Sentinel surveillance as an alternative approach for monitoring antibiotic-resistant invasive pneumococcal disease in Washington State.

OBJECTIVES As an alternative to statewide, mandated surveillance for antibiotic-resistant Streptococcus pneumoniae, a sentinel surveillance network of 27 hospitals was developed in Washington State. METHODS The utility of targeted surveillance in population centers was assessed, current laboratory susceptibility testing practices were evaluated, and a baseline of pneumococcal resistance in Washington State was obtained for use in a statewide campaign promoting the judicious use of antibiotics. RESULTS Between July 1997 and June 1998, 300 cases were reported; 67 (22%) had diminished susceptibility to penicillin. Only 191 (64%) were fully tested with penicillin and an extended-spectrum cephalosporin (ESC) as nationally recommended; 10.5% were resistant to penicillin and 6.8% were resistant to an ESC. The number of isolates inadequately tested declined through the year. The findings were similar to those from more comprehensive active surveillance in Oregon for the same time period. CONCLUSIONS Targeted surveillance may be an adequate alternative for limited monitoring of antibiotic resistance for states that choose not to mandate reporting.