The emergence of Streptococcus pneumoniae resistant to macrolide antimicrobial agents: a 6-year population-based assessment.

From 1994 through 1999, the available isolates (4148 isolates) from active population-based surveillance of invasive pneumococcal disease in metropolitan Atlanta were serotyped and were tested for antimicrobial susceptibility. Macrolide-resistant isolates were studied for the presence of ermAM (a ribosomal methylase gene), mefE (a macrolide efflux gene), and tetM (the class M tetracycline resistance gene). Macrolide resistance increased from 16% of all invasive isolates in 1994 to 32% in 1999. Of the macrolide-resistant pneumococcal isolates studied, 99% contained genomic copies of mefE or ermAM. Isolates with ermAM were mainly serotypes 6B, 23F, 14, or 19F and contained tetM; mefE-associated isolates were predominantly serotypes 14, 6A, or 19F, and most did not contain tetM. The frequency of the ermAM-mediated phenotype in invasive Streptococcus pneumoniae remained stable over the 6-year surveillance. However, the mefE-mediated phenotype increased from 9% in 1994 to 26% of all isolates in 1999 and was noted in new serotypes. By 1999, 93% of the mefE-containing strains had minimum inhibitory concentrations >/=8 microgram/mL. Dissemination of the mefE determinant accounted for the rapid increase in the rate of macrolide resistance in our S. pneumoniae population.

Evaluation of subjective oral health status indicators.

OBJECTIVES: This paper reports the results of a study to evaluate the performance of a battery of subjective oral health status indicators originally developed for use in large scale surveys of older adults. The aim was to assess their generalizability, efficiency, reliability, and validity when used in a study of adults aged 18 years and over and to compare their performance with respect to younger and older adults. METHODS: Data were collected by means of a mail survey and self-complete questionnaire of a random sample of the population aged 18 years and older. RESULTS: The results suggested that the measures were sensitive to the oral health concerns of adults of all ages and that item nonresponse was within acceptable limits. Test-retest and internal consistency reliability statistics were good and all hypotheses designed to assess concurrent and construct validity were confirmed. CONCLUSIONS: The results confirm an earlier, but more limited, evaluation and suggest that these indicators are useful for descriptive oral health surveys of general populations.