BackgroundIncreasing pneumococcal resistance to commonly used antibiotics and multidrug resistance is a serious public health concern. Data on distribution of resistant Streptococcus pneumoniae (SPn) strains among children in Lithuania are limited. We evaluated the circulation of SPn serotypes and antimicrobial susceptibility among preschool children in Lithuania before the introduction of universal infant pneumococcal vaccination.MethodsA prospective study was carried out from February 2012 to March 2013 in five cities of Lithuania. A total of 900 children under six years of age who presented to primary care centre or a hospital emergency department with acute respiratory tract infection were enrolled in the study. Nasopharyngeal swabs were obtained and cultured for SPn. Positive samples (n = 367) were serotyped and tested for antimicrobial susceptibility. Associations of pneumococcal non-susceptibility with study site, season, age, sex, attendance of day care centre and treatment with antimicrobials (between one and six months prior the study) were evaluated.ResultsAbout a half (56.7 %) of SPn strains were susceptible to all the antibiotics tested. Pneumococcal non-susceptibility to penicillin, erythromycin, clindamycin and trimethoprim–sulphamethoxazole was 15.8, 21.3, 16.9 and 27.3 %, respectively. None of the tested isolates was resistant to norfloxacin or vancomycin. We found a geographical variation of pneumococcal resistance within the cities of the country. Age, sex, the attendance of day care centre and treatment with antimicrobials prior the study was not significantly associated with a carriage of non-susceptible SPn strains. Among non-susceptible SPn serotypes 67.9 %–82.4 % were present in currently available pneumococcal conjugate vaccines.ConclusionsThe rates of nasopharyngeal SPn susceptibility to penicillin and macrolides are still high among preschool children in Lithuania, however they are lower compared with previous studies. A strict policy with respect to antibiotic prescription together with widespread use of vaccination could potentially reduce the carriage rate of antibiotic-resistant pneumococci in our country.

Data on distribution of Streptococcus pneumoniae (SPn) serotypes among children in Lithuania are limited. A prospective study was carried out from February 2012 to March 2013 to evaluate the circulation of SPn serotypes among young children in five cities of Lithuania before the introduction of universal vaccination with pneumococcal conjugate vaccine (PCV). A total of 900 children under six years of age who presented to primary care centres or a hospital emergency department with acute respiratory tract infection (RTI) were enrolled in the study. The SPn colonisation rate was 40.8% (367/900), with a peak at two and three yearsold (48.8% and 45.4%, respectively). Of the 367 SPn isolates, the most common serotypes were 6B (15.8%, n = 58), 19F (13.9%, n = 51), 23F (13.9%, n = 51), 15 (10.1%, n = 37), 14 (9.5%, n = 35), 6A (9.3%, n= 34), 11 (4.6%, n = 17), 3 (3.0%, n = 11) and 18C (3.0%, n = 11); less frequent were 23 (non-23F) (2.7%, n = 10), 19A (2.2%, n = 8) and 9V (1.6%, n = 6). Serotypes 6A and 11 were more common in children under two years-old; 18C was found only in children aged two to five years. The serotypes found might be an important predictor of the likely effectiveness of the PCVs currently available in Lithuania

Reikšminiai žodžiai: H. pylori, atsparumas antibiotikams, vaikai. Daugelyje šalių pastebimas didėjantis Helicobacter pylori (H. pylori) atsparumas antibiotikams, ypač vaikų amžiuje. Tai nulemta augančio antibiotikų vartojimo. Darbo tikslas. Nustatyti Helicobacter pylori pirminį atsparumą antibiotikams Lietuvoje, gautus rezultatus palyginti su seniau atliktais tyrimais. Tyrimo medžiaga ir metodai. Į tyrimą įtraukti nuo 2013 metų rugsėjo iki 2015 metų balandžio Vaikų ligoninėje, VšĮ Vilniaus universiteto ligoninės Santariškių klinikų filiale (toliau – Vaikų ligoninė) gydyti vaikai. Atrankos kriterijai: vaikai, besiskundžiantys pilvo skausmu, dispepsija ar nustatyta neaiškios kilmės anemija; atlikta fibrogastroskopija ir gautas teigiamas ureazės testas, anksčiau netaikyta H.pylori eradikacija. Biopsijos buvo paimtos iš 137 pacientų (80 mergaičių ir 57 berniukų). Biopsijos medžiaga buvo išsėta į arklio kraujo agaro terpę ir auginama 35–37°C mikroaerobinėmis sąlygomis 4–7 dienas. Atlikti E-testai amoksicilinui (minimali slopinanti koncentracija (MIC) ≥0,125 mg/l), klaritromicinui (MIC ≥ 0,5 mg/l), metronidazoliui (MIC ≥ 8 mg/l) ir levofloksacinui (MIC ≥1 mg/l). Rezultatai. Iš 137 pasėlių augimas buvo stebimas 82 atvejais (60,4 proc.). Atsparumas vienam ar keliems antibiotikams nustatytas 41 pasėlyje. Atsparumas klaritromicinui buvo 33 (40,2 proc., metronidazoliui – 18 (22 proc.), levofloksacinui 2 (2,4 proc.), klaritromicino ir metronidazolio deriniui – 11 (13,4 proc.) atvejų. Amoksicilinui atsparumo nebuvo pastebėta. Rezultatai palyginti su 2007–2008 m. Lietuvoje atliktu tyrimu [4]: atsparumas klaritromicinui padidėjo nuo 16,8 proc. iki 40,2 proc. (p<0,05), metronidazoliui – nuo 20,7 proc. iki 22 proc. (p=0,88), abiejų vaistų deriniui nuo 4,2 proc. iki 13,4 proc. (p=0,089). Išvados. Nuo 2007–2008 m. iki 2013–2015 m. H. pylori atsparumas klaritromicinui padidėjo 2,4 kartus, o metronidazoliui padidėjo statistiškai nereikšmingai. Stebėti pavieniai atsparumo levofloksacinui atvejai, amoksicilinui atsparumo nebuvo. Padidėjęs atsparumas klaritromicinui gali būti susijęs su padidėjusiu klaritromicino suvartojimu šalyje.