The Spread of Multiply Resistant Streptococcus pneumoniae at a Day Care Center in Ohio

Reichler, Mary R.; Allphin, Allan A.; Breiman, Robert F.; Schreiber, John R.; Arnold, James E.; McDougal, Linda K.; Facklam, Richard R.; Boxerbaum, Bernard; May, Daniel S.; Walton, Robert O.; Jacobs, Michael

doi:10.1093/infdis/166.6.1346

Cited by 356 publications

(160 citation statements)

References 44 publications

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“…[1][2][3] Studies of the epidemiology of PRSP have consistently identified a strong association between prior antibiotic use and the risk of acquiring PRSP. 1,[4][5][6] In light of these findings, the Centers for Disease Control and Prevention and other authorities have intensified their recommendations and efforts to promote judicious antibiotic use. [7][8][9][10] A recent study of physician practice patterns in the United States identified bronchitis as an important target for reducing unnecessary antibiotic use in ambulatory practice.…”

Section: T He Rapidly Rising Prevalence Of Penicillin-resistantmentioning

confidence: 99%

Factors associated with antibiotic use for acute bronchitis

et al. 1998

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OBJECTIVES:To describe the clinical features of adults diagnosed with acute bronchitis, and to identify clinical variables associated with antibiotic treatment of acute bronchitis. DESIGN:Prospective, cohort study. SETTING:Primary care office practices at a group-model HMO in the Denver metropolitan area. PATIENTS/PARTICIPANTS:Patients were adults seeking care for acute respiratory illnesses. Participating clinicians included internists, family medicine physicians, nurse practitioners, physician assistants, and registered nurses. MEASUREMENTS AND MAIN RESULTS:Clinicians voluntarily completed encounter forms for patients presenting with acute respiratory illnesses between February and May, 1996. Acute bronchitis was the primary diagnosis in 16% of acute respiratory illness visits ( n ‫؍‬ 1,525). The most frequent symptoms of acute bronchitis were cough (92%), phlegm production (63%), "runny nose" (50%), and throat pain (50%). The most frequent physical examination findings were pharyngeal erythema (45%), cervical lymphadenopathy (19%), wheezes (18%), and rhonchi (17%). Antibiotics were prescribed to 85% of patients diagnosed with acute bronchitis. Purulent nasal discharge by patient report, and sinus tenderness on physical examination were moderately associated with antibiotic treatment ( p ‫؍‬ .06 and .08, respectively). Antibiotic prescription rates did not vary by patient age or gender, duration of illness, days of work lost due to illness, or clinician type. CONCLUSIONS:Acute bronchitis is frequently treated with antibiotics in ambulatory practice. The clinical factors we identified to be associated with antibiotic use for acute bronchitis appear to play a minor role in explaining the excessive use of antibiotics for this condition. These findings suggest that clinicians use the diagnosis of acute bronchitis as an indication for antibiotic treatment, despite clinical trials and expert recommendations to the contrary. KEY WORDS: physician practice patterns; acute respiratory illness; antibiotic treatment; acute bronchitis. J GEN INTERN MED 1998;13:541-548.

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Section: T He Rapidly Rising Prevalence Of Penicillin-resistantmentioning

confidence: 99%

Factors associated with antibiotic use for acute bronchitis

et al. 1998

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“…Although the US, along with many other developed nations, is facing a large-scale problem with antibiotic resistant bacteria (Baquero, Baquero-Artigao, Canton, & Garcia-Rey, 2002;McCaig & Hughes, 1995;Neu, 1992;Reichler et al, 1992;Schwartz, 1999; Whitney et al, 2000;Wise et al, 1998), inappropriate prescribing of antibiotics for viral infections is common (Finkelstein et al, 2000;Gonzales, Malone, Maselli, & Sande, 2001;Gonzalez, Steiner, & Sande, 1997;Mainous, Hueston, & Clark, 1996;Mangione-Smith et al, in press;McCaig, Besser, & Hughes, 2002;Pennie, 1998). Inappropriate use of antibiotics has led to rapidly increasing risks of resistance among many strains of bacteria that commonly infect children and adults (Cristino, 1999;Deeks et al, 1999;Gomez et al, 1995;Nava et al, 1994;Watanabe et al, 2000).…”

mentioning

confidence: 99%

Non-antibiotic treatment recommendations: delivery formats and implications for parent resistance

Stivers

2005

Social Science & Medicine

144

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This study draws on a database of 570 community-based acute pediatric encounters in the USA and uses conversation analysis as a methodology to identify two formats physicians use to recommend non-antibiotic treatment in acute pediatric care (using a subset of 309 cases): recommendations for particular treatment (e.g., ''I'm gonna give her some cough medicine.'') and recommendations against particular treatment (e.g., ''She doesn't need any antibiotics.''). The findings are that the presentation of a specific affirmative recommendation for treatment is less likely to engender parent resistance to a non-antibiotic treatment recommendation than a recommendation against particular treatment even if the physician later offers a recommendation for particular treatment. It is suggested that physicians who provide a specific positive treatment recommendation followed by a negative recommendation are most likely to attain parent alignment and acceptance when recommending a non-antibiotic treatment for a viral upper respiratory illness. r

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“…The presence of multiply-resistant pneumococcal strains among children at a DCC and in household members and members of the surrounding community is of substantial importance because of the potential of these strains to cause invasive disease. 6,[9][10][11][12][13][14][15][16] This study also demonstrates that the risk of carrying multiply-resistant strains of pneumococci is directly related to the administration of antimicrobial therapy in the preceding three to four months. In settings in which a strain is resistant to multiple antimicrobial agents, prevalent antibiotic therapy can result in increased risk of carriage of the drug-resistant strain.…”

Section: Discussionmentioning

confidence: 55%

“…Our findings supports earlier studies from similar centers over the last decade. [9][10][11][12][13][14][15][16][17][18][19][20][21] Recent research established daycare attendance as an important factor influencing the epidemiology of many infectious diseases. [26][27][28] A number of studies have demonstrated a strong association between daycare attendance and increased carriage of S. pneumoniae, especially of resistant strains.…”

Section: Discussionmentioning

confidence: 99%

“…[9][10][11][12][13][14][15][16][17][18][19][20][21] Upper respiratory tract and invasive infections caused by such strains have increased. Antibiotic-resistant pneumococci were more common in isolates from children in DCC than in isolates from patients admitted at a tertiary care hospital -a group of patients presumably at increased risk of infection by resistant strains.…”

Section: Introductionmentioning

confidence: 99%

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Carriage of antibiotic-resistant pneumococci in a cohort of a daycare center

Gómez-Barreto¹,

Calderón-Jaimes²,

Rodrı́guez³

et al. 2002

Salud pública Méx

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ResumenObjetivo. Analizar longitudinalmente la dinámica de colonización por Streptococcus pneumoniae, determinar la prevalencia, los factores de riesgo potencial para la colonización nasofaríngea con cepas de neumococo resistentes, determinar los serotipos y el perfil de sensibilidad a varios fár-macos antimicrobianos. Material y métodos. Estudio prospectivo de una cohorte de niños de guardería, hecho de septiembre de 1997 a septiembre de 1999 entre 53 niños asistentes a la guardería del Hospital Infantil de México Federico Gómez, atendida por 20 empleados. Todos los participantes fueron seguidos en forma prospectiva, tomándose exudado nasofaríngeo cada cuatro meses. Los S. pneumoniae aislados se tipificaron y sometieron a pruebas de sensibilidad a diversos fármacos. Las razones de momios y la prueba exacta de Fisher o ji cuadrada se efectuaron a través de tablas de contingencia; se utilizaron intervalos de confianza a 95% para las razones de momios. Para el análisis se empleó el programa estadístico EPI INFO, versión 6.04 a. Resultados. S. pneumoniae se recuperó de 45/53 niños en una o más de las tomas. Se aisló un total de 178 cepas. El promedio de portador fue de 47%. Sólo siete adultos adquirieron un neumococo durante el estudio. Los tipos 6, 14, 19 y 23 representaron 77% del total. Se encontró elevada resistencia a la penicilina y eritromicina. Conclusiones. El estado de portador nasofaríngeo de S. pneumoniae, es un proceso dinámico. La colonización ocurre durante los primeros meses de vida y comprende solamente unos cuantos serotipos de neumococo. El estado portador disminuye conforme avanza la edad. Se encontró alta proporción de portadores con cepas resistentes de neumococo. Los niños que recibieron varios cursos de antimicrobianos, fueron Patients were enrolled in the study during a two-year period from September 1997 to September 1999. All the participants were followed prospectively, swabbing them every four months. The strains recovered were typed and screened for susceptibility to several antibiotics. The daycare records were reviewed also. Odds ratios and fisher's exact test: or chi square test of significance were computed from contingency tables as appropriate. Exact 95% confidence intervals were computed for odds ratios. Data analysis was performed using Epi statistics program version 6.04 a.Results. Pneumococci were recovered from 45/53 of the infants at one or more visits. A total of 178 isolates were carried. The carriage rate was 47%. Only 7 adults acquired pneumococci during the study. Types 6,14,19 and 23 were prevalent and represented 77% of the total. Antibioticresistant strains were higher to penicillin and erythromycin. Conclusions. Children were frequent carriers of pneumococci, the rate of carriage was high in infancy and tended to decrease with age. The types commonly carried by children were the same as those causing invasive disease. There is a high proportion of carriers with antibiotic-resistant S. pneumoniae strains. Children who have had frequent antimicrobial courses are at p...

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The Spread of Multiply Resistant Streptococcus pneumoniae at a Day Care Center in Ohio

Cited by 356 publications

References 44 publications

Factors associated with antibiotic use for acute bronchitis

Factors associated with antibiotic use for acute bronchitis

Non-antibiotic treatment recommendations: delivery formats and implications for parent resistance

Carriage of antibiotic-resistant pneumococci in a cohort of a daycare center

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