We describe a patient with methicillin-resistant Staphylococcus aureus (MRSA) colonizing the pharynx. The MIC of mupirocin was 0.25 g/ml before treatment and increased after treatment to 8 g/ml. Using pulsedfield gel electrophoresis, we confirmed that the genotypes of MRSA that colonized the pharynx before and after the use of mupirocin were identical. We measured the delivery of mupirocin to the pharynx in three normal volunteers and two patients. Low concentrations of mupirocin were present in the pharynx in all cases 10 min to 3 days after intranasal application. Our data suggested that low concentrations of the drug in the pharynx after intranasal application of mupirocin ointment might explain the selection of mupirocin resistance in MRSA.
Out of 175 pneumococcal isolates from middle ear fluids, 26.3% were penicillin-resistant S. pneumoniae (PRSP). Serotypes 19F and 23F occurred most frequently among PRSP strains. The 7-valent pneumococcal conjugate vaccine (PCV) showed better coverage of PRSP strains (87.0%). The 7-valent PCV may reduce the prevalence of PRSP in Japan.Acute otitis media (AOM) is one of the leading infectious diseases caused by Streptococcus pneumoniae (3, 9). In recent decades, penicillin-resistant S. pneumoniae (PRSP) has evolved into a global problem, especially with AOM (7,12,18,21). The 7-valent pneumococcal conjugate vaccine (PCV) introduced in the United States and Europe has reduced the incidences of invasive pneumococcal disease and AOM (8,13,17,25,26). Nasopharyngeal carriage and transmission in children were also reduced (24). However, in Japan, use of the 7-valent PCV has not yet been licensed, and little is known about the distribution of pneumococcal serotypes. Prior to the introduction of 7-valent PCV in Japan, it is important to determine the distribution of pneumococcal serotypes in Japan as well as the prevalence of antimicrobial-resistant pneumococci associated with AOM. In this study, we evaluated the distribution of pneumococcal serotypes among children with AOM and determined the serotype coverage of pneumococcal vaccine formulas in Japan.(This paper was presented at the 108th General Meeting of the American Society for Microbiology, Boston, MA, 1 to 5 June 2008.)One hundred seventy-five pneumococcal isolates were collected randomly from middle ear fluids of 175 children with AOM at outpatient clinics in different regions of Japan during nationwide surveillance from February 2006 to June 2007. The range and quartiles of the ages of the subjects were 1 to 127, 12.8 (25th percentile), 17.0 (median), and 42.3 (75th percentile) months. Susceptibilities to penicillin G (PCG) were tested, and breakpoints were defined according to the Clinical and Laboratory Standards Institute (CLSI) (6). All isolates were serotyped or serogrouped by the capsular quelling method with pneumococcal capsule-specific antisera (Statens Serum Institut, Copenhagen, Denmark) as recommended by the manufacturer. The chi-square test and Fisher's exact test were used for categorical variables to test for significant differences between groups with Prism 4 (GraphPad Software, Inc.). A P value of Ͻ0.05 was considered statistically significant.Out of 175 pneumococcal isolates, 63 (36.0%), 66 (37.7%), and 46 (26.3%) were penicillin-susceptible S. pneumoniae (PSSP), penicillin-intermediate-resistant S. pneumoniae (PISP), and PRSP, respectively (Table 1). The predominant serotype was 19F (19.4%), followed by 23F (14.9%), 14 (11.4%), 6B (11.4%), 6A (9.1%), and 3 (9.1%). The distribution of S. pneumoniae serotypes among PCGsusceptible strains was significantly different from that among PCG-resistant strains (P Ͻ 0.01). Serotype 3 was the most prevalent PSSP serotype (odds ratio [OR], 78.2; 95% confidence interval [CI], 4.6 to 1,330; P Ͻ 0.01), while s...
Transmission of Streptococcus pneumoniae between children and their parents was evaluated in 29 pairs from 25 families. The serotypes of 35 pneumococcal isolates from 18 (62.1%) of 29 child-parent pairs were identical. Of the 35 isolates, 23 showed intermediate resistance and 10 were fully resistant to penicillin G. PCR indicated that all 35 strains had at least one alteration in penicillin-binding protein genes pbp1a, pbp2x, and pbp2b and 33 strains had macrolide resistance genes mef(A) and/or erm(B). As a result, the PCR patterns of 16 of 18 pairs were identical. Molecular typing by pulsed-field gel electrophoresis showed that 12 pairs were indistinguishable, 3 pairs were closely related, 2 pairs were possibly related, and only one pair was different. Our data indicate the presence of a high rate of transmission of penicillin-resistant S. pneumoniae between children and their parents.Streptococcus pneumoniae, which can colonize the human nasopharynx, is a leading bacterial cause of pneumonia, as well as otitis media, sinusitis, septicemia, and meningitis (10). Especially, children are frequent carriers of pneumococci, which may lead to invasive pneumococcal disease (5, 6). Penicillinresistant S. pneumoniae (PRSP) is widespread all over the world, and the resistance is broadening to include other antimicrobial agents (1, 9, 15). It has been reported that children could acquire PRSP at child care centers (13) or from their siblings (14). However, the problem of whether PRSP colonizing the upper respiratory tract can be transmitted between children and parents and cause invasive diseases is not clear. To address this issue, we conducted the following prospective study.New patients with invasive infections (e.g., pneumonia, sinusitis, otitis media, etc.) caused by S. pneumoniae who visited Nagasaki University Hospital or the Sugita Otorhinolaryngologic Clinic from January 2000 to May 2001 were asked to bring their family as soon as possible for clinical examination and collection of biological specimens (e.g., sputum, nasopharynx, middle ear). To diagnose invasive disease caused by pneumococci, gram-stained smears and cultures of good-quality specimens, according to the criteria of Bartlett (2), that were obtained as recently as possible were performed by standard methods. Fifty-four S. pneumoniae isolates from 29 pairs of children (mean age, 1.7 years) and their parents (mean age, 31.5 years) in 25 families were evaluated. We collected two isolates from each of 21 families and three isolates from each of 4 families. Culture plates were incubated overnight in a 5% CO 2 incubator. Optochin sensitivity and bile solubility tests were performed for confirmation of S. pneumoniae. The MICs of penicillin G (Meiji Seika Kaisha, Tokyo, Japan) for 54 S. pneumoniae isolates were determined by the broth microdilution method in accordance with the guidelines of the NCCLS (12). Pneumococci were serotyped on the basis of capsular swelling (Quellung reaction) observed microscopically after suspension in Pneumococcal Diagnostic An...
The present findings first indicate that minimally essential application of mupirocin ointment is an extremely useful ototopical agent against MRSA otorrhea without ototoxicity.
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