To investigate the nasal carriage of antibiotic-resistant pneumococci by children, anterior nasal swabs were done for 4963 children <5 years old in 11 countries in Asia and the Middle East. In total, 1105 pneumococci isolates (carriage rate, 22.3%) were collected, 35.8% of which were found to be nonsusceptible to penicillin. Prevalence of penicillin nonsusceptibility was highest in Taiwan (91.3%), followed by Korea (85.8%), Sri Lanka (76.5%), and Vietnam (70.4%). Penicillin resistance was related to residence in urban areas, enrollment in day care, and a history of otitis media. The most common serogroups were 6 (21.5%), 23 (16.5%), and 19 (15.7%). The most common clone, as assessed by pulsed-field gel electrophoresis, was identical to the Spanish 23F clone and to strains of invasive isolates from adult patients. Data in this study documented the high rate of penicillin or multidrug resistance among isolates of pneumococci carried nasally in children in Asia and the Middle East and showed that this is due to the spread of a few predominant clones in the region.

We report a case of Pseudomonas pseudomallei infection, in which the patient acquired the bacteria by aspiration of river water after a drowning incident near Manila, the Philippines. The pulmonary form of melioidosis was noted at the onset, but septicemia developed at a later stage. Positive blood cultures were obtained 17 days after the accident. The patient was treated successfully with a combination of amikacin and cephalothin. This is the first report of P. pseudomallei infection documented in Taiwan. Melioidosis, a rapidly fatal granulomatous disease caused by Pseudomonas pseudomallei, was first described by Whitmore and Krishnaswami in 1912 (29). It was observed that human infections with P. pseudomallei occurred almost exclusively in the between latitude 200 north and latitude 20°s outh. It is endemic in Southeast Asia (Indochina) (19). Although Taiwan is very close geographically to this area, no case of melioidosis has been reported. The present report describes the first imported case ofP. pseudomallei infection in Taiwan. Interestingly, the route of infection was neither airborne transmission nor introduction of the bacterium into a skin wound as reported for the majority of the cases (2, 7, 12). The patient acquired the organisms by aspiration of river water, and developed sepsis after a drowning incident near

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