An Outbreak of Multidrug-Resistant Pneumococcal Pneumonia and Bacteremia among Unvaccinated Nursing Home Residents

Pneumococcal disease accounts for more deaths than any other vaccine-preventable bacterial disease. 1 Among the elderly, the case fatality rates for bacteremia approach 40 percent. 2 , 3 Most cases are sporadic, and during the antibiotic era outbreaks caused by a single pneumococcal serotype have been rare, occurring mainly in institutions such as hospitals, 4 military camps, 5 , 6 shelters, 7 , 8 jails, 9 day-care centers, 10 , 11 and nursing homes. 12 , 13 Since 1990, drug-resistant pneumococcal strains have become increasingly common in the United States, 14 – 18 making the selection of empirical treatment for pneumococcal infections difficult. 15 , 18 – 20 Drug-resistant infections have also been associated with certain institutional settings, . . .