High prevalence of antibiotic resistance in nasopharyngeal bacterial isolates from healthy children in rural Uganda: A cross-sectional study

Abstract

Background: In Uganda, the main causes of death in children under 5 years of age are malaria and pneumonia—often due to delayed diagnosis and treatment. In preparation for a community case management intervention for pneumonia and malaria, the bacterial composition of the nasopharyngeal flora and its in vitro resistance were determined in children aged five or under to establish baseline resistance to commonly used antibiotics.Methods: In a population-based survey in April 2008, nasopharyngeal specimens were collected from 152 randomly selected healthy children under 5 years of age in the Iganga/Mayuge Health and Demographic Surveillance Site (HDSS). Medical history and prior treatment were recorded. Demographic characteristics and risk factors for carriage of resistant strains were obtained from the HDSS census. Bacteria were isolated and analysed for antibiotic susceptibility using disk diffusion and E test.Results: Streptococcus pneumoniae (S. pneumoniae) carriage was 58.6%, and, while most (80.9%) isolates had intermediate resistance to penicillin, none was highly resistant. Whereas no isolate was resistant to erythromycin, 98.9% were resistant to trimethoprim-sulphamethoxazole (co-trimoxazole).Conclusions: In vitro resistance in S. pneumoniae to co-trimoxazole treatment was high, and the majority of isolates had intermediate resistance to penicillin. To inform treatment policies on the clinical efficacy of current treatment protocols for pneumonia in health facilities and at the community level, routine surveillance of resistance in pneumonia pathogens is needed as well as research on treatment efficacy in cases with resistant strains. Improved clinical algorithms and diagnostics for pneumonia should be developed.

Pneumococcal Carriage and Antibiotic Susceptibility Patterns in Mother-Baby Pairs in a rural community in Eastern Uganda

“…Both the Iganga/Mayuge and Kenyan studies were carried out prior to the introduction of PCV10 accounting for the difference in the carriage observed in our study. Different studies have shown varied carriage rates of pneumococci among children below ve years in Uganda and elsewhere [4,11,12] with most of them reporting a higher carriage rate than reported in our study. A systematic review reported a carriage rate in Africa to range between 21-94% [13] with more studies done among children than in adult population.…”

Pneumococcal Carriage in Children under Five Years in Uganda-Will Present Pneumococcal Conjugate Vaccines Be Appropriate?

“…In the cRCT, community health workers (CHWs) were trained and equipped to provide community case management of malaria (control) or malaria and pneumonia (intervention) for children aged 6–59 months [25]. Data on antibiotic resistance from these surveys is presented elsewhere [26]. …”

“…The laboratory assays of identifying and isolating the bacterial isolates were performed as described in detail elsewhere [26]. In short, each swab was streaked on agar plates supplemented with 7% whole sheep blood and on chocolate agar.…”

Antibiotic-Resistant Escherichia coli and Class 1 Integrons in Humans, Domestic Animals, and Wild Primates in Rural Uganda

“…KEYWORDS antibiotic resistance, Escherichia coli, Africa, protected areas, primates, class 1 integrons A ntibiotic resistance is ubiquitous in the developing world (1)(2)(3). In some African countries, resistance to commonly available antibiotics can exceed 75% (3)(4)(5)(6)(7)(8)(9). Cost, ease of use, and time on the market influence the use of antibiotics in Africa and the consequent resistance of bacteria to those antibiotics (10).…”