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    GOOSSENS, M. C. CATRY, B. and VERHAEGEN, J. 2013. Antimicrobial resistance to benzylpenicillin in invasive pneumococcal disease in Belgium, 2003–2010: the effect of altering clinical breakpoints. Epidemiology and Infection, Vol. 141, Issue. 03, p. 490.


Probabilistic network modelling of the impact of penicillin consumption on spread of pneumococci

  • D. KARLSSON (a1) (a2)
  • DOI:
  • Published online: 15 December 2010

The worldwide increase of resistant S. pneumoniae is a growing clinical problem. In several countries, a more restrictive use of penicillin has been promoted in hope of slowing the rates of resistant pneumococci. However, the consequences of such an action on pneumococcal population dynamics are not fully understood. Thus, a network model was constructed to assess the impacts of penicillin consumption and between-strain competition on the spread of penicillin non-susceptible pneumococci. Model simulations suggest that the age distribution for carriage of penicillin non-susceptible pneumococci, in contrast to susceptible pneumococci, is affected by penicillin consumption. Furthermore, it appears extremely difficult to reduce the incidence of penicillin non-susceptible pneumococci by simply controlling penicillin consumption, assuming that reduced penicillin susceptibility does not confer a fitness cost for the organism. A more judicious use of penicillin together with control measures are in that case required to manage penicillin resistance in pneumococci.

Corresponding author
*Address for correspondence: Dr D. Karlsson, Infection Biology, School of Life Sciences, University of Skövde, Box 408, SE-541 28 Skövde, Sweden. (Email:
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1.M Lipsitch , MH Samore . Antimicrobial use and antimicrobial resistance: a population perspective. Emerging Infectious Diseases 2002; 8: 347354.

2.VA Arason , Clonal spread of resistant pneumococci despite diminished antimicrobial use. Microbial Drug Resistance 2002; 8: 187192.

3.K Ekdahl , Duration of nasopharyngeal carriage of penicillin-resistant Streptococcus pneumoniae: experiences from the south Swedish pneumococcal intervention project. Clinical Infectious Diseases 1997; 25: 11131117.

4.R Cohen , Change in nasopharyngeal carriage of Streptococcus pneumoniae resulting from antibiotic therapy for acute otitis media in children. Pediatric Infectious Disease Journal 1997; 16: 555560.

5.R Dagan , Dynamics of pneumococcal nasopharyngeal colonization during the first days of antibiotic treatment in pediatric patients. Pediatric Infectious Disease Journal 1998; 17: 880885.

6.F Ghaffar , Effects of amoxicillin/clavulanate or azithromycin on nasopharyngeal carriage of Streptococcus pneumoniae and Haemophilus influenzae in children with acute otitis media. Clinical Infectious Diseases 2000; 31: 875880.

7.K Sjostrom , Clonal success of piliated penicillin nonsusceptible pneumococci. Proceedings of the National Academy of Sciences USA 2007; 104: 1290712912.

8.VA Arason , Do antimicrobials increase the carriage rate of penicillin resistant pneumococci in children? Cross sectional prevalence study. British Medical Journal 1996; 313: 387391.

9.E Melander , Frequency of penicillin-resistant pneumococci in children is correlated to community utilization of antibiotics. Pediatric Infectious Disease Journal 2000; 19: 11721177.

10.N van de Sande-Bruinsma , Antimicrobial drug use and resistance in Europe. Emerging Infectious Diseases 2008; 14: 17221730.

11.K Auranen , Between-strain competition in acquisition and clearance of pneumococcal carriage – epidemiologic evidence from a longitudinal study of day-care children. American Journal of Epidemiology 2010; 171: 169176.

12.M Andersson , Modelling the spread of penicillin-resistant Streptococcus pneumoniae in day-care and evaluation of intervention. Statistics in Medicine 2005; 24: 35933607.

13.SS Huang , JA Finkelstein , M Lipsitch . Modeling community- and individual-level effects of child-care center attendance on pneumococcal carriage. Clinical Infectious Diseases 2005; 40: 12151222.

14.D Karlsson , An individual-based network model to evaluate interventions for controlling pneumococcal transmission. BMC Infectious Diseases 2008; 8: 83.

16.L Hogberg , Age- and serogroup-related differences in observed durations of nasopharyngeal carriage of penicillin-resistant pneumococci. Journal of Clinical Microbiology 2007; 45: 948952.

17.MP Borres , Carriage of penicillin-susceptible and non-susceptible pneumococci in healthy young children in Goteborg, Sweden. Journal of Infection 2000; 40: 141144.

18.M Kalin . Bacteremic pneumococcal pneumonia: value of culture of nasopharyngeal specimens and examination of washed sputum specimens. European Journal of Clinical Microbiology 1982; 1: 394396.

19.A Sandgren , Effect of clonal and serotype-specific properties on the invasive capacity of Streptococcus pneumoniae. Journal of Infectious Diseases 2004; 189: 785796.

25.S Libson , Nasopharyngeal carriage of Streptococcus pneumoniae at the completion of successful antibiotic treatment of acute otitis media predisposes to early clinical recurrence. Journal of Infectious Diseases 2005; 191: 18691875.

26.AS Craig , Carriage of multidrug-resistant Streptococcus pneumoniae and impact of chemoprophylaxis during an outbreak of meningitis at a day care center. Clinical Infectious Diseases 1999; 29: 12571264.

27.BM Gray , GM Converse 3rd, HC Dillon Jr.. Epidemiologic studies of Streptococcus pneumoniae in infants: acquisition, carriage, and infection during the first 24 months of life. Journal of Infectious Diseases 1980; 142: 923933.

31.SC Castle . Clinical relevance of age-related immune dysfunction. Clinical Infectious Diseases 2000; 31: 578585.

32.DI Andersson . The biological cost of mutational antibiotic resistance: any practical conclusions? Current Opinion in Microbiology 2006; 9: 461465.

33.SJ Schrag , B Beall , SF Dowell . Limiting the spread of resistant pneumococci: biological and epidemiologic evidence for the effectiveness of alternative interventions. Clinical Microbiology Reviews 2000; 13: 588601.

34.OG Vanderkooi , Predicting antimicrobial resistance in invasive pneumococcal infections. Clinical Infectious Diseases 2005; 40: 12881297.

35.JJ Calix , MH Nahm . A new pneumococcal serotype, 11E, has a variably inactivated wcjE gene. Journal of Infectious Diseases 2010; 202: 2938.

37.MH Kyaw , Effect of introduction of the pneumococcal conjugate vaccine on drug-resistant Streptococcus pneumoniae. New England Journal of Medicine 2006; 354: 14551463.

38.D Goldblatt , Antibody responses to nasopharyngeal carriage of Streptococcus pneumoniae in adults: a longitudinal household study. Journal of Infectious Diseases 2005; 192: 387393.

39.S Cauchemez , S. pneumoniae transmission according to inclusion in conjugate vaccines: Bayesian analysis of a longitudinal follow-up in schools. BMC Infectious Diseases 2006; 6: 14.

40.DR Feikin , Increased prevalence of pediatric pneumococcal serotypes in elderly adults. Clinical Infectious Diseases 2005; 41: 481487.

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Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
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