Pneumococcal Resistance to β-Lactam Antibiotics: A Global Geographic Overview

beta-Lactam resistance in Streptococcus pneumoniae has spread over the entire world. The 10 main foci of resistant organisms are located in the following areas: (1) southwest Europe (Spain, France, Portugal), (2) central-east Europe (Hungary, Roumania, Bulgaria, Turkey) and Israel, (3) northwest Russia, (4) South Africa, (5) Japan and South Korea, (6) Papua-New Guinea, (7) Alaska, (8) southeast North America, (9) southwest North America, and (10) south cone in South America. A comparison of the presumed factors influencing the increase of pneumococcal resistance in these foci with those occurring in low incidence areas, such as central-north Europe, Scandinavia, north and western Africa, or middle-north Mediterranean countries (Italy, Greece) should provide the clues to predict and prevent further spread of resistant pneumococci.