Pneumococcal drug resistance: the new "special enemy of old age".

Streptococcus pneumoniae is a leading cause of illness and death among the elderly. The recent emergence of drug-resistant strains has complicated selection of antimicrobial therapy for suspected pneumococcal infections. In some areas of North America, nearly 40% of pneumococcal isolates from the blood or cerebrospinal fluid of persons > or = 65 years old had reduced susceptibility to penicillin. Of all penicillin-resistant infections, >30% occur in persons > or = 65 years old. The increasing prevalence of drug-resistant pneumococci and recent outbreaks of pneumococcal disease in chronic-care facilities emphasize the importance of efforts to prevent these infections in the elderly. Limiting selection for drug-resistant strains through judicious use of antimicrobial drugs and preventing invasive pneumococcal infections through increased use of pneumococcal vaccine form the foundation of these efforts.