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NOTE: A surveillance case definition is a set of uniform criteria used to define a disease for public health surveillance. Surveillance case definitions enable public health officials to classify and count cases consistently across reporting jurisdictions. Surveillance case definitions are not intended to be used by healthcare providers for making a clinical diagnosis or determining how to meet an individual patient’s health needs.

Clinical Description

Streptococcus pneumoniae causes many clinical syndromes, depending on the site of infection (e.g., acute otitis media, pneumonia, bacteremia, or meningitis).

Laboratory Criteria For Diagnosis

  • Isolation of S. pneumoniae from a normally sterile site (e.g., blood, cerebrospinal fluid, or, less commonly, joint, pleural, or pericardial fluid), AND
  • "Nonsusceptible" isolate (i.e., intermediate- or high-level resistance of the S. pneumoniae isolate to at least one antimicrobial agent currently approved for use in treating pneumococcal infection+1,2

+Resistance defined by National Committee for Clinical Laboratory Standards (NCCLS)-approved methods and NCCLS-approved interpretive minimum inhibitory concentration (MIC) standards (µg/mL) for S. pneumoniae. NCCLS recommends that all invasive S. pneumoniae isolates found to be "possibly resistant" to beta-lactams (i.e., an oxacillin zone size of less than 20 mm) by oxacillin screening should undergo further susceptibility testing by using a quantitative MIC method acceptable for penicillin, extended-spectrum cephalosporins, and other drugs as clinically indicated.1

Case Classification


A clinically compatible case caused by laboratory-confirmed culture of S. pneumoniae identified as "nonsusceptible" (i.e., an oxacillin zone size of less than 20 mm) when oxacillin screening is the only method of antimicrobial susceptibility testing performed


A clinically compatible case that is laboratory confirmed


*The difference between this case definition and the previous case definition for this condition is the inclusion of new case classifications for reporting purposes.

Case classifications for Drug Resistant Streptococcus pneumoniae (DRSP) and Invasive pneumococcal disease (IPD) are modified as listed below:

  • Isolates causing IPD from children less than five years of age for which antibacterial susceptibilities are available and determined to be DRSP should be reported only as DRSP (event code 11720).
  • Isolates causing IPD from children less than five years of age which are susceptible, or for which susceptibilities are not available should be reported ONLY as IPD in children less than five years of age (event code 11717).


  1. National Committee for Clinical Laboratory Standards (NCCLS). Performance standards for antimicrobial susceptibility testing. Villanova, PA: National Committee for Clinical Laboratory Standards, 1994;14(16); NCCLS document M100-S5.
  2. CDC. Defining the public health impact of drug-resistant Streptococcus pneumoniae: Report of a working group. MMWR 1996;45(No. RR-1).

Related Case Definition(s)