A Multicenter Evaluation of the US Prevalence and Regional Variation in Macrolide-Resistant S. pneumoniae in Ambulatory and Hospitalized Adult Patients in the United States

Abstract

Macrolide resistance was found in 39.5% of 3626 nonduplicate Streptococcus pneumoniae isolates from adult ambulatory and inpatient settings at 329 US hospitals (2018-2019). Macrolide resistance was significantly higher for respiratory vs blood isolates and ambulatory vs inpatient settings. Despite geographic variation, S. pneumoniae macrolide resistance was >25% in most regions.

Keywords: Streptococcus pneumoniae; antibiotic resistance; community-acquired pneumonia; epidemiology; macrolides.

Figure 1.

Geographic distribution of S. pneumoniae macrolide resistance rates by zip code. The data represent 3464 isolates collected from 314 facilities between October 2018 and September 2019.^a Shaded circles show the geographic centroid for each geographic cluster, and numbers indicate the total number of included hospitals at the state level. ^aFacilities with <5 isolates were not included, which resulted in slight differences between the numbers shown here and in Table 1. Data were aggregated into geographic clusters of ≥5 hospitals from ≥2 integrated delivery networks; the geographic centroid for each cluster is represented by a shaded circle. Zip code tabulation areas were attributed a rate based on that area’s proximity to the nearest cluster’s geographic centroid. Within each state, the number of hospitals in each cluster is distributed equally, and the total number of hospitals at the state level is labeled on the map. Data for contiguous states each containing <5 hospitals were aggregated (IA, NE, SD, MN, WI, MI; KY, WV, MD, DC, VA; MS, AR, MO).