Acute respiratory infections due to antibiotic-nonsusceptible Streptococcus pneumoniae in United States adults

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Background: (pneumococcus) in US adults (≥18 years). Methods: We estimated antibiotic-nonsusceptible pneumococcal sinusitis and non-bacteremic pneumonia incidence as products of non-bacteremic pneumococcal pneumonia and sinusitis incidence rates, serotype distribution, and serotype-specific antimicrobial nonsusceptibility prevalences by antibiotic class and guideline-recommended agents from 2016-2019. We derived pneumonia and sinusitis incidence rates from national healthcare utilization surveys and administrative datasets; pneumococcal-attributable attributable percents and serotype distributions from published data; and serotype-specific nonsusceptibility estimates from Active Bacterial Core surveillance data. We evaluated nonsusceptibility for all serotypes and those targeted by 15-, 20- and 21-valent pneumococcal conjugate vaccines (PCV15/20/21). Results: An estimated 16.4% (95% confidence interval 12.8-21.4%) of non-bacteremic pneumococcal pneumonia and 19.0% (14.8-24.9%) of sinusitis cases were nonsusceptible to ≥3 antibiotic classes, translating to 243,521 (179,673-333,675) and 1,844,726 (1,070,763-2,904,089) outpatient visits for pneumonia and sinusitis, respectively, and 10,155 (7,542-13,803) pneumonia hospitalizations annually. An estimated 31.2% (26.6-36.3%) of non-bacteremic pneumococcal pneumonia and 10.5% (9.4-12.0%) of pneumococcal sinusitis cases were nonsusceptible to ≥1 outpatient first-line antibiotic agent. Cases attributable to serotypes targeted by PCV15, PCV20, and PCV21 that were nonsusceptible to ≥3 antibiotic classes accounted for 7.4% (4.7-11.1%), 8.5% (5.8-12.1%), and 12.6% (9.2-17.5%) of all non-bacteremic pneumococcal pneumonia cases, and 8.4% (5.3-12.5%), 9.4% (6.2-13.4), and 14.4% (10.4-20.0%) of all pneumococcal sinusitis cases. Conclusions: We demonstrated high proportions of antibiotic nonsusceptibility in non-bacteremic pneumococcal pneumonia and sinusitis in US adults. PCVs and antibiotic stewardship may mitigate antibiotic nonsusceptibility in pneumococcal disease.

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