Low incidence of antibiotic resistance among invasive and nasopharyngeal isolates of Streptococcus pneumoniae from children in rural Philippines between 1994 and 2000

Abstract

The purpose of this study was to determine the prevalence of acquired antimicrobial resistance in Streptococcus pneumoniae isolated from nasopharyngeal swabs and blood and cerebrospinal fluid (CSF) specimens of 3,028 children hospitalized with signs or symptoms of pneumonia, sepsis, or meningitis in rural Philippines between 1994 and 2000. Pneumococci were identified using standard methods, serotyped, and their susceptibility to oxacillin, erythromycin, tetracycline, chloramphenicol, and trimethoprim-sulfamethoxazole was determined using the disk diffusion method. Penicillin minimum inhibitory concentrations (MICs) of the oxacillin-resistant isolates were further tested. The clonality of the penicillin-nonsusceptible (PNSP) isolates was analyzed using pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST). Altogether 1,048 isolates were analyzed, of which 35 were invasive and 1,013 nasopharyngeal isolates. None was resistant, but 22 (2.1%) were intermediately resistant to penicillin, 4 (0.2%) were resistant to chloramphenicol, 3 (0.2%) to erythromycin, 39 (3.7%) to tetracycline, and 4 (0.2%) to trimethoprim/sulfamethoxazole. Twelve of the 22 PNSP isolates were of serotype 14 and of sequence type 63. These included the two invasive PNSP isolates. PFGE profiling further identified three separate clusters among the sequence of type 63, serotype 14 (ST63(14)) isolates. Antimicrobial resistance in both invasive and nasopharyngeal pneumococcal pediatric isolates in rural Philippines is rare. In spite of this remote setting, the PNSP isolates of the serotype 14 clusters were of ST63 type, which has been described previously on other continents.

Respiratory viruses from hospitalized children with severe pneumonia in the Philippines

“…Moreover, antibiotics can be purchased without prescription in the Philippines. For S. pneumoniae, all three invasive isolates were susceptible to penicillin, as reported in a previous study in Bohol, Philippines [61]. However, two cases with MRSA did not exhibited improvement during hospitalization.…”

Prospective Surveillance Study of Invasive Pneumococcal Disease Among Urban Children in the Philippines

“…Other studies in asia have yielded mixed rates of antibiotic resistance, possibly influenced by local prescribing patterns. 5,10,13,[22][23][24][25] importantly, isolation of S. pneumoniae in this study may have been limited by the observed *Results from years 1 and 2 were annualized. The number of cases was the total of the number of cases captured during years 1 and 2.…”

Streptococcus pneumoniaeCapsular Serotype 19F Is More Resistant to C3 Deposition and Less Sensitive to Opsonophagocytosis than Serotype 6B

“…In MLST, bacterial strains are identified by comparing the sequences of internal fragments of seven housekeeping genes (35). Six of the strains had been sequence typed in previous studies (12, 13) and 10 were analyzed at the National Public Health Institute, Helsinki, Finland, using the same method with minor modifications (8,52). PspA family typing.…”