This enormous level of antimicrobial drug use in the community has implications at the individual level, especially for Streptococcus pneumoniae, the leading cause of community-acquired bacterial pneumonia, meningitis, sinusitis, and otitis media in the United States (3-5). Prior antibiotic use is a risk factor for carriage of, and infection with, antimicrobial-resistant S. pneumoniae (1,6-9). The very high rate of pediatric antibiotic use is especially important, particularly for individuals in childcare. As young children are the age group most likely to be pneumococcal carriers and most likely to be exposed to antimicrobial drugs, they are not surprisingly major carriers of resistant organisms (1,10) and at high risk of resistant infections (8). Colonized individuals in close quarters with symptoms of upper respiratory infection are at increased risk of spreading resistant organisms to other individuals (1). The transmission of drug-resistant pneumococci is of clinical importance, as shown by studies of inpatients with community-acquired pneumonia, infection with antimicrobial-resistant organisms demonstrating an increased risk of treatment failure, complications, and mortality (11-14).
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