No abstract

In Europe, antimicrobial resistance has been monitored since 1998 by the European Antimicrobial Resistance Surveillance System (EARSS). We examined the relationship between penicillin nonsusceptibility of invasive isolates of Streptococcus pneumoniae (an indicator organism) and antibiotic sales. Information was collected on 1998-99 resistance data for invasive isolates of S. pneumoniae to penicillin, based on surveillance data from EARSS and on outpatient sales during 1997 for beta-lactam antibiotics and macrolides. Our results show that in Europe antimicrobial resistance is correlated with use of beta-lactam antibiotics and macrolides.

Plague has received much attention because it may be used as a weapon by terrorists. Intentionally released aerosols of Yersinia pestis would cause pneumonic plague. In order to prepare for such an event, it is important, particularly for medical personnel and first responders, to form a realistic idea of the risk of person-to-person spread of infection. Historical accounts and contemporary experience show that pneumonic plague is not as contagious as it is commonly believed to be. Persons with plague usually only transmit the infection when the disease is in the endstage, when infected persons cough copious amounts of bloody sputum, and only by means of close contact. Before antibiotics were available for postexposure prophylaxis for contacts, simple protective measures, such as wearing masks and avoiding close contact, were sufficient to interrupt transmission during pneumonic plague outbreaks. In this article, I review the historical literature and anecdotal evidence regarding the risk of transmission, and I discuss possible protective measures.

In a community with a high prevalence of HIV infection, much of the burden of pneumococcal disease was attributable to AIDS. High incidence rates were seen in young adults and especially in black persons. Efforts to increase pneumococcal vaccination rates should target HIV-infected adults, particularly those living in poor urban areas.