Background: The US routine infant pneumococcal vaccination program began in 2000 with PCV7, followed by PCV13 in February 2010. PCVs have induced direct protection in vaccinated children and indirect protection across all-age groups. PCV use could have reduced antibiotic resistance by reducing the number of pneumococcal disease cases overall and by reducing pneumococcal serotypes, such as 19A, known to be commonly resistant to antibiotics. Overall all-cause antibiotic consumption in the US population could have also impacted patterns of antibiotic resistance. We compared trends of IPD cumulative incidence, parenteral use of broad spectrum penicillin and cephalosporin for any cause in all healthcare settings, and antibiotic resistance to penicillin and cefotaxime in IPD isolates. Both antibiotic classes are commonly used to treat IPD.
Methods: Annual all-age IPD cases/100,000 population, antibiotic consumption, all-cause antibiotics consumption in eaches (pack size times total number of packages sold), and percentage of antibiotic non-susceptible isolates for 2009-2013 in US were assessed. Data were from publications from the US Active Bacterial Core surveillance for S. pneumonia and the IMS National Sales Perspectives, a proxy for US consumption of parenteral antibiotics.
Results: In the US, in the years following the introduction of PCV13, all-age, all-cause IPD incidence decreased from 14.3 to 10.4 cases per 100,000 population from 2009 through 2013. Parenteral use for any cause of broad spectrum penicillin and cephalosporin remained overall flat during the same period (from 60 to 59 million and 74 to 77 million eaches, respectively). The percentage of penicillin and cefotaxime non-susceptible IPD isolates decreased monotonically over time from 10.6% and 8.6% in 2010 to 4.7% and 2.6% in 2013, respectively.
Conclusion: PCV13 implementation has reduced all-cause IPD incidence across all-age groups by 28% in the US. Overall consumption of parenteral broad spectrum penicillin and cephalosporin for any cause did not decrease during the study period. However, antibiotic non-susceptible strains of IPD have also decreased. These findings suggest a link between the decrease of IPD through the use of PCV13 and the decrease of antibiotic resistance.
J. Scaife, Pfizer Inc: Employee , Salary
A. Quintana, Pfizer Inc: Employee , Salary
R. Isturiz, Pfizer Inc: Employee , Salary