Nasopharyngeal Carriage and Antimicrobial Susceptibility Patterns of Streptococcus pneumoniae among Children under Five in Southwest Ethiopia

Gebre, Tiglu; Tadesse, Mulualem; Aragaw, Dossegnaw; Feye, Dagne; Beyene, Hunachew; Seyoum, Dinberu; Mekonnen, Mekidim

doi:10.3390/children4040027

Cited by 28 publications

(45 citation statements)

References 24 publications

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“…pneumoniae (10.3%) in the present study is comparable to earlier findings in Cameroon (11.6–18.2%) [ 20 ], Seoul, Korea (12.2%) [ 3 ] and Thailand (12.9%) [ 24 ]. However, higher colonization rate was documented in North and South Ethiopia (41–43.8%) [ 9 , 25 ], Estonia (17%) [ 28 ], Uganda (18%) [ 29 ], West Bengal (15.6%) [ 30 ], Ghana (30.5%) [ 31 ], Rural Uganda (58.6%) [ 32 ], Tanzania (56%) [ 33 ]and South Africa (22.2%) [ 34 ]. On the other hand, lower (5.1%) colonization rate was documented in Cambodia [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Pharyngeal colonization and drug resistance profiles of Morraxella catarrrhalis, Streptococcus pneumoniae, Staphylococcus aureus, and Haemophilus influenzae among HIV infected children attending ART Clinic of Felegehiwot Referral Hospital, Ethiopia

et al. 2018

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BackgroundAsymptomatic pharyngeal colonization by potential bacteria is the primary reservoir for bacterial species within a population and is considered a prerequisite for development of major childhood diseases such as sinusitis, otitis media, pneumonia, bacteremia, and meningitis. However, there is dearth of data on the colonization and drug resistance pattern of the main bacterial pathogens in the pharynx of HIV infected children in Ethiopia. Therefore, this study determined the pharyngeal colonization and drug resistance profile of bacterial pathogens in HIV infected children attending ART clinic of Felegehiwot Referral Hospital (FHRH), Amhara Region, Ethiopia.MethodsA hospital based cross-sectional study was conducted from May 2016 to June 2017 at the ART clinic of FHRH. A total of 300 HIV infected children were enrolled in the study. Data on socio-demographic characteristics of the study participants were collected with face-to-face interview and patient—card review using structured questionnaire. Bacterial species were identified using standard bacteriological techniques. Drug susceptibility testing was performed using disk diffusion technique. Chi-square test was done to determine associations among variables.ResultsThe median age of the participants was 11 years. Overall, 153 (51%) of children were colonized by respiratory bacteria in their pharynx. Colonization rate was higher in children from mothers who had attained college and above levels of education than others (P = 0.04). It was also higher in children without the sign of malnutrition than others (P = 0.004). The colonization rate of S.aureus, M.catarrhalis, S.pneumoniae and H.influenzae were 88 (29%), 37 (12.3%), 31 (10.3%) and 6 (2%), respectively. S.aureus—M.catarrhalis concurrent colonization was found in 14 (4.7%) of children. Age (P = 0.03), schooling (P = 0.045) and history of running nose (P = 0.043) were significantly associated with S.aureus colonization. Living in urban setting (P = 0.042) and children from mothers with college and above levels of education (P = 0.002) were significantly associated with M.catarrhalis colonization. Majority of the isolates were resistant to penicillin (68.5%) and cotrimoxazole (52.5%).S.aureus isolates were resistant to penicillin (84.1%) and cotrimoxazole (51.1%).M.catarrhalis isolates were resistant to penicillin (94.6%), erythromycin (86.5%)and cotrimoxazole (78.4%). Overall, 99 (59.3%) of the isolates were multi-drug (MDR) resistant. The overall MDR rates among S.aureus, M.catarrhalis and S.pneumoniae isolates were 65.9%, 78.4% and 22.6%, respectively.ConclusionsPharyngeal colonization of respiratory bacteria in HIV infected children is a major public health problem. Single and multiple antibiotic resistant is alarmingly high among respiratory colonizers. Therefore, regular screening of HIV infected children for culture and antimicrobial susceptibility testing is recommended to prevent the development of severe opportunistic infections.

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Section: Discussionmentioning

confidence: 99%

Pharyngeal colonization and drug resistance profiles of Morraxella catarrrhalis, Streptococcus pneumoniae, Staphylococcus aureus, and Haemophilus influenzae among HIV infected children attending ART Clinic of Felegehiwot Referral Hospital, Ethiopia

et al. 2018

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“…There are parallels at respiratory mucosal surfaces. In Ethiopia, nasopharyngeal carriage of Streptococcus pneumonia was assessed in 361 children at an outpatient clinic [ 37 ]. Overall, 44% were colonized by S. pneumoniae (not serotyped, 18% multidrug resistant) and colonization was associated with the number of siblings in the household and presence of malnutrition defined by weight-for-age, capturing aspects of both wasting and stunting: adjusted odds ratio 2.1 [95% confidence interval (CI) 1.2–3.4].…”

Section: Mechanismsmentioning

confidence: 99%

The impact of malnutrition on childhood infections

Walson

Berkley

2018

Current Opinion in Infectious Diseases

217

139

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Purpose of reviewAlmost half of all childhood deaths worldwide occur in children with malnutrition, predominantly in sub-Saharan Africa and South Asia. This review summarizes the mechanisms by which malnutrition and serious infections interact with each other and with children's environments.Recent findingsIt has become clear that whilst malnutrition results in increased incidence, severity and case fatality of common infections, risks continue beyond acute episodes resulting in significant postdischarge mortality. A well established concept of a ‘vicious-cycle’ between nutrition and infection has now evolving to encompass dysbiosis and pathogen colonization as precursors to infection; enteric dysfunction constituting malabsorption, dysregulation of nutrients and metabolism, inflammation and bacterial translocation. All of these interact with a child's diet and environment. Published trials aiming to break this cycle using antimicrobial prophylaxis or water, sanitation and hygiene interventions have not demonstrated public health benefit so far.SummaryAs further trials are planned, key gaps in knowledge can be filled by applying new tools to re-examine old questions relating to immune competence during and after infection events and changes in nutritional status; and how to characterize overt and subclinical infection, intestinal permeability to bacteria and the role of antimicrobial resistance using specific biomarkers.

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“…We found only three studies undertaken after PCV was introduced into national immunization programs that assessed factors associated with pneumococcal carriage, and included PCV vaccination status as a variable [16,54,55]. In a cross-sectional study of 361 children under five years of age in Jimma, Ethiopia, the odds of overall pneumococcal carriage increased in association with having siblings under five years old (aOR 1.80 [95% CI 1.17-2.77] P = 0.008), and malnutrition (aOR 2.07 [95% CI 1.24-3.44] P = 0.005), but PCV vaccination was not associated with a decrease in carriage (three doses aOR 1.08 [95% CI 0.60-1.89] P = 0.82, one or two doses aOR 1.06 [95% CI 0.40-2.83] P = 0.90) [54]. This may have been due to serotype replacement and capsular switching of pneumococci by recombination, such that the immune pressure from PCV selected for non-vaccine serotypes [54].…”

Section: Plos Onementioning

confidence: 99%

“…In a cross-sectional study of 361 children under five years of age in Jimma, Ethiopia, the odds of overall pneumococcal carriage increased in association with having siblings under five years old (aOR 1.80 [95% CI 1.17-2.77] P = 0.008), and malnutrition (aOR 2.07 [95% CI 1.24-3.44] P = 0.005), but PCV vaccination was not associated with a decrease in carriage (three doses aOR 1.08 [95% CI 0.60-1.89] P = 0.82, one or two doses aOR 1.06 [95% CI 0.40-2.83] P = 0.90) [54]. This may have been due to serotype replacement and capsular switching of pneumococci by recombination, such that the immune pressure from PCV selected for non-vaccine serotypes [54]. However, in a cross-sectional study of 1,668 healthy children aged [12][13][14][15][16][17][18][19][20][21][22][23] [55].…”

Section: Plos Onementioning

confidence: 99%

Factors associated with pneumococcal carriage and density in children and adults in Fiji, using four cross-sectional surveys

et al. 2020

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This study describes predictors of pneumococcal nasopharyngeal carriage and density in Fiji. We used data from four annual (2012-2015) cross-sectional surveys, pre-and postintroduction of ten-valent pneumococcal conjugate vaccine (PCV10) in October 2012. Infants (5-8 weeks), toddlers (12-23 months), children (2-6 years), and their caregivers participated. Pneumococci were detected and quantified using lytA qPCR, with molecular serotyping by microarray. Logistic and quantile regression were used to determine predictors of pneumococcal carriage and density, respectively. There were 8,109 participants. Pneumococcal carriage was negatively associated with years post-PCV10 introduction (global P<0.001), and positively associated with indigenous iTaukei ethnicity (aOR 2.74 [95% CI 2.17-3.45] P<0.001); young age (infant, toddler, and child compared with caregiver participant groups) (global P<0.001); urban residence (aOR 1.45 [95% CI 1.30-2.57] P<0.001); living with �2 children <5 years of age (aOR 1.42 [95% CI 1.27-1.59] P<0.001); low family income (aOR 1.44 [95% CI 1.28-1.62] P<0.001); and upper respiratory tract infection (URTI) symptoms (aOR 1.77 [95% CI 1.57-2.01] P<0.001). Predictors were similar for PCV10 and non-PCV10 carriage, except PCV10 carriage was negatively associated with PCV10 vaccination (0.58 [95% CI 0.41-0.82] P = 0.002) and positively associated with exposure to household cigarette smoke (aOR 1.21 [95% CI 1.02-1.43] P = 0.031), while there was no association between years post-PCV10 introduction and non-PCV10 carriage. Pneumococcal density was positively associated with URTI symptoms (adjusted median difference 0.28 [95% CI 0.16, 0.40] P<0.001) and toddler and child, compared with caregiver, participant groups (global P = 0.008). Predictors were similar for PCV10 and non-PCV10 density, except infant, toddler, and child participant groups were not associated with PCV10 density. PCV10 introduction was associated with reduced the odds of overall and PCV10 pneumococcal carriage in Fiji. However, after adjustment iTaukei ethnicity was positively

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Nasopharyngeal Carriage and Antimicrobial Susceptibility Patterns of Streptococcus pneumoniae among Children under Five in Southwest Ethiopia

Cited by 28 publications

References 24 publications

Pharyngeal colonization and drug resistance profiles of Morraxella catarrrhalis, Streptococcus pneumoniae, Staphylococcus aureus, and Haemophilus influenzae among HIV infected children attending ART Clinic of Felegehiwot Referral Hospital, Ethiopia

Pharyngeal colonization and drug resistance profiles of Morraxella catarrrhalis, Streptococcus pneumoniae, Staphylococcus aureus, and Haemophilus influenzae among HIV infected children attending ART Clinic of Felegehiwot Referral Hospital, Ethiopia

The impact of malnutrition on childhood infections

Factors associated with pneumococcal carriage and density in children and adults in Fiji, using four cross-sectional surveys

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