Nasopharyngeal Colonization With Streptococcus Pneumoniae in Children Receiving Trimethoprim-Sulfamethoxazole Prophylaxis

Abdel‐Haq, Nahed; Abuhammour, Walid; Asmar, Basim I.; Thomas, Ronald; Dabbagh, Shermine; González, Ricardo

doi:10.1097/00006454-199907000-00017

Cited by 36 publications

(9 citation statements)

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“…This phenomenon occurred both in the crèche and in the orphanage facilities in this study, where the spread of two unrelated pneumococcal clones clearly correlated with prior treatment with ␤-lactams. Similar associations were reported by other researchers in relation to macrolides and trimethoprim-sulfamethoxazole (1,19). In this study, these antimicrobial agents were prescribed only occasionally in both centers.…”

Section: Discussionsupporting

confidence: 91%

Characteristics of Streptococcus pneumoniae , Haemophilus influenzae , and Moraxella catarrhalis Isolated from the Nasopharynges of Asymptomatic Children and Molecular Analysis of S. pneumoniae and H. influenzae Strain Replacement in the Nasopharynx

et al. 2004

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Nasopharyngeal carriage of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis in 226 children in different settings (in a crèche [day care center], in an orphanage, and at home) during two seasons (winter and spring) was studied. The rates of carriage of S. pneumoniae and H. influenzae were markedly higher in the crèche and in the orphanage than in the home setting (e.g., 56.5, 63.3, and 25.9%, respectively, for S. pneumoniae in winter). Approximately 80% of the S. pneumoniae isolates identified in the crèche and in the orphanage belonged to the serotypes represented in the seven-valent pneumococcal vaccine, and 4.4% of the children were colonized by H. influenzae type b. Almost all H. influenzae isolates were fully susceptible to the antimicrobial agents tested, and only five (3.6%) produced ␤-lactamase; in contrast, 100% of the M. catarrhalis isolates were ␤-lactamase positive. Among S. pneumoniae isolates, 36.2% were nonsusceptible to penicillin (PNSP) and 11.8% were fully resistant to penicillin (PRP). All PNSP isolates were obtained from children at the crèche and at the orphanage but not among children brought up at home, and all PRP isolates showed a multiresistant phenotype. Colonization by PRP isolates correlated well with prior treatment with ␤-lactams. For the majority of children colonized at both sampling times, strain replacement of S. pneumoniae and H. influenzae was observed; long-term colonization by a single strain was rare.The nasopharynx of children is colonized by a broad variety of microorganisms, including such potential pathogens as Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Well-known risk factors that promote bacterial carriage include overcrowding, e.g., due to attending day care centers (DCCs) (crèches) or residing in orphanages; frequent viral infections; and an excessive use of antibiotics (12). DCCs and orphanages have also been identified as places that promote the clonal spread of multiresistant strains; thus, healthy children represent an important reservoir of bacterial strains, in particular, S. pneumoniae, that are resistant to many antimicrobial agents. These strains are subsequently disseminated in the community by other contacts of colonized children, e.g., their siblings and parents. It is possible to limit the spread of H. influenzae type b and some serotypes of S. pneumoniae by vaccination, but studies of the impact of immunization on colonization have yielded discrepant results (5,11,14,22).Colonization of mucosal surfaces in the human respiratory tract represents a dynamic process in which bacteria are acquired, eliminated, and reacquired many times in a lifetime. Extensive and often excessive use of antibiotics can promote the replacement of strains susceptible to antimicrobial agents by resistant ones (12, 28). Moreover, the human nasopharynx is also often viewed as a place where frequent genetic exchange takes place due to such processes as transformation with foreign DNA, bacterial intra-and interspecies c...

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Section: Discussionsupporting

confidence: 91%

Characteristics of Streptococcus pneumoniae , Haemophilus influenzae , and Moraxella catarrhalis Isolated from the Nasopharynges of Asymptomatic Children and Molecular Analysis of S. pneumoniae and H. influenzae Strain Replacement in the Nasopharynx

et al. 2004

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“…In another study conducted in America, no difference was reported in either the pneumococcal carriage rate or the level of CoT-resistant pneumococci (42). A further study in America showed that although there was no effect on pneumococcal carriage, higher levels of resistance to penicillin and CoT were observed (1). A more recent study in Zambia indicated that CoT prophylaxis reduced colonization by ca.…”

Section: Discussionmentioning

confidence: 93%

Impact of Cotrimoxazole on Carriage and Antibiotic Resistance of Streptococcus pneumoniae and Haemophilus influenzae in HIV-Infected Children in Zambia

Mwenya

Charalambous

Phillips

et al. 2010

Antimicrob Agents Chemother

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This is a substudy of a larger randomized controlled trial on HIV-infected Zambian children, which revealed that cotrimoxazole prophylaxis reduced morbidity and mortality despite a background of high cotrimoxazole resistance. The impact of cotrimoxazole on the carriage and antibiotic resistance of Streptococcus pneumoniae and Haemophilus influenzae as major causes of childhood mortality in HIV-infected children was investigated since these are unclear. Representative nasopharyngeal swabs were taken prior to randomization for 181 of 534 children (92 on cotrimoxazole and 89 on placebo). Bacterial identification and antibiotic susceptibility were performed by routine methods. Due to reduced mortality, prophylactic cotrimoxazole increased the median time from randomization to the last specimen from 48 to 56 months (P ‫؍‬ 0.001). The carriage of H. influenzae was unaltered by cotrimoxazole. Carriage of S. pneumoniae increased slightly in both arms but was not statistically significant in the placebo arm. In S. pneumoniae switching between carriage and no carriage in consecutive pairs of samples was unaffected by cotrimoxazole (P ‫؍‬ 0.18) with a suggestion that the probability of remaining carriage free was lower (P ‫؍‬ 0.10). In H. influenzae cotrimoxazole decreased switching from carriage to no carriage (P ‫؍‬ 0.02). Cotrimoxazole resistance levels were higher in postbaseline samples in the cotrimoxazole arm than in the placebo arm (S. pneumoniae, P < 0.0001; H. influenzae, P ‫؍‬ 0.005). Cotrimoxazole decreased switching from cotrimoxazole resistance to cotrimoxazole sensitivity in S. pneumoniae (P ‫؍‬ 0.002) and reduced the chance of H. influenzae remaining cotrimoxazole sensitive (P ‫؍‬ 0.05). No associations were observed between the percentage of CD4 (CD4%), the change in CD4% from baseline, child age at date of specimen, child gender, or sampling month with carriage of either pathogen.

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“…TMP-SMX prophylaxis, given to all HIV-exposed and infected children from 6 weeks of age to prevent Pneumocystis jirovecii pneumonia (PCP) has been associated with NP carriage of multiresistant S. pneumoniae [ 14 ] and increased colonization with S. aureus [ 15 ]. Moreover, its use for intercurrent infections such as otitis media, is linked to increased resistance [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

High incidence of antimicrobial resistant organisms including extended spectrum beta-lactamase producing Enterobacteriaceae and methicillin-resistant Staphylococcus aureusin nasopharyngeal and blood isolates of HIV-infected children from Cape Town, South Africa

et al. 2008

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BackgroundThere is little information on nasopharyngeal (NP) flora or bacteremia in HIV-infected children. Our aim was to describe the organisms and antimicrobial resistance patterns in children enrolled in a prospective study comparing daily and three times weekly trimethoprim-sulfamethoxazole (TMP-SMX) and isoniazid (INH) or placebo prophylaxis.MethodsNP swabs were taken at baseline from HIV-infected children enrolled in the study. Standard microbiological techniques were used. Children were grouped according to previous or current exposure to TMP-SMX and whether enrolled to the study during a period of hospitalization. Blood culture results were also recorded within 12 months of baseline.ResultsTwo hundred and three children, median age 1.8 (Interquartile [IQ]: 0.7–4) years had NP swabs submitted for culture. One hundred and eighty-four (90.7%) had either stage B or C HIV disease. One hundred and forty-one (69.8%) were receiving TMP-SMX and 19 (9.4%) were on antiretroviral therapy. The majority, 168 (82%) had a history of hospitalization and 91 (44.8%) were enrolled during a period of hospitalization. Thirty-two subjects (16.2%) died within 12 months of study entry.One hundred and eighty-one potential pathogens were found in 167 children. The most commonly isolated organisms were Streptococcus pneumoniae (48: 22.2%), Gram-negative respiratory organisms (Haemophilus influenzae and Moraxella catarrhalis) (47: 21.8%), Staphylococcus aureus (44: 20.4%), Enterobacteriaceae 32 (14.8%) and Pseudomonas 5 (2.3%).Resistance to TMP-SMX occurred in > 80% of pathogens except for M. catarrhalis (2: 18.2% of tested organisms). TMP-SMX resistance tended to be higher in those receiving it at baseline (p = 0.065). Carriage of Methicillin resistant S. aureus (MRSA) was significantly associated with being on TMP-SMX at baseline (p = 0.002). Minimal inhibitory concentrations (MIC) to penicillin were determined for 18 S. pneumoniae isolates: 7 (38.9%) were fully sensitive (MIC ≤ 0.06 μg/ml), 9 (50%) had intermediate resistance (MIC 0.12 – 1 μg/ml) and 2 (11.1%) had high level resistance (MIC ≥2 μg/ml). Fifty percent of Enterobacteriaceae produced extended spectrum beta-lactamases (ESBL) (resistant to third generation cephalosporins) and 56% were resistant to gentamicin. Seventy-seven percent of S. aureus were MRSA. Carriage of resistant organisms was not associated with hospitalization.On multivariate logistic regression, risk factors for colonization with Enterobacteriaceae were age ≤ one year (Odds ratio 4.4; 95% Confidence Interval 1.9–10.9; p = 0.0008) and CDC stage C disease (Odds ratio 3.6; 95% Confidence Interval 1.5–8.6; p = 0.005)Nineteen (9.4%) subjects had 23 episodes of bacteremia. Enterobacteriaceae were most commonly isolated (13 of 25 isolates), of which 6 (46%) produced ESBL and were resistant to gentamicin.ConclusionHIV-infected children are colonized with potential pathogens, most of which are resistant to commonly used antibiotics. TMP-SMX resistance is extremely common. Antibiotic resistance is widespread in col...

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Nasopharyngeal Colonization With Streptococcus Pneumoniae in Children Receiving Trimethoprim-Sulfamethoxazole Prophylaxis

Cited by 36 publications

References 15 publications

Characteristics of Streptococcus pneumoniae , Haemophilus influenzae , and Moraxella catarrhalis Isolated from the Nasopharynges of Asymptomatic Children and Molecular Analysis of S. pneumoniae and H. influenzae Strain Replacement in the Nasopharynx

Characteristics of Streptococcus pneumoniae , Haemophilus influenzae , and Moraxella catarrhalis Isolated from the Nasopharynges of Asymptomatic Children and Molecular Analysis of S. pneumoniae and H. influenzae Strain Replacement in the Nasopharynx

Impact of Cotrimoxazole on Carriage and Antibiotic Resistance of Streptococcus pneumoniae and Haemophilus influenzae in HIV-Infected Children in Zambia

High incidence of antimicrobial resistant organisms including extended spectrum beta-lactamase producing Enterobacteriaceae and methicillin-resistant Staphylococcus aureusin nasopharyngeal and blood isolates of HIV-infected children from Cape Town, South Africa

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