Risk factors for carriage of drug-resistant Streptococcus pneumoniae among children in Memphis, Tennessee

Arnold, Kathryn E.; Leggiadro, Robert J.; Breiman, Robert F.; Lipman, Harvey; Schwartz, Benjamin; Appleton, Melissa A.; Cleveland, Kerry O.; Szeto, Herbert C.; Hill, Bertha C.; Tenover, Fred C.; Elliott, John A.; Facklam, Richard R.

doi:10.1016/s0022-3476(96)70326-8

Cited by 181 publications

(108 citation statements)

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“…9,36 Although the high prevalence of penicillin-resistant strains (MIC Ն2) is similar to that reported from some areas, 10,12 it far exceeds that found in most studies. 11,13,17 The variability in these reports is not surprising because most reflected a single geographic area.…”

Section: Discussionsupporting

confidence: 55%

“…9 Multidrug resistance (MDR) to several classes of antibiotics is also increasingly prevalent. 9,10 Despite broad consensus that pneumococcal resis-tance constitutes a significant threat, recent studies of nasopharyngeal carriage of resistant organisms among generally healthy children are limited. Community-based studies of colonization in the United States over the past decade have revealed varying rates of S pneumoniae colonization, 10 -14 with even more extreme international variability reported.…”

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confidence: 99%

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Antibiotic-Resistant Streptococcus pneumoniae in the Heptavalent Pneumococcal Conjugate Vaccine Era: Predictors of Carriage in a Multicommunity Sample

et al. 2003

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Objective. Despite immunization with heptavalent pneumococcal conjugate vaccine (PCV7), the rising prevalence of antibiotic resistance makes Streptococcus pneumoniae a continuing threat to child health. Data on carriage of resistant organisms by healthy children in communities in which immunization with PCV7 has been implemented will help to define and decrease these risks further. Methods. Children who were <7 years old, resided in a study community, and presented for routine well care or a “sick” visit between March 13 and May 11, 2001, at 31 primary care practices in 16 geographically distinct Massachusetts communities were studied. Consenting parents provided demographic information and data on potential risk factors for carriage of S pneumoniae and of penicillin-nonsusceptible S pneumoniae (PNSP). S pneumoniae isolates from nasopharyngeal specimens were tested for resistance to commonly used antibiotics including penicillin, ceftriaxone, erythromycin, and trimethoprim/sulfamethoxazole. Isolates were serotyped and grouped into PCV7-included serotypes, potentially cross-reactive serotypes (ie, an organism of a serogroup included in the vaccine), or non-PCV7 serotypes. Diagnosis on the day of collection, history of recent antibiotic use, and history of PCV7 immunization were obtained by chart review. Separate bivariate and multivariate analyses were performed to identify correlates of colonization with S pneumoniae and colonization with PNSP, accounting for clustering within communities. Results. S pneumoniae was isolated from the nasopharynx of 190 (26%) of the 742 children studied. Of the 166 tested, 33% were nonsusceptible to penicillin, with 14% showing intermediate susceptibility (minimum inhibitory concentration [MIC] 0.12–1.0) and 19% fully resistant (MIC ≥2). Nonsusceptibility to other antibiotics was common, including ceftriaxone (14%), erythromycin (22%), and trimethoprim/sulfa (31%); 20% of S pneumoniae isolates were not susceptible to ≥3 antibiotics. Thirty-six percent of isolates were of serotypes covered by PCV7; 30% were of PCV7 serogroups and potentially cross-reactive, but not 1 of the 7 included serotypes; and 34% were unrelated to PCV7 serogroups. Nonsusceptibility to penicillin was more common in PCV7-included strains (45%) and potentially cross-reactive strains (51%) than in non-PCV7 serotypes (8%). Risk factors for PNSP colonization included child care attendance (odds ratio [OR]: 3.9; 95% confidence interval [CI]: 2.3–6.5), current respiratory tract infection (OR: 4.7; 95% CI: 2.5–8.6), and recent antibiotic use (OR: 1.7; 95% CI: 1.0–2.8). PCV7 immunization was associated with decreased carriage of PCV7-included serotypes but not with an overall decrease in S pneumoniae colonization or with a decline in PNSP colonization. Conclusions. In this multicommunity sample, pneumococcal antibiotic resistance was common and was most frequently found in PCV7-included and PCV7 serogroup strains. The long-term impact of PCV7 immunization will be partially determined by the protection that it affords against invasive infection with potentially cross-reactive serotypes, as well as the virulence and future resistance patterns of unrelated serotypes.

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Section: Discussionsupporting

confidence: 55%

mentioning

confidence: 99%

Antibiotic-Resistant Streptococcus pneumoniae in the Heptavalent Pneumococcal Conjugate Vaccine Era: Predictors of Carriage in a Multicommunity Sample

et al. 2003

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“…Hospitalization has been shown to be associated with carriage of penicillin-resistant strains in children [20], but although there was an indication of increased risk of carriage associated with hospitalization (OR 3n56), this did not achieve significance as only 24 children (1n6 %) had been hospitalized. Several studies have shown an association between antibiotic use and carriage of resistant strains of Streptococcus pneumoniae [22,32]. Investigation of this association was made difficult because many of the parents were unaware of the types of drugs prescribed for their children.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of carriage of antimicrobial resistant strains of Streptococcus pneumoniae in primary school children in Hong Kong

Boost

O'Donoghue

Dooley³

2001

Epidemiol. Infect.

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SUMMARYA cross-sectional survey was conducted to determine prevalence and assess risk factors for carriage of antibiotic resistant strains of Streptococcus pneumoniae in healthy school children in Hong Kong. Throat swabs were collected from 1455 subjects and written questionnaires providing demographic data and medical history were completed by parents. The overall carriage rate of Streptococcus pneumoniae was 3n5 %, of which 49 % were penicillin resistant. High levels of resistance to tetracycline (73 %), erythromycin (52 %), trimethoprim (66 %) and ciprofloxacin (57 %) were observed. Carriage was associated with presence of a younger sibling (OR l 1n79) and use of antibiotics (OR l 2n31). High use of day care and small size of housing units did not result in a high rate of carriage. The low rate of carriage may be linked to high use of antibiotics, geographical factors or ethnicity. High rates of antibiotic resistance reflect heavy use of antibiotics by general practitioners.

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“…Woolfson et al 17 demonstraram uma prevalên-cia de colonização de 71,9% em nasofaringe de crianças africanas menores de 6 anos, com rinofaringite aguda. Arnold et al 18 encontraram 47% de portadores nos EUA, com metodologia semelhante. Dagan et al 19 , em Israel, encontraram elevada prevalência de colonização (63%) em crianças sadias.…”

Section: Discussionunclassified

Colonização de orofaringe por Streptococcus pneumoniae em crianças de creches municipais de Taubaté-SP: correlação entre os principais sorotipos e a vacina pneumocócica conjugada heptavalente

Lucarevschi¹,

Baldacci

Bricks

et al. 2003

J. Pediatr. (Rio J.)

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Objective: Streptococcus pneumoniae usually colonizes the oropharynx of healthy people. Oropharyngeal carriage is related to the invasion of adjacent structures and to the development of invasive disease. A descriptive cross-sectional study was performed aiming at verifying the prevalence of oropharyngeal colonization by S. pneumoniae in children attending day care centers in the city of Taubaté -SP; verifying the frequency of S. pneumoniae serotypes in isolated strains; and relating the most frequent serotypes to the composition of the conjugated heptavalent pneumococcal vaccine currently in use.Methods: from June 29 to December 15 1998, samples of oropharyngeal material were collected from 987 children, ranging from 8 to 71 months old, enrolled in day care centers in Taubaté -SP. The identification of S. pneumoniae was based on the observation of the colonies that presented partial hemolysis in agar-blood and agarblood with gentamycin plates and on the observation of inhibited growth around the optochin disc. Serotyping was performed by the Quellung reaction, using specific antiserum, provided by the Centers for Disease Control and Prevention (Atlanta, GA/USA), and the Danish nomenclature system.Results: as a result, S. pneumoniae was isolated from the oropharynx in 209 out of 987 children (colonization rate of 21.2%). Twenty eight serotypes were identified. The seven most frequent serotypes were: 6A/6B (21.5%), 19F (14.8%), 18C (7.4%), 23F (7.4%), 9V (6.7%), 14 (5.2%), 10A (4.4%). Except for serotype 10A, all the other six are included in the vaccine. The only vaccine serotype which was not found was serotype 4.Conclusion: agreement of 63% between the oropharynx colonizer serotypes and the serotypes present in the vaccine was found. ResumoObjetivos: o Streptococcus pneumoniae habitualmente coloniza a orofaringe de pessoas sadias. O estado de portador assintomático está relacionado à invasão de estruturas adjacentes e ao surgimento de doença invasiva. Foi realizado estudo transversal, descritivo, objetivando verificar a prevalência de colonização de orofaringe pelo S. pneumoniae em crianças que freqüentam creches no município de Taubaté, SP, verificar a freqüência de sorotipos de Streptococcus pneumoniae nas cepas isoladas e relacionar os sorotipos mais freqüen-tes com os sorotipos presentes na composição da vacina pneumocócica heptavalente conjugada atualmente em uso.Métodos: foram coletados, de 29 de junho a 15 de dezembro de 1998, 987 swabs de orofaringe de crianças entre 8 e 71 meses de idade, matriculadas nas creches municipais de Taubaté, SP. A identificação do S. pneumoniae foi baseada na observação das colônias que apresentassem hemólise parcial nos meios AS e AS-G, e pela observação da inibição do crescimento ao redor do disco de optoquina. A sorotipagem foi realizada pela reação de Quellung, utilizando anti-soros específi-cos, e adotado o sistema de nomenclatura dinamarquês.Resultados: o Streptococcus pneumoniae foi isolado em 209 das 987 crianças (taxa de colonização= 21,1%). Vinte e oito s...

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Risk factors for carriage of drug-resistant Streptococcus pneumoniae among children in Memphis, Tennessee

Cited by 181 publications

References 19 publications

Antibiotic-Resistant Streptococcus pneumoniae in the Heptavalent Pneumococcal Conjugate Vaccine Era: Predictors of Carriage in a Multicommunity Sample

Antibiotic-Resistant Streptococcus pneumoniae in the Heptavalent Pneumococcal Conjugate Vaccine Era: Predictors of Carriage in a Multicommunity Sample

Prevalence of carriage of antimicrobial resistant strains of Streptococcus pneumoniae in primary school children in Hong Kong

Colonização de orofaringe por Streptococcus pneumoniae em crianças de creches municipais de Taubaté-SP: correlação entre os principais sorotipos e a vacina pneumocócica conjugada heptavalente

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