle Tennessee: a 10-Year Clinical and Molecular Analysis

Yi-Wei Tang,^1,2* Haijing Li,¹ Jane P. Griffin,² David W. Haas,^1,3 and Erika M. C. D'Agata^1,

Departments of Medicine,¹ Pathology,² Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee 37232³

Received 16 August 2001/ Returned for modification 18 September 2001/ Accepted 9 November 2001

The clinical and molecular epidemiology of penicillin-resistant Streptococcus pneumoniae and the diagnostic accuracy of a six-primer PCR assay in identifying penicillin resistance were analyzed by using clinical isolates recovered over a 10-year period in middle Tennessee. The prevalence of non-penicillin-susceptible S. pneumoniae isolates (MIC, 0.1 µg/ml) increased from 10% in 1990 to 70% in 1999 (P < 0.001). Among S. pneumoniae isolates for which the penicillin MIC was 2 µg/ml (highly penicillin-resistant S. pneumoniae [PRSP]), 23 and 5% were resistant to at least three and at least five other antimicrobial classes, respectively. Pulsed-field gel electrophoresis identified 13 unique strain types, with type B accounting for 33% of PRSP isolates. The sensitivity, specificity, and negative and positive predictive values of the PCR assay in detecting PRSP were 99, 100, 99, and 100%, respectively. Penicillin resistance is rapidly increasing among S. pneumoniae isolates in Tennessee. The simultaneous detection of S. pneumoniae and high-level penicillin resistance can be accurately performed with the six-primer PCR assay.

Present address: Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA 02215.

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