Epidemiological Features of and Risk Factors for Infection by Streptococcus pneumoniae Strains with Diminished Susceptibility to Penicillin: Findings of a French Survey

Abstract

A nationwide retrospective study was performed in France to describe the susceptibility of Streptococcus pneumoniae strains to penicillin G and to identify risk factors for infection with nonsusceptible strains. From January 1991 to May 1992, 10,350 S. pneumoniae strains were recorded. The overall rate of penicillin-nonsusceptible pneumococcal (PNSP) strains was 11%; specific prevalence rates, according to the sources of the isolates, were as follows: blood, 6%; cerebrospinal fluid, 10%; lower respiratory tract, 10%; and middle ear, 18%. Large variations in regional distribution were observed. In 85% of cases, PNSP strains belonged to serogroup 23, 19, 6, 14, or 9, by order of decreasing frequency. A logistic regression model identified the following factors as being associated with PNSP infections: age of < 15 years (OR = 2.01), isolation of the organisms from the upper respiratory tract (OR = 2.36) or from sinus and middle ear (OR = 1.63), HIV infection (OR = 2.01), beta-lactam antimicrobial therapy in the previous 6 months (OR = 1.99), and nosocomial acquisition (OR = 2.12). The attributable risk of beta-lactam antimicrobial therapy in the previous 6 months was 19%, showing that suppression of this factor alone could not eradicate PNSP infections.

Biological and Epidemiological Features of Antibiotic-Resistant Streptococcus pneumoniae in Pre- and Post-Conjugate Vaccine Eras: a United States Perspective

“…Currently, Ͼ40% of isolates are penicillin resistant in several countries that lack significant conjugate vaccine coverage (56)(57)(58)(59)(60)(61)(62). Studies have found that previous use of ␤-lactam antibiotics (63), extremes of age (e.g., children Ͻ5 years of age and the elderly) (63)(64)(65)(66), and child care attendance (in a carriage study using PNSP defined as an MIC of Ͼ0.06 g/ml) (65) were associated with penicillin-nonsusceptible pneumococcal infections.…”

Social Mixing with Other Children during Infancy Enhances Antibody Response to a Pneumococcal Conjugate Vaccine in Early Childhood

“…Nasopharyngeal carriage of S. pneumoniae is very common in infancy and early childhood (5), and invasive disease is preceded by acquisition of pneumococci from a carrier (4). A longitudinal study of pneumococcal carriage in infants in Oxfordshire, United Kingdom, found that 60% of these children carried one or more pneumococcal serotypes in the first year of life.…”

Critical analysis of investigation of respiratory infectious disease in children attending daycare centers

“…Um dos estudos trabalhou especificamente com cepas de bactérias, investigando 10.350 cepas de Streptococcus pneumoniae 22 . A seleção dos sujeitos, nos demais estudos, variou de acordo com o objetivo da investigação e, portanto, envolveu uma população extremamente variá-vel.…”

“…Há, ainda, a proposição de uma série de intervenções nas creches, como diminuição no tamanho das turmas de crianças, treinamento das educadoras e estruturação de programas nutricionais e novas políti-cas 8,18 , a necessidade de elaboração de novas vacinas 11,24,29,31,32,34 e a imunoestimulação inespecífica das crianças, com agentes feitos de extratos de bactérias 11,25,34 . Outras sugestões feitas são a modificação no uso de antibióticos 22,34,35 , a estimulação do aleitamento materno 18,31 , a educação dos pais 18,26 , o planejamento familiar 18 , a ação em nível de saúde pública 30 e a realização de novos estudos 10,11,19,23,33,34 .…”

“…Nesse sentido, Fogarty 38 refere que o ambiente da creche, pela maior presença de crianças, apresenta uma maior variedade de agentes infecciosos e, pelas características da idade das crianças, há uma facilitação da disseminação e transmissão de um maior número de agentes infecciosos. Com relação ao agente, a disseminação de agentes não suscetíveis tem crescido, resultando em diferenças nos fatores de virulên-cia, nos serogrupos e na resistência do agente ao antibió-tico, sendo mais difícil seu tratamento 14,22,35 . Além disso, vários são os agentes infecciosos, devendo-se considerar seu tipo e virulência 37 .…”