Nasopharyngeal Carriage of Klebsiella pneumoniae and Other Gram-Negative Bacilli in Pneumonia-Prone Age Groups in Semarang, Indonesia

Abstract

Gram-negative bacilli (GNB) cause many cases of pneumonia in Indonesia. We investigated nasopharyngeal carriage of GNB in Semarang, Indonesia. Klebsiella pneumoniae carriage in adults (15%) was higher than in children (7%) (P ‫؍‬ 0.004), while that of other GNB was comparable. Poor food and water hygiene are determinants of carriage of these bacteria.W orldwide, Streptococcus pneumoniae is the most common cause of community-acquired pneumonia (CAP). However, in low-to-middle-income countries, Gram-negative bacilli (GNB) are reported as frequent causes of CAP (1). In a recent study on CAP in Indonesia, Klebsiella pneumoniae was the most common etiological agent (our unpublished observation). Since nasopharyngeal colonization may precede pneumonia, as for S. pneumoniae (2), we investigated nasopharyngeal carriage of K. pneumoniae and other GNB among children and adults compared to that of S. pneumoniae in Indonesia. Subjects were healthy children (6 to 60 months old) and adults (45 to 70 years old) living in the city of Semarang on the island of Java in Indonesia, without respiratory symptoms and without antibiotic consumption within the last 3 days. Subjects were recruited from all 16 districts of Semarang by cluster random sampling from February to April 2010.Nasopharyngeal swabs were obtained and transported in Amies (COPAN, Italy) and then were inoculated on 5% sheep blood agar with gentamicin (5 mg/liter) and on MacConkey agar. The plates were incubated at 35°C in 5% CO 2. Identification and antimicrobial susceptibility tests for GNB were performed using Vitek 2 (bioMérieux, Marcy l'Etoile, France). Identification of S. pneumoniae was performed using the optochin test (Oxoid, Basingstoke, United Kingdom). Control strains were included, and CLSI guidelines were applied.A questionnaire was developed to identify determinants of carriage of these bacteria. Data on demography, water supply (for drinking, preparing food, and bathing), food hygiene and house sanitation (crowding, flies, and exposure to smoke from cigarettes and mosquito coils), were collected. Water hygiene was considered poor when water other than tap water or bottled water was used. Food hygiene was considered poor if food was bought from street vendors. Crowding was considered if the ratio of bedroom space per family member was Ͻ4 m 2 (3). Univariate analysis was done with chi-square or Fisher's exact test when appropriate, followed by logistic regression using SPSS 17 (SPSS Inc., Chicago, IL, USA). Confidence interval (CI) was calculated at the 95% level (CI 95 ), and P values of Ͻ0.05 were considered significant. Written informed consent was obtained from the subjects or their caregivers. The study was approved by the Ethical Committee of the Faculty of Medicine, Diponegoro University.A total of 253 adults and 243 children participated in the study; approximately 25% resided in the suburbs, and the majority were living under hygienically restricted circumstances regarding their food and water supplies. Crowding and exposure to smoke were common...

Klebsiella pneumoniae Oropharyngeal Carriage in Rural and Urban Vietnam and the Effect of Alcohol Consumption

“…The correlation between alcohol consumption and K. pneumoniae carriage has also received little prior attention. The K. pneumoniae oropharyngeal carriage rate of 14.1% is comparable to the nasopharyngeal carriage rate of 11% determined by a recent study in Indonesia [17]. The rate of carriage of 1.6% (95% CI 0–5.1%) in children is also comparable to a study that reported a carriage rate of 1.4% amongst children aged less than 5 years attending daycare in Brazil, an upper-middle income country (The World Bank 2013) [18].…”

Nasopharyngeal Carriage of Streptococcus pneumonia in Pneumonia-Prone Age Groups in Semarang, Java Island, Indonesia

“…The characteristics of the participants have been presented previously [4]. Crowding was common, as was exposure to smoke.…”

Viruses and Gram-negative bacilli dominate the etiology of community-acquired pneumonia in Indonesia, a cohort study

“…1,18,19 The high prevalence of K. pneumoniae and other GNB might, in part, be explained by the common carriage of these bacterial species in the nasopharynx of healthy individuals in the same area. 20 The tropical climate with higher temperature and humidity in Semarang may increase the incidence of GNB infection, as those conditions promote the growth and virulence of GNB. 21,22 S. pneumoniae infection was detected in only 13% of the patients, mostly by urinary antigen tests.…”