An Outbreak of Multidrug-Resistant Pneumococcal Pneumonia and Bacteremia among Unvaccinated Nursing Home Residents

Nuorti, J. Pekka; Butler, Jay C.; Crutcher, James M.; Guevara, Ramon E.; Welch, David; Holder, Patricia; Elliott, John A.

doi:10.1056/nejm199806253382601

Cited by 239 publications

(139 citation statements)

References 61 publications

Supporting

Mentioning

132

Contrasting

Unclassified

Order By: Relevance

“…Pneumococci are often part of the nasopharyngeal flora; especially due to circumstances of crowding, as observed in day-care centers, nursing homes, and hospitals, the risk of being colonized with pneumococci is increased (3,20,27,28). Usually, colonization is not followed by disease, as local barriers at the mucosal level of the respiratory tract and the human immune system are often protective.…”

mentioning

confidence: 99%

Molecular Epidemiology of Pneumococcal Carriage among Children with Upper Respiratory Tract Infections in Hanoi, Vietnam

Bogaert

Sluijter

et al. 2002

J Clin Microbiol

View full text Add to dashboard Cite

To investigate the molecular epidemiology of pneumococcal nasopharyngeal carriage in Hanoi, Vietnam, we studied 84 pneumococcal strains retrieved from children with upper respiratory tract infections. Serotypes 23F (32%), 19F (21%), 6B (13%), and 14 (10%) were found most often. A significant number of strains were antibiotic resistant. Fifty-two percent of the strains were (intermediate) resistant to penicillin, 87% were (intermediate) resistant to co-trimoxazole, 76% were resistant to tetracycline, 73% were resistant to erythromycin, and 39% were (intermediate) resistant to cefotaxime. Seventy-five percent were resistant to three or more classes of antibiotics. A high degree of genetic heterogeneity among the penicillin resistance genes was observed. In addition, the tetracycline resistance gene tet(M) and the erythromycin resistance gene erm(B) were predominantly observed among the isolates. Molecular analysis of the 84 isolates by restriction fragment end labeling (RFEL) revealed 35 distinct genotypes. Twelve of these genotypes represented a total of eight genetic clusters with 61 isolates (73%). The two largest clusters contained 24 and 12 isolates, and the isolates in those clusters were identical to the two internationally spreading multidrug-resistant clones Spain 23F-1 and Taiwan 19F-14, respectively. The remaining RFEL types were Vietnam specific, as they did not match the types in our reference collection of 193 distinct RFEL types from 16 countries. Furthermore, 57 of the 61 horizontally spreading isolates (93%) in the eight genetic clusters were covered by the seven-valent conjugate vaccine, whereas this vaccine covered only 43% of the isolates with unique genotypes. According to the serotype distribution of the nasopharyngeal pneumococcal isolates, this study suggests a high potential benefit of the seven-valent pneumococcal conjugate vaccine for children in Hanoi.

show abstract

mentioning

confidence: 99%

Molecular Epidemiology of Pneumococcal Carriage among Children with Upper Respiratory Tract Infections in Hanoi, Vietnam

Bogaert

Sluijter

et al. 2002

J Clin Microbiol

View full text Add to dashboard Cite

show abstract

“…It is a disease of continuing endemicity particularly in infancy and old age [6]. Day care centres are very likely to be places for spread of organisms in toddlers [7,8,9,10]. In military medical literature, there are accounts of pneumococcal outbreaks.…”

Section: Discussionmentioning

confidence: 99%

Outbreak of Pneumococcal Pneumonia among Military Recruits

Banerjee¹,

Kalghatgi

Saiprasad

et al. 2005

Medical Journal Armed Forces India

View full text Add to dashboard Cite

“…Multidrug-resistant strains of Streptococcus pneumonia accounted for 4 of these outbreaks. The largest, involved a 100-bed nursing home in Oklahoma (Nuorti JP, 1998). Eleven of 84 residents (13%) developed pneumonia, and 3 residents died.…”

Section: Others Outbreaksmentioning

confidence: 99%

“…The Author observed that 13% of the residents developed pneumonia, and that the mortality rate was 23%. Resistant isolates were recovered from 64% of residents with pneumonia and from 23% of non infected residents (Nuorti JP & Al, 1998).…”

Section: Penicillin-resistant Pneumococcimentioning

confidence: 99%