Longitudinal investigation of nasopharyngeal pneumococcal carriage in early childhood: The PATCH birth cohort study

Tsai, Ming‐Han; Liao, Sui‐Ling; Chiu, Chih‐Yung; Shih, Hsuan‐Jen; Hua, Mau‐Sun; Yao, Tsung‐Chieh; Lai, Shen‐Hao; Yeh, Kuo‐Wei; Chen, Li‐Chen; Chang, Yi-Jung; Huang, Jing‐Long

doi:10.1371/journal.pone.0237871

“…Among the S. aureus carriage trends during the first five yr of life, the highest prevalence of S. aureus and MRSA carriage was observed at the age of one month, and the trend declined gradually in the first yr of life; however, the rising trend occurred between two and five yr of age. By contrast, an increasing trend of Streptococcus pneumoniae colonization was found during the first three yr of life in our previous report (19). This finding is consistent with those of other longitudinal studies conducted in Taiwan (20).…”

Section: Discussionsupporting

confidence: 92%

Community-Associated Methicillin-Resistant Staphylococcus Aureus Colonization in a Birth Cohort of Early Childhood: The Role of Maternal Carriage

Tsai

¹

,

Chiu

²

,

Su

³

et al. 2021

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Background: Methicillin-resistant Staphylococcus aureus (MRSA) colonization in infants may pose a risk for subsequent infection in children. The study aimed to determine S. aureus colonization patterns in infancy, and strain relatedness between maternal and infant colonization.Methods: A prospective cohort study was conducted for nasopharyngeal S. aureus detection in neonates at delivery; in children at 1, 6, 12, 24, 36, and 60 months of age; and from mothers immediately after the delivery of their baby and when their child is 1 month old. A questionnaire for infants and mothers was administered at each planned visit.Results: In total, 521 and 135 infant–mother dyads underwent nasopharyngeal swab collection at 1 month and immediately after delivery, respectively. Among the 521 dyads at 1 month of age, concordant S. aureus colonization was found in 95 dyads, including MRSA in 48.4% (46/95). No concordant MRSA carriage was present among the 135 dyads at delivery. The genetic relatedness of concurrent MRSA-colonized dyads showed that more than two-thirds (32/46 [69.6%]) had identical genotypes, mainly ST 59/PVL-negative/SCCmec IV. Infants aged 1 month had the highest incidence of S. aureus, and the trend declined to a nadir at the age of 12 months. Carrier mothers who smoked cigarettes may increase the risk of infant Staphylococcus colonization (odds ratio, 2.12; 95% confidence interval, 1.23–3.66; p < 0.01).Conclusions: Maternal–infant horizontal transmission may be the primary source of MRSA acquisition in early infancy. The avoidance of passive smoking could be recommended for the prevention of S. aureus carriage.

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“…Then, Penicillin can be used as the first choice of drugs for the treatment of LRTI caused by Streptococcus pneumoniae in this region. The application of Streptococcus pneumoniae vaccines can reduce antibiotic use thereby reducing disease burden caused by Streptococcus pneumoniae resistant strains [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

Distribution and Drug Resistance of Bacterial Pathogens Associated with Lower Respiratory Tract Infection in Children and the Effect of COVID-19 on the Distribution of Pathogens

Zhu

¹

,

Ye

²

,

Zhong

³

et al. 2022

Canadian Journal of Infectious Diseases and Medical Microbiolog

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By studying the distribution and drug resistance of bacterial pathogens associated with lower respiratory tract infection (LRTI) in children in Chengdu and the effect of the COVID-19 on the distribution of pathogens and by analyzing the epidemic trend and drug resistance changes of the main pathogens of LRTI, this research is supposed to provide a useful basis for the prevention of LRTI in children and the rational use of drugs in clinical practice. Hospitalized children clinically diagnosed with LRTI in Chengdu Women and Children’s Central Hospital from 2011 to 2020 were selected as the study subjects. The pathogens of LRTI in children and the distribution of pathogens in different ages, genders, seasons, years, and departments and before and after the pandemic situation of COVID-19 were counted. The drug resistance distribution of the top six pathogens with the highest infection rate in the past three years and the trend of drug resistance in the past decade were analyzed. A total of 26,469 pathogens were isolated. Among them, 6240 strains (23.6%) were Gram-positive bacteria, 20152 strains (76.1%) were Gram-negative bacteria, and 73 strains (0.3%) were fungi. Klebsiella pneumoniae, Escherichia coli, Enterobacter cloacae, and Staphylococcus aureus were highly isolated in the group of infants aged 0-1 P < 0.01 , Moraxella catarrhalis and Streptococcus pneumoniae were highly isolated in children aged 1–6 P < 0.01 , and Haemophilus influenzae was highly isolated in children over 1 P < 0.01 . The isolation rates of Enterobacteriaceae, Acinetobacter baumannii, Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Staphylococcus aureus, and Candida albicans in the lower respiratory tract of 0-1 year-old male infants were higher than those of female infants p < 0.05 . Haemophilus influenzae was highly isolated in spring and summer, and Moraxella catarrhalis was highly isolated in autumn and winter, while the infection of Streptococcus pneumoniae was mainly concentrated in winter. This difference was statistically significant P < 0.01 . Affected by the COVID-19 pandemic, the isolation rates of Haemophilus influenzae and Streptococcus pneumoniae were significantly lower than those before the pandemic, and the isolation rate of Moraxella catarrhalis was significantly higher. The difference was statistically significant P < 0.01 . The proportion of isolated negative bacteria in NICU and PICU was higher than that in positive bacteria, and the infection rates of Klebsiella pneumoniae, Escherichia coli, Enterobacter cloacae, and Acinetobacter baumannii were higher than those in other departments. The differences were statistically significant P < 0.01 . The results of drug sensitivity test showed that the drug resistance of Haemophilus influenzae and Moraxella catarrhalis was mainly concentrated in Ampicillin, First- and Second-generation cephalosporins, and Cotrimoxazole, with stable sensitivity to Third-generation cephalosporins, while the drug resistance of Streptococcus pneumoniae was concentrated in Macrolides, Sulfonamides, and Tetracyclines, with stable sensitivity to Penicillin. Staphylococcus aureus is highly resistant to penicillins and macrolides and susceptible to vancomycin. Enterobacteriaceae resistance is concentrated in cephalosporins, with a low rate of carbapenem resistance. From 2018 to 2020, 1557 strains of Staphylococcus aureus were isolated, of which 416 strains were MRSA, accounting for 27% of the isolates; 1064 strains of Escherichia coli were isolated, of which 423 strains were ESBL and 23 strains were CRE, accounting for 40% and 2% of the isolates, respectively; and 1400 strains of Klebsiella pneumoniae were isolated, of which 385 strains were ESBL and 402 strains were CRE, accounting for 28% and 29% of the isolates, respectively. Since 2011, the resistance of Escherichia coli and Klebsiella pneumoniae to Third-generation cephalosporins has increased, peaking in 2017, and has decreased after 2018, years after which carbapenem resistance has increased significantly, corresponding to an increase in the detection rate of Carbapenem-resistant Enterobacteriaceae CRE. Findings from this study revealed that there are significant differences in community-associated infectious pathogens before and after the COVID-19 pandemic, and there are significant age differences, seasonal epidemic trends, and high departmental correlation of pathogens related to lower respiratory tract disease infection in children. There was a significant gender difference in the isolation rate of pathogens associated with LRTI in infants under one year. Vaccination, implementation of isolation measures and social distance, strengthening of personal protective measures, aseptic operation of invasive medical treatment, hand hygiene, and environmental disinfection are beneficial to reducing community-associated pathogen infection, opportunistic pathogen infection, and an increase in resistant bacteria. The strengthening of bacterial culture of lower respiratory tract samples by pediatricians is conducive to the diagnosis of respiratory tract infections caused by different pathogens, contributing to the selection of effective drugs for treatment according to drug susceptibility results, which is important for the rational use of antibiotics and curbing bacterial resistance.

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“…The catch‐up immunization program with one dose PCV13 for children aged 2−5 years and two doses for children aged 1−2 years has successfully controlled the incidence of IPD in children aged 1−5 years 11 . The pneumococcal carriage rate also decreased to 3%−6% in children aged 1−3 years after PCV13 immunization 17 . Our study also demonstrates a significantly decreased IPD rate in patients aged 3 and 4 years from the non‐NIP to the catch‐up cohort and in patients aged 2 years from the non‐NIP to the full NIP cohort.…”

Section: Discussionmentioning

confidence: 99%

“…11 The pneumococcal carriage rate also decreased to 3%−6% in children aged 1−3 years after PCV13 immunization. 17 T A B L E 3 Fatality rate and rates of severe outcomes in cases with pneumococcal pneumonia. declined.…”

Section: Other Bacterial and Viral Infectionsmentioning

confidence: 99%

Outcomes of pediatric community‐acquired pneumonia before and after national pneumococcal immunization in Taiwan

Chang,

Lin,

Liu

et al. 2023

Pediatric Pulmonology

0

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ObjectiveIn Taiwan, the incidence of invasive pneumococcal disease (IPD) in children declined after the catch‐up primary vaccination programs and the full national immunization program (NIP) with PCV13. The objective of the study was to investigate the clinical outcomes of pediatric community‐acquired pneumonia (CAP) before and after the NIP.MethodsThe study included patients aged 3 months to 17 years who were diagnosed with CAP and treated at the National Taiwan University Hospital between 2007 and 2019. Patients were assigned to three birth cohorts according to their birth years and vaccination eligibility: non‐NIP, catch‐up, and full NIP. We compared the rates of severe outcomes, including case fatality and pathogens.ResultsA total of 6557 patients who met the CAP criteria were enrolled during the study period. The case‐fatality rate decreased from 3.2% (94/2984) in the non‐NIP cohort to 0.3% (7/2176) in the catch‐up cohort and 0.8% (11/1397) in the full NIP cohort (p < 0.001). Furthermore, there was a significant decrease in invasive ventilation from the non‐NIP (17.9%) to both catch‐up (6.8%) and full NIP cohorts (9.1%). The rate of IPD declined from the non‐NIP cohort to the catch‐up cohort (1.8% vs. 0.6%, p < 0.001) and from the catch‐up to the full NIP cohort (0.6% vs. 0.07%, p = 0.014). In contrast, the rates of infections with other pathogens increased after NIP.ConclusionThe introduction of PCV13 showed significant reduction in case‐fatality and IPD rates. The increasing rates of other pathogens warrant further surveillance for their clinical significance.

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Longitudinal investigation of nasopharyngeal pneumococcal carriage in early childhood: The PATCH birth cohort study

Cited by 9 publications

References 25 publications

Community-Associated Methicillin-Resistant Staphylococcus Aureus Colonization in a Birth Cohort of Early Childhood: The Role of Maternal Carriage

Community-Associated Methicillin-Resistant Staphylococcus Aureus Colonization in a Birth Cohort of Early Childhood: The Role of Maternal Carriage

Distribution and Drug Resistance of Bacterial Pathogens Associated with Lower Respiratory Tract Infection in Children and the Effect of COVID-19 on the Distribution of Pathogens

Outcomes of pediatric community‐acquired pneumonia before and after national pneumococcal immunization in Taiwan

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