High Rates of Multiple Antibiotic Resistance in<i>Streptococcus pneumoniae</i>From Healthy Children Living in Isolated Rural Communities: Association With Cephalosporin Use and Intrafamilial Transmission

Samore, Matthew H.; Magill, Michael K.; Alder, Stephen C.; Severina, Elena; Boer, Leonie Morrison-de; Lyon, Joseph L.; Carroll, Karen C.; Leary, Joyce; Stone, Mary Bishop; Bradford, David C.; Reading, James; Tomasz, Alexander; Sande, Merle A.

doi:10.1542/peds.108.4.856

Cited by 130 publications

(61 citation statements)

References 54 publications

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“…Specimens for this analysis were obtained from children in 16 noncontiguous communities, some of which are more densely populated than some regions previously studied. 13,17,18 The variability seen here by community in the fraction of S pneumoniae nonsusceptible to penicillin (0%-58%) partly reflects the small number of isolates from some communities but has also been seen in a study of French schools. 37 However, when we used multivariate techniques to examine the degree of variability observed, we found that it did not exceed what would be expected by chance.…”

Section: Discussionmentioning

confidence: 50%

“…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. Specimens for this analysis were obtained from children in 16 noncontiguous communities, some of which are more densely populated than some regions previously studied.…”

Section: Discussionmentioning

confidence: 97%

“…15 Recently published studies from Wisconsin and Utah showed substantial fractions of S pneumoniae with reduced susceptibility to penicillin, but in these rural communities, only 2% to 4% were fully resistant to penicillin (minimum inhibitory concentration [MIC] Ն2.0). 17,18 Many of these surveillance studies have been based in child care centers, [12][13][14] where particular strains may be circulating, 19 thus limiting the generalizability of findings to the entire community. The distribution of resistance among S pneumoniae serotypes is of particular interest in the context of the recent introduction of heptavalent pneumococcal conjugate vaccine (PCV7).…”

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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: Discussionmentioning

confidence: 50%

Section: Discussionmentioning

confidence: 97%

mentioning

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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“…Soon after, resistance rates to different antimicrobial agents among S. pneumoniae strains increased disturbingly and they have become a worldwide problem [13]. The carriage prevalence of resistant strains has also extended and this has amplified the issue [14,15]. Furthermore, S. pneumoniae has intrinsic resistance to a large group of antibiotics, including polypeptides, aminoglycosides and first-generation quinolones [16].…”

Section: Mechanisms Of Resistance In Streptococcus Pneumoniaementioning

confidence: 99%

Molecular mechanisms and epidemiology of resistance in Streptococcus pneumoniae in the Middle East region

Moujaber

Osman

Rafei

et al. 2017

Journal of Medical Microbiology

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Purpose. Streptococcus pneumoniae is a commensal bacterium that normally colonizes the human nasopharyngeal cavity. Once disseminated, it can cause several diseases, ranging from non-invasive infections such as acute otitis media and sinusitis through to invasive infections with higher mortality, including meningitis and septicaemia. Since the identification of the first S. pneumoniae strain with decreased susceptibility to penicillin in the 1960s, antibiotic resistance among S. pneumoniae has increased disturbingly and the mechanisms of resistance have begun to unfold.Methodology. This work briefly reviewed the available data on the molecular mechanisms underlying antimicrobial resistance and its epidemiology among pneumococcal strains in Middle Eastern countries.Key findings. Both intrinsic and acquired mechanisms (mutations, acquisition of novel mobile genetic elements and sometimes gene duplication and overexpression) affect susceptibility to a large variety of antibiotics. In Middle Eastern countries, including Lebanon, Iran, Saudi Arabia and Turkey, surveillance showed a disturbing increase in the strength and prevalence of resistance to antibiotics over the years, especially in the last decade. However, no surveillance reports were found in other Middle Eastern countries, such as Syria and Iraq.Conclusion. In order to better survey, control and prevent the emergence of multidrug-and extremely drug-resistant S. pneumoniae strains, antimicrobial stewardship, national surveillance and public awareness programmes should be developed urgently in Middle Eastern countries.

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“…5 The volume of antimicrobial use is the main factor in the development of resistance 6,7 both in individuals 8 and populations. 9,10 In populations with heavy use, the risk of carrying resistant organisms caused by household members' use of antibiotics, 11 intrafamilial transmission, 12,13 or proximity to an antibiotics source 14 often outweighs the risk of personal antibiotics use.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Antibiotic-Resistant Escherichia coli Carriage in Young Children in Peru: Community-Based Cross-Sectional Prevalence Study

Kalter¹,

Gilman²,

Moulton³

et al. 2010

The American Society of Tropical Medicine and Hygiene

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Abstract. Few studies have examined the influence of individual-, household-, and community-scale risk factors on carriage of resistant commensal bacteria. We determined children's medical, agricultural, and environmental exposures by household, pharmacy, and health facility surveys and Escherichia coli cultures of children, mothers' hands, household animals, and market chickens in Peru. Among 522 children with a positive stool culture, by log-binomial regression, using "any antibiotic" and 1-14 (versus 0) sulfa doses in the past 3 months increased children's risk, respectively, for ampicillin-and sulfamethoxazole-resistant E. coli carriage ( P = 0.01-0.02). Each household member taking "any antibiotic" increased children's risk for sulfamethoxazole-and multidrug-resistant E. coli carriage ( P < 0.0001). Residence in a zone where a larger proportion of households served home-raised chicken (as contrasted with intensively antibiotic-raised market chicken) protected against carrying E. coli resistant to all drugs ( P = 0.0004-0.04). Environmental contamination with drug-resistant bacteria appeared to significantly contribute to children's carriage of antibiotic-resistant E. coli .

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High Rates of Multiple Antibiotic Resistance inStreptococcus pneumoniaeFrom Healthy Children Living in Isolated Rural Communities: Association With Cephalosporin Use and Intrafamilial Transmission

Cited by 130 publications

References 54 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

Molecular mechanisms and epidemiology of resistance in Streptococcus pneumoniae in the Middle East region

Risk Factors for Antibiotic-Resistant Escherichia coli Carriage in Young Children in Peru: Community-Based Cross-Sectional Prevalence Study

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