Trends in antibiotic resistance of Streptococcus pneumoniae and Haemophilus influenzae isolated from nasopharyngeal flora in children with acute otitis media in France before and after 13 valent pneumococcal conjugate vaccine introduction

Abstract

BackgroundAfter the implementation of pneumococcal conjugate vaccines (PCVs), the marked shift in Streptococcus pneumoniae (Pnc) serotype distribution led to a modification in pneumococcal antibiotic susceptibility. In 2011, the pattern of antibiotic prescription in France for acute otitis media in infants was greatly modified, with decreased use of third-generation cephalosporins and amoxicillin–clavulanate replaced by amoxicillin alone. To assess antibiotic strategies, here we measured the antibiotic susceptibility of Pnc and Haemophilus influenzae (Hi) isolated from nasopharyngeal flora in infants with acute otitis media in the 13-valent PCV (PCV13) era in France.MethodsFrom November 2006 to June 2013, 77 pediatricians obtained nasopharyngeal swabs from infants (6 to 24 months old) with acute otitis media. The swabs were sent for analysis to the national reference centre for pneumococci in France. Demographics, medical history, and physical examination findings were recorded.ResultsWe examined data for 7200 children, 3498 in the pre-PCV13 period (2006–2009) and 3702 in the post-PCV13 period (2010–2013). The Pnc carriage rate decreased from 57.9 % to 54.2 % between the 2 periods, and the proportion of pneumococcal strains with reduced susceptibility to penicillin or resistant to penicillin decreased from 47.1 % to 39 % (P < 0.0001). The Hi carriage rate increased from 48.2 % to 52.4 %, with the proportion of ß-lactamase–producing strains decreasing from 17.1 % to 11.9 % and the proportion of ß-lactamase–nonproducing, ampicillin-resistant strains remaining stable, from 7.7 % to 8.2 %. We did not identify any risk factor associated with carriage of ß-lactamase–producing Hi strains (such as daycare center attendance, otitis-prone condition or recent antibiotic use).ConclusionIn France, the nasopharyngeal carriage rate of reduced-susceptibility pneumococcal strains and ß-lactamase–producing Hi strains decreased in children with acute otitis media after 2010, the year the PCV13 was introduced. Accordingly, amoxicillin as the first-line drug for acute otitis media requiring antibiotics remains a valid choice.

Efficacy of 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine against acute otitis media and nasopharyngeal carriage in Panamanian children – A randomized controlled trial

“…The reduction in nasopharyngeal carriage of vaccine pneumococcal serotypes following PHiD-CV vaccination tended to be lower in the present study than in previous studies on PHiD-CV 15,41 or on other PCVs that were administered in the same age group 25-27,42-46 . The impact of 7vCRM on vaccine-type nasopharyngeal carriage has been reported to be around 43%, 47, 48 and reductions in vaccine-type carriage (mainly the 6 new vaccine serotypes) were also observed after PCV13 introduction, both in general, 49, 50 and in children with AOM 51,52 . Some studies also show a modest decrease in overall pneumococcal carriage after PCV13 introduction, despite the increase in non-vaccine-serotype carriage, 53,54 while other reports indicate stable overall pneumococcal carriage rates after PCV introduction 49,55,56 .…”

Prevalence of Kingella kingae oropharyngeal carriage and predominance of type a and type b polysaccharide capsules among French young children

“…First, the low number of carriers identified may lead to a decrease in the representativeness of our results. Second, the rate of children who were cared for out-of-home in the two-paediatrician group (78.8% of the study population) was lower than that in the sevenpaediatrician group, the latter being close to that observed in France [10] (17.0%, 47.8% and 45%, respectively). This may have led to an underestimate of the carriage rate in our study.…”

Acute otitis media guidelines in selected developed and developing countries: uniformity and diversity

“…AOM is a substantial cause of health services use (office visits, antibiotic costs), potential complications (ie, acute mastoiditis, meningitis) and indirect costs (ie, absence from school or work). Reduced susceptibility to antibiotics among bacteria commonly causing AOM is also a major concern 6 7. In order to reduce the burden of AOM and limit antibiotic prescriptions, various professional guidelines and consensus statements have been published.…”