This is a presentation by Professor Keith Klugman,
the William H. Foege Professor of Global Health at
the Rollins School of Public Health in Atlanta Georgia,
and I will be addressing you on this subject of
Risk Factors for Antibiotic Resistance in Streptococcus Pneumoniae.
The pneumococcus is important
because acute respiratory infections are the leading infectious cause of death.
Now, deaths from acute respiratory infections
is really a function of death from pneumonia,
and the pneumococcus is the leading pathogen that causes pneumonia.
Deaths from acute respiratory infections outnumber deaths from AIDS, TB, and Malaria,
and are characterized by an enormous burden of
mortality that is around two million deaths per year,
in both children and in adults.
There are a considerable number of factors
that select for antibiotic-resistant pneumococci,
and I will review all of these factors in the course of this presentation.
The first factor to consider is age.
Resistance to all of the major classes of anti-microbials used to treat
pneumococcal infections has emerged in
children with one important exception that I will come to later.
In this slide, we are reviewing the incidence of
penicillin-resistance in the pneumococcus, in Brazil.
And it is striking,
that the burden of
penicillin-resistant pneumococci is much higher in children less than five years of age,
in the upper bar,
than in those more than five years of age,
in the dotted line below.
One of the largest studies on risk factors for anti-microbial resistance in