trimethoprim--sulfamethoxazole-drug-combination and Pneumococcal-Infections

Pneumococcal serotypes differ in antimicrobial susceptibility. However, patterns and causes of this variation are not comprehensively understood.. We undertook a systematic review of epidemiologic studies of pneumococci isolated from carriage or invasive disease among children globally from 2000-2019. We evaluated associations of each serotype with nonsusceptibility to penicillin, macrolides, and trimethoprim/sulfamethoxazole. We evaluated differences in the prevalence of nonsusceptibility to major antibiotic classes across serotypes using random-effects meta-regression models and assessed changes in prevalence of nonsusceptibility after implementation of pneumococcal conjugate vaccines (PCVs). We also evaluated associations between biological characteristics of serotypes and their likelihood of nonsusceptibility to each drug.. We included data from 129 studies representing 32 187 isolates across 52 countries. Within serotypes, the proportion of nonsusceptible isolates varied geographically and over time, in settings using and those not using PCVs. Factors predicting enhanced fitness of serotypes in colonization as well as enhanced pathogenicity were each associated with higher likelihood of nonsusceptibility to penicillin, macrolides, and trimethoprim/sulfamethoxazole. Increases in prevalence of nonsusceptibility following PCV implementation were evident among non-PCV serotypes, including 6A, 6C, 15A, 15B/C, 19A, and 35B; however, this pattern was not universally evident among non-PCV serotypes. Postvaccination increases in nonsusceptibility for serotypes 6A and 19A were attenuated in settings that implemented PCV13.. In pneumococci, nonsusceptibility to penicillin, macrolides, and trimethoprim/sulfamethoxazole is associated with more frequent opportunities for antibiotic exposure during both prolonged carriage episodes and when serotypes cause disease. These findings suggest multiple pathways leading to resistance selection in pneumococci.

Topics: Anti-Bacterial Agents; Child; Humans; Infant; Macrolides; Nasopharynx; Penicillins; Pneumococcal Infections; Pneumococcal Vaccines; Serogroup; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination; Vaccines, Conjugate

HIV-infected persons are particularly susceptible to the development of severe pneumococcal disease, even in the setting of combination antiretroviral therapy (cART), due to slow, incomplete recovery of anti-pneumococcal host defenses. This risk is increased by avoidable aspects of lifestyle, particularly smoking, which intensify immunosuppression. Clearly, more effective preventive measures are needed to counter this threat. Areas covered: This is a detailed review of the published literature focusing on currently available strategies for prevention of pneumococcal infection in HIV-infected patients, including cotrimoxazole prophylaxis, cART, pneumococcal vaccination, and smoking cessation strategies. This is preceded by a consideration of the epidemiology, clinical presentation, risk factors, and outcome of pneumococcal disease. Expert commentary: Cotrimoxazole prophylaxis has been shown to reduce morbidity and mortality in HIV-infected patients, although there is inconsistent data on the preventive efficacy against pneumococcal infections. Some recent studies have documented unchanged incidences of IPD in adult patients in the cART era. With regard to pneumococcal vaccination, routine acceptance of the efficacy of the PCV13/PPV23 sequential administration prime-boost strategy awaits the outcome of clinical trials in those with HIV infection. Smoking cessation, and discontinuation of excessive alcohol consumption and intravenous drug abuse, are priority strategies to prevent severe pneumococcal infection.

Topics: Adult; Anti-Bacterial Agents; HIV Infections; Humans; Incidence; Pneumococcal Infections; Pneumococcal Vaccines; Risk Factors; Smoking; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination

Streptococcus pneumoniae is a leading cause of bacterial pneumonia, meningitis, otitis media, and sinusitis; it results in significant morbidity and mortality in patients with pneumonia and meningitis. The pneumococcus is a common colonizing bacterium in the respiratory tract; it is especially common in the respiratory tracts of children, where it is frequently exposed to antimicrobial agents. This exposure can lead to resistance. Penicillin nonsusceptibility is found in nearly 40% of strains causing disease in adults, although often these cases are treatable with appropriate dosing regimens of many oral and parenteral beta-lactam agents. In the United States resistance to macrolides is widespread--averaging approximately 28%--but geographically variable, ranging from 23% in the northwest to 30% in the northeast. Resistance to tetracyclines and trimethoprim-sulfamethoxazole are reported in approximately 20% and 35% of isolates, respectively, and resistance to multiple classes of agents is increasingly common. Amoxicillin, amoxicillin-clavulanate, respiratory fluoroquinolones, and clindamycin are currently the most effective agents for treatment of respiratory tract infections caused by S pneumoniae, with >90% of isolates in the United States being susceptible. Vancomycin is the only agent against which resistance has not emerged. Patient groups that are at increased risk for developing resistant pneumococcal infections have been identified and include patients with malignancies, human immunodeficiency virus infection, and sickle-cell disease. Judicious use of antimicrobials is the key to preventing the emergence of further resistance, particularly as few new classes of agents are likely to become available for clinical use in the short term.

Topics: Acute Disease; Adult; Anti-Bacterial Agents; beta-Lactam Resistance; Community-Acquired Infections; Drug Resistance, Bacterial; Fluoroquinolones; Humans; Macrolides; Microbial Sensitivity Tests; Pneumococcal Infections; Pneumonia, Pneumococcal; Prevalence; Risk Factors; Sinusitis; Streptococcus pneumoniae; Tetracyclines; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination; United States

Topics: Amoxicillin; Anti-Bacterial Agents; Cefazolin; Cefotaxime; Cephalosporins; Child, Preschool; Clavulanic Acid; Drug Resistance, Microbial; Epidural Abscess; Humans; Male; Penicillins; Pneumococcal Infections; Respiratory Tract Infections; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination

The last decade is characterized by the increase in antibiotic resistance among respiratory bacterial pathogens in the presence of only modest progress in the development of new antibacterial agents to overcome this resistance. A series of recent studies show clearly that the increased resistance among the main AOM pathogens (namely Streptococcus pneumoniae and Haemophilus influenzae) is associated with a dramatic decrease in bacteriologic response to antibiotic treatment, which in turn has an impact on clinical response. Thus, the individual patient is affected by the increasing antibiotic resistance. Moreover, the society as a whole is now also affected because the carriage and spread of antibiotic resistant AOM pathogens is remarkably impacted by antibiotic treatment. New studies show the remarkable ability of antibiotics to rapidly promote nasopharyngeal carriage and spread of antibiotic-resistant AOM pathogens. In these studies, the increase in carriage of antibiotic resistant S. pneumoniae is shown already after 3-4 days from initiation of antibiotic treatment and may last for weeks to months after treatment. Children carrying antibiotic-resistant organisms transmit those organisms to their family and to their day care centers and thus a vicious cycle is created in which increased antibiotic resistance with decreased response leads to increased antibiotic use, which in turn leads to further increase in resistance. New antibiotics are not likely to improve this situation. It is clear that the challenge in the next decade is to prevent AOM rather than to treat it. Efforts to prevent AOM include improved environmental factors, immunization with bacterial and viral vaccines and some creative measures such as prevention of colonization and attachment to epithelium of AOM pathogens. Whether these efforts will prove successful or, even if successful, will only modify the clinical and bacteriologic picture presenting new challenges, only time will tell.

Topics: Anti-Bacterial Agents; Bacterial Adhesion; Carrier State; Child; Child, Preschool; Drug Resistance, Microbial; Drug Resistance, Multiple; Drug Utilization; Environment; Haemophilus Infections; Haemophilus influenzae; Haemophilus Vaccines; Humans; Infant; Nasopharynx; Otitis Media; Pneumococcal Infections; Retrospective Studies; Streptococcal Vaccines; Streptococcus pneumoniae; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Vaccination; Viral Vaccines

This is a substudy of a larger randomized controlled trial on HIV-infected Zambian children, which revealed that cotrimoxazole prophylaxis reduced morbidity and mortality despite a background of high cotrimoxazole resistance. The impact of cotrimoxazole on the carriage and antibiotic resistance of Streptococcus pneumoniae and Haemophilus influenzae as major causes of childhood mortality in HIV-infected children was investigated since these are unclear. Representative nasopharyngeal swabs were taken prior to randomization for 181 of 534 children (92 on cotrimoxazole and 89 on placebo). Bacterial identification and antibiotic susceptibility were performed by routine methods. Due to reduced mortality, prophylactic cotrimoxazole increased the median time from randomization to the last specimen from 48 to 56 months (P = 0.001). The carriage of H. influenzae was unaltered by cotrimoxazole. Carriage of S. pneumoniae increased slightly in both arms but was not statistically significant in the placebo arm. In S. pneumoniae switching between carriage and no carriage in consecutive pairs of samples was unaffected by cotrimoxazole (P = 0.18) with a suggestion that the probability of remaining carriage free was lower (P = 0.10). In H. influenzae cotrimoxazole decreased switching from carriage to no carriage (P = 0.02). Cotrimoxazole resistance levels were higher in postbaseline samples in the cotrimoxazole arm than in the placebo arm (S. pneumoniae, P < 0.0001; H. influenzae, P = 0.005). Cotrimoxazole decreased switching from cotrimoxazole resistance to cotrimoxazole sensitivity in S. pneumoniae (P = 0.002) and reduced the chance of H. influenzae remaining cotrimoxazole sensitive (P = 0.05). No associations were observed between the percentage of CD4 (CD4%), the change in CD4% from baseline, child age at date of specimen, child gender, or sampling month with carriage of either pathogen.

Topics: Anti-Infective Agents; Child, Preschool; Drug Resistance, Bacterial; Female; Haemophilus Infections; Haemophilus influenzae; HIV Infections; Humans; Male; Pneumococcal Infections; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination; Zambia

Antibiotic-resistant pneumococci are difficult to eradicate from middle ear fluid (MEF) and the nasopharynx (NP). Bacteriologic eradication from the NP and MEF during acute otitis media (AOM) by 3 common antibiotic drugs was prospectively evaluated. In 19 (16%) of 119 MEF culture-positive patients, an organism susceptible to the treatment drug (Haemophilus influenzae, Streptococcus pneumoniae, or both) was isolated from the initial MEF, whereas resistant S. pneumoniae was present in the NP; in 9 (47%) patients, the initial resistant NP organism (identified by serotyping, resistance to the administered drug, and pulsed-field gel electrophoresis) replaced the susceptible MEF organism within only a few days after initiation of treatment. In regions where resistant pneumococci are prevalent, antibiotics may not only fail to eradicate the organisms, but they may often induce MEF superinfection with resistant pneumococci initially carried in the NP. This is an important mechanism by which, in recently treated patients, AOM infections often become refractory to treatment.

Topics: Acute Disease; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Azithromycin; Child; Drug Resistance, Microbial; Drug Therapy, Combination; Ear, Middle; Female; Humans; Male; Nasopharynx; Otitis Media; Pneumococcal Infections; Serotyping; Streptococcus pneumoniae; Superinfection; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination

Emerging drug resistance threatens the effectiveness of existing therapies for pneumococcal infections. Modifying the dose and duration of antibiotic therapy may limit the spread of resistant pneumococci.. To determine whether short-course, high-dose amoxicillin therapy reduces risk of posttreatment resistant pneumococcal carriage among children with respiratory tract infections.. Randomized trial conducted in an outpatient clinic in Santo Domingo, Dominican Republic, October 1999 through July 2000.. Children aged 6 to 59 months who were receiving antibiotic prescriptions for respiratory tract illness (n = 795).. Children were randomly assigned to receive 1 of 2 twice-daily regimens of amoxicillin: 90 mg/kg per day for 5 days (n = 398) or 40 mg/kg per day for 10 days (n = 397).. Penicillin-nonsusceptible Streptococcus pneumoniae carriage, assessed in nasopharyngeal specimens collected at days 0, 5, 10, and 28; baseline risk factors for nonsusceptible pneumococcal carriage; and adherence to regimen, compared between the 2 groups.. At the day 28 visit, risk of penicillin-nonsusceptible pneumococcal carriage was significantly lower in the short-course, high-dose group (24%) compared with the standard-course group (32%); relative risk (RR), 0.77; 95% confidence interval (CI), 0.60-0.97; P =.03; risk of trimethoprim-sulfamethoxazole nonsusceptibility was also lower in the short-course, high-dose group (RR, 0.77; 95% CI, 0.58-1.03; P =.08). The protective effect of short-course, high-dose therapy was stronger in households with 3 or more children (RR, 0.72; 95% CI, 0.52-0.98). Adherence to treatment was higher in the short-course, high-dose group (82% vs 74%; P =.02).. Short-course, high-dose outpatient antibiotic therapy appears promising as an intervention to minimize the impact of antibiotic use on the spread of drug-resistant pneumococci.

Topics: Amoxicillin; Anti-Bacterial Agents; Carrier State; Child, Preschool; Drug Administration Schedule; Drug Resistance, Microbial; Female; Humans; Infant; Male; Nasopharynx; Penicillins; Pneumococcal Infections; Regression Analysis; Respiratory Tract Infections; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adolescent; Anti-Bacterial Agents; Antibiotic Prophylaxis; Carrier State; Child; Child, Preschool; Humans; Infant; Microbial Sensitivity Tests; Nasopharynx; Pneumococcal Infections; Risk Factors; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination

To assess the antimicrobial susceptibility of 14 138 invasive Streptococcus pneumoniae isolates collected in Canada from 2011 to 2020.. Antimicrobial susceptibility testing was performed using the CLSI M07 broth microdilution reference method. MICs were interpreted using 2022 CLSI M100 breakpoints.. In 2020, 90.1% and 98.6% of invasive pneumococci were penicillin-susceptible when MICs were interpreted using CLSI meningitis or oral and non-meningitis breakpoints, respectively; 96.9% (meningitis breakpoint) and 99.5% (non-meningitis breakpoint) of isolates were ceftriaxone-susceptible, and 99.9% were levofloxacin-susceptible. Numerically small, non-temporal, but statistically significant differences (P < 0.05) in the annual percentage of isolates susceptible to four of the 13 agents tested was observed across the 10-year study: chloramphenicol (4.4% difference), trimethoprim-sulfamethoxazole (3.9%), penicillin (non-meningitis breakpoint, 2.7%) and ceftriaxone (meningitis breakpoint, 2.7%; non-meningitis breakpoint, 1.2%). During the same period, annual differences in percent susceptible values for penicillin (meningitis and oral breakpoints) and all other agents did not achieve statistical significance. The percentage of isolates with an MDR phenotype (resistance to ≥3 antimicrobial classes) in 2011 and 2020 (8.5% and 9.4%) was not significantly different (P = 0.109), although there was a significant interim decrease observed between 2011 and 2015 (P < 0.001) followed by a significant increase between 2016 and 2020 (P < 0.001). Statistically significant associations were observed between resistance rates to most antimicrobial agents included in the MDR analysis (penicillin, clarithromycin, clindamycin, doxycycline, trimethoprim/sulfamethoxazole and chloramphenicol) and patient age, specimen source, geographic location in Canada or concurrent resistance to penicillin or clarithromycin, but not biological sex of patients. Given the large isolate collection studied, statistical significance did not necessarily imply clinical or public health significance in some analyses.. Invasive pneumococcal isolates collected in Canada from 2011 to 2020 generally exhibited consistent in vitro susceptibility to commonly tested antimicrobial agents.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Canada; Ceftriaxone; Chloramphenicol; Clarithromycin; Drug Resistance, Bacterial; Humans; Microbial Sensitivity Tests; Penicillins; Pneumococcal Infections; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination

Data related to carriage of Streptococcus pneumoniae (Spn) and antimicrobial resistance patterns in middle-aged and older adults are limited. We assessed the carriage of Spn, and its antibiotic resistance patterns, among participants ≥50 years of age living in the city of Novi Sad during the second year of COVID-19 pandemic.. Analysis of prospectively collected data among participants with or without symptoms of upper respiratory tract infection who visited their elected physicians in the Primary Health Care Centre of Novi Sad (outpatient facility) was conducted from May 18, 2021 to December 7, 2021. Both nasopharyngeal (NP) and oropharyngeal (OP) samples from each participant were collected.. A total of 1042 samples from 521 study subjects (1 NP and 1 OP sample from each person) were collected. Sixteen samples from the same number of persons (3.1%, 95% confidence interval: 1.76%-4.94%) were culture positive for the presence of Spn. Overall, the median age of study participants was 71 years (range, 50-93 years; 90th percentile, 77 years), and most (197/521, 37.8%) of them were 70-79 years of age. A majority of the study subjects were: females (324/521; 62.2%), sampled during May and June 2021 (376/521, 72.2%), those who did not have contact with children aged 0-10 years in the family (403/521; 77.4%), without smokers in the household (443/521; 85.0%), and those who did not receive vaccine against Spn (519/521; 99.6%). Out of 16 Spn positive samples, for six participants, Spn carriage serotypes were obtained and there were four vaccine (6A, 11A, 15B, and 18C) serotypes, and two (6C and 35F) non-vaccine serotypes. Remaining 10 (62.50%) samples were non-typeable isolates of pneumococci. Among four vaccine serotypes, two (6A and 18C) were represented in PCV13, and 18C along with the other two (11A and 15B) in PPSV23 vaccine. The highest level of resistance of Spn isolates was observed for erythromycin, (10 or 62.50%), and tetracycline, (7 or 43.75%), one isolate showed resistance to penicillin, ampicillin, and amoxicillin/amoxicillin-clavulanic acid, while none of them were resistant to ceftriaxone, trimethoprim/sulfamethoxazole and levofloxacin. There were three multi-drug resistant isolates; one was identified as 6C (non-vaccine serotype), and two other were non-typeable isolates of Spn.. In this first study conducted in Serbia on Spn carriage in adults ≥50 years of age, we found low prevalence of Spn carriage and identified 6 serotypes of Spn, four of which were represented in vaccines. These results may support future Spn colonization studies among middle-aged and older adults.

Topics: Aged; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Carrier State; Ceftriaxone; Child; COVID-19; Delivery of Health Care; Erythromycin; Female; Humans; Infant; Levofloxacin; Middle Aged; Nasopharynx; Outpatients; Pandemics; Penicillins; Pneumococcal Infections; Pneumococcal Vaccines; Serbia; Serogroup; Streptococcus pneumoniae; Tetracyclines; Trimethoprim, Sulfamethoxazole Drug Combination

Antimicrobial-resistant strains of Streptococcus pneumoniae have become one of the greatest challenges to global public health today and inappropriate use of antibiotics and high level of antibiotic use is probably the main factor driving the emergence of resistance worldwide. The aim of this study is, therefore, to assess the antimicrobial resistance profiles and multidrug resistance patterns of S. pneumoniae isolates from patients suspected of pneumococcal infections in Ethiopia.. A hospital-based prospective study was conducted from January 2018 to December 2019 at Addis Ababa city and Amhara National Region State Referral Hospitals. Antimicrobial resistance tests were performed from isolates of S. pneumoniae that were collected from pediatric and adult patients. Samples (cerebrospinal fluid, blood, sputum, eye discharge, ear discharge, and pleural and peritoneal fluids) from all collection sites were initially cultured on 5% sheep blood agar plates and incubated overnight at 37 °C in a 5% CO. Of the 57 isolates, 17.5% were fully resistant to penicillin. The corresponding value for both cefotaxime and ceftriaxone was 1.8%. Resistance rates to erythromycin, clindamycin, tetracycline, chloramphenicol and trimethoprim-sulfamethoxazole were 59.6%, 17.5%, 38.6%, 17.5 and 24.6%, respectively. Multidrug resistance (MDR) was seen in 33.3% isolates. The most common pattern was co-resistance to penicillin, erythromycin, clindamycin, and tetracycline.. Most S. pneumoniae isolates were susceptible to ceftriaxone and cefotaxime. Penicillin has been used as a drug of choice for treating S. pneumoniae infection. However, antimicrobial resistance including multidrug resistance was observed to several commonly used antibiotics including penicillin. Hence, it is important to periodically monitor the antimicrobial resistance patterns to select empirical treatments for better management of pneumococcal infection.

Topics: Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Chloramphenicol; Clindamycin; Drug Resistance, Multiple, Bacterial; Erythromycin; Ethiopia; Female; Hospitals; Humans; Male; Microbial Sensitivity Tests; Penicillins; Pneumococcal Infections; Prospective Studies; Streptococcus pneumoniae; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

A 15-valent conjugate vaccine that provides protection against Streptococcus pneumoniae serotypes 22F and 33F is in development. Here we report on the prevalence, antimicrobial susceptibility, and clonal structure of these serotypes in Canada. From 2011 to 2018, the SAVE study collected 11,044 invasive S. pneumoniae isolates. Of these, 9.3% (1024/11,044) and 3.8% (416/11,044) were 22F and 33F, respectively. Serotype 22F isolates were susceptible to most antimicrobials tested except clarithromycin, where susceptibility significantly decreased over time (2011: 80.4%, 2018: 52.9%, P < 0.0001). Only 1.6% of serotype 22F isolates were multidrug-resistant (MDR), while 96% of typed strains were clonal cluster (CC) 433. Serotype 33F isolates demonstrated low susceptibility to clarithromycin and trimethoprim/sulfamethoxazole (22.4% and 24.6%, respectively) and 4.8% MDR. Most serotype 33F isolates were CC100, CC673 and CC717. CC100 prevalence increased significantly over time (2011: 50.0%, 2018: 84.8%, P < 0.006). Continued surveillance of these serotypes is crucial to identify further changes in prevalence, antimicrobial susceptibility, and clonal spread.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Canada; Child; Child, Preschool; Clarithromycin; Drug Resistance, Multiple, Bacterial; Female; Humans; Infant; Male; Middle Aged; Pneumococcal Infections; Pneumococcal Vaccines; Serogroup; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination; Vaccines, Conjugate; Young Adult

Topics: Agammaglobulinemia; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis; Antirheumatic Agents; Churg-Strauss Syndrome; Delphi Technique; Duration of Therapy; Granulomatosis with Polyangiitis; Humans; Immunocompromised Host; Influenza Vaccines; Influenza, Human; Maintenance Chemotherapy; Microscopic Polyangiitis; Neutropenia; Pneumococcal Infections; Pneumococcal Vaccines; Pneumonia, Pneumocystis; Practice Guidelines as Topic; Recurrence; Rituximab; Trimethoprim, Sulfamethoxazole Drug Combination; United Kingdom

Streptococcus pneumoniae causes serious infections worldwide. The aim of this study was to determine the molecular characteristic, antibiotic resistance pattern and capsular types of invasive S. pneumoniae in Tehran, Iran.. Of the 44 pneumococcal invasive isolates, 39 (89%) were isolated from children and 5 (11%) from adults. The results show that all pneumococcal isolates were susceptible to linezolid but had varying resistance to trimethoprim-sulfamethoxazole (86%), erythromycin (73%), tetracycline (66%), clindamycin (43%), penicillin (16%), chloramphenicol (14%) and levofloxacin (2%). The range of erythromycin, tetracycline and penicillin MICs were 2 - ≥ 256 μg/mL, 4 - ≥ 48 μg/mL, and 0.047 - ≥ 256 respectively. All of the penicillin resistant isolates were multidrug resistant (MDR) and in addition to penicillin were resistant to tetracycline, erythromycin and trimethoprim-sulfamethoxazole. The most common capsular types detected in 64% of the pneumococcal isolates was 6A/B, 19A, 15A, 23F. The multilocus sequence typing (MLST) of 10 pneumococcal isolates revealed 9 different sequence types (STs), including ST 15139 (capsular type 19A) and ST 15140 (capsular type 23F), which have not previously been reported.. The study revealed that the S. pneumoniae isolates belonged to diverse capsular types and clones with high rate of resistance to erythromycin, tetracycline, and penicillin.

Topics: Adult; Anti-Bacterial Agents; Bacterial Capsules; Bacterial Typing Techniques; Child; Drug Resistance, Multiple, Bacterial; Erythromycin; Gene Expression Regulation, Bacterial; Humans; Iran; Microbial Sensitivity Tests; Multilocus Sequence Typing; Penicillins; Pneumococcal Infections; Streptococcus pneumoniae; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

Infections caused by antibiotic-resistant bacteria results in high rates of morbidity and mortality. Although the prolonged cotrimoxazole (CTX) prophylaxis is arguably associated with the risk of increasing drug resistance in the common pathogens, information regarding its impact on Streptococci pneumoniae / pneumococcus is very limited.. This study was conducted to investigate the effect of cotrimoxazole prophylaxis on nasopharyngeal colonization rate and antimicrobial resistance using Streptococci pneumoniae (pneumococcus) as an indicator organism among HIV patients in Arba Minch, Ethiopia.. A comparative cross-sectional study was designed and conducted among HIV patients attending the Anti-Retroviral Treatment (ART) clinic of Arba Minch General Hospital (AMGH) from April 01 to August 31, 2018. A total of 252 participants were systematically selected and clustered into two study groups based on their CTX prophylaxis status, one taking CTX prophylaxis, and the second one, the control group (without prophylaxis). A structured questionnaire was used to collect socio-demographic and clinical data from patients. A nasopharyngeal swab was collected and cultured for pneumococcal isolation and identification in accordance with standard microbiological techniques. An antibiotics sensitivity test was performed according to the CLSI guidelines. Data were analyzed using the Statistical package for social science (SPSS) version 20. The primary outcome was determined using logistic regression analysis.. Of the 252 enrolled HIV patients (mean age (37.38± 9.03 years), 144 (57.14%) were males. The overall, nasopharyngeal colonization rate of S. pneumoniae was 13.5% (95% CI: 8.4-15.6). Asymptomatic pneumococcal carriage rates among patients on CTX prophylaxis and the control group were 16.3%, and 10.3% respectively (p-value = 0.03). Regarding the risk factors analyzed, CTX prophylaxis (AOR: 2.2; 95% CI: 1.05-4.9) and gender (AOR: 2.5; 95% CI: 1.09-5.93) were significantly associated with pneumococcal colonization, showing a male preponderance. Cotrimoxazole-resistant pneumococci were 85.7% vs. 47.4% in the prophylaxis group and the control group respectively and it was statistically significant (AOR: 6.7; 95% CI: 1.3-36). Percentages of multi-drug resistant isolates in these two groups were 38.09 and 15.38 respectively (p-value = 0.04). Among the CTX resistant pneumococci isolates, 85% were also found to be co-resistant towards penicillin and was statistically significant.. The percentage prevalence of nasopharyngeal pneumococci colonization was higher in patients taking CTX prophylaxis. It was noted that CTX prophylaxis eventually results in the selection of cotrimoxazole resistance and multi-drug resistance in pneumococci. There is evidence of existing cross-resistance between cotrimoxazole and penicillin antibiotics. Therefore, CTX prophylaxis must be administered judiciously. Surveillance for antimicrobial susceptibility is warranted where the prophylaxis is common.

Topics: Adult; Anti-HIV Agents; Antibiotic Prophylaxis; Carrier State; Case-Control Studies; Cross-Sectional Studies; Drug Resistance, Multiple, Bacterial; Ethiopia; Female; HIV Infections; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Nasopharynx; Pneumococcal Infections; Sex Characteristics; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination

This study was performed to analyze the serotype distribution of Streptococcus pneumoniae causing invasive pneumococcal disease (IPD) in children aged 5 years and under in Malaysia and to assess the antimicrobial resistance.. From 2014 to 2017, a total of 245 invasive S. pneumoniae isolates from children ≤5 years of age were received from hospitals all around Malaysia. All isolates were identified and subjected to serotyping and antimicrobial susceptibility testing.. Of the 245 isolates, 117 (48.0%) were from children aged <1year, 46 (19.05%) were from children aged 1-2 years, and 82 (33.0%) were from children aged 2-5 years. The most common serotypes were 14 (26.9%), 6B (19.6%), 19A (11.8%), 6A (10.6%), and 19F (6.9%) and vaccine coverage was 88.2% for PCV13, 64.1% for PCV10, and 63.3% for PCV7. Resistance to penicillin was 0.2% for non-meningitis cases and 22.2% for meningitis cases; erythromycin resistance was reported in 42.9%, co-trimoxazole in 35.9%, and tetracycline in 42.9%.. Serotypes 14, 6B, 19A, 6A, and 19F were the most common serotypes isolated from children with IPD in Malaysia during this pre-vaccination era. The lack of reports on the serotype distribution has limited action for the implementation of PCV in the national immunization programme (NIP). The information from this study may benefit future policies for the introduction of PCV in the Malaysian NIP and ultimately may reduce the morbidity and mortality among children in Malaysia.

Topics: Anti-Bacterial Agents; Child, Preschool; Drug Resistance, Multiple, Bacterial; Erythromycin; Female; Heptavalent Pneumococcal Conjugate Vaccine; Hospitals; Humans; Infant; Malaysia; Male; Penicillins; Pneumococcal Infections; Pneumococcal Vaccines; Serogroup; Serotyping; Streptococcus pneumoniae; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination; Vaccination; Vaccination Coverage

The aim of this study was to investigate nasopharyngeal carriage rate and antibiotic susceptibility patterns of Streptococcus pneumoniae among school children.. Three hundred eleven (43.8%) became culture positive for S. pneumoniae. The carriage rate among children, 3-5 years old was 62.5%, which was higher than the carriage rate of 38.6% among 6-13 years old children. Age ≤ 5 years and co-sleeping with siblings remained significantly associated with S. pneumoniae carriage. 155 (49.8%) of the isolates were resistant to co-trimoxazole, 152 (48.9%) of the isolates were resistant to tetracycline, and 88 (28.3%) of isolates were resistant to oxacillin. Multi drug resistant S. pneumoniae was observed in 90 (28.9%) of isolates. There is high prevalence of S. pneumoniae in primary school children in our study area. Relatively high carriage rate of resistance to oxacillin, tetracycline and co-trimoxazole were observed. These findings provide baseline data for future studies to further compare pneumococcal carriage rates and antibiotic resistance patterns.

Topics: Adolescent; Animals; Anti-Bacterial Agents; Carrier State; Child; Child, Preschool; Drug Resistance, Microbial; Ethiopia; Female; Humans; Male; Microbial Sensitivity Tests; Nasopharynx; Pneumococcal Infections; Siblings; Streptococcus pneumoniae; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination; Vaccination

Emergent resistance to antibiotics among Streptococcus pneumoniae isolates is a severe problem worldwide. Antibiotic resistance profiles for S pneumoniae isolates identified from pediatric patients in mainland China remains to be established.The clinical features, antimicrobial resistance, and multidrug resistance patterns of S pneumoniae were retrospectively analyzed at 10 children's hospitals in mainland China in 2016.Among the collected 6132 S pneumoniae isolates, pneumococcal diseases mainly occurred in children younger than 5 years old (85.1%). The resistance rate of S pneumoniae to clindamycin, erythromycin, tetracycline, and trimethoprim/sulfamethoxazole was 95.8%, 95.2%, 93.6%, and 66.7%, respectively. The resistance rates of S pneumoniae to penicillin were 86.9% and 1.4% in non-meningitis and meningitis isolates, while the proportions of ceftriaxone resistance were 8.2% and 18.1%, respectively. Pneumococcal conjugate vaccine was administered to only 4.1% of patients. Penicillin and ceftriaxone resistance, underling diseases, antibiotic resistant risk factors, and poor prognosis appeared more frequently in invasive pneumococcal diseases. The incidence of multidrug resistance (MDR) was 46.1% in patients with invasive pneumococcal disease which was more than in patients with non-invasive pneumococcal disease (18.3%). Patients with invasive pneumococcal disease usually have several MDR coexistence.S pneumoniae isolates showed high resistance to common antibiotics in mainland China. Penicillin and ceftriaxone resistance rate of invasive streptococcal pneumonia patients were significantly higher than that of non-invasive S pneumoniae patients. Alarmingly, 46.1% of invasive clinical isolates were multidrug resistant, so it is important to continued monitor the resistance of S pneumoniae when protein conjugate vaccine (PCV13) is coming in mainland China.

Topics: Anti-Bacterial Agents; Ceftriaxone; Child; Child, Preschool; China; Drug Resistance, Multiple, Bacterial; Erythromycin; Female; Humans; Infant; Infant, Newborn; Male; Microbial Sensitivity Tests; Penicillins; Pneumococcal Infections; Retrospective Studies; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination

Patients with cancer, particularly those with hematologic malignancies, are at an increased risk of invasive pneumococcal disease (IPD) and they are included in the list of subjects for whom pneumococcal vaccination is recommended. The main aim of this study was to evaluate Streptococcus pneumoniae colonization in school-aged children and adolescents with cancer to determine the potential protective efficacy of 13-valent pneumococcal conjugate vaccine (PCV13). An oropharyngeal swab was obtained from 277 patients (age range 6-17 years) with cancer during routine clinical visits and analyzed for S. pneumoniae using real-time polymerase chain reaction. S. pneumoniae was identified in 52 patients (18.8%), including 47/235 (20.0%) with hematologic malignancies and 5/42 (11.9%) with solid tumors. Colonization declined significantly with an increase in age (odds ratio [OR] 0.34, 95% confidence interval [CI] 0.16-0.71, and OR 0.30, 95% CI 0.11-0.82 in children aged 10-14 and ≥15 years, respectively, as compared to those <10 years). Carriage was more common among patients with leukemia or lymphoma than in children with solid tumors. Co-trimoxazole prophylaxis was significantly associated with reduced pneumococcal carriage (OR 0.41, 95% CI 0.19-0.89). A total of 15/58 (25.9%) and 26/216 (12.0%) children were colonized by PCV13 serotypes among cancer patients previously vaccinated and not vaccinated with 7-valent pneumococcal conjugate vaccine (PCV7), respectively. In conclusion, this study indicates that children and adolescents with cancer are frequently colonized by S. pneumoniae. Because most of the carried serotypes are included in PCV13, this vaccine is presently the best solution to reduce the risk of IPD in these patients.

Topics: Adolescent; Carrier State; Child; DNA, Bacterial; Female; Heptavalent Pneumococcal Conjugate Vaccine; Humans; Male; Nasopharynx; Neoplasms; Pneumococcal Infections; Pneumococcal Vaccines; Real-Time Polymerase Chain Reaction; Serogroup; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination; Vaccination; Vaccines, Conjugate

Increasing pneumococcal resistance to commonly used antibiotics and multidrug resistance is a serious public health concern. Data on distribution of resistant Streptococcus pneumoniae (SPn) strains among children in Lithuania are limited. We evaluated the circulation of SPn serotypes and antimicrobial susceptibility among preschool children in Lithuania before the introduction of universal infant pneumococcal vaccination.. A prospective study was carried out from February 2012 to March 2013 in five cities of Lithuania. A total of 900 children under six years of age who presented to primary care centre or a hospital emergency department with acute respiratory tract infection were enrolled in the study. Nasopharyngeal swabs were obtained and cultured for SPn. Positive samples (n = 367) were serotyped and tested for antimicrobial susceptibility. Associations of pneumococcal non-susceptibility with study site, season, age, sex, attendance of day care centre and treatment with antimicrobials (between one and six months prior the study) were evaluated.. About a half (56.7 %) of SPn strains were susceptible to all the antibiotics tested. Pneumococcal non-susceptibility to penicillin, erythromycin, clindamycin and trimethoprim-sulphamethoxazole was 15.8, 21.3, 16.9 and 27.3 %, respectively. None of the tested isolates was resistant to norfloxacin or vancomycin. We found a geographical variation of pneumococcal resistance within the cities of the country. Age, sex, the attendance of day care centre and treatment with antimicrobials prior the study was not significantly associated with a carriage of non-susceptible SPn strains. Among non-susceptible SPn serotypes 67.9 %-82.4 % were present in currently available pneumococcal conjugate vaccines.. The rates of nasopharyngeal SPn susceptibility to penicillin and macrolides are still high among preschool children in Lithuania, however they are lower compared with previous studies. A strict policy with respect to antibiotic prescription together with widespread use of vaccination could potentially reduce the carriage rate of antibiotic-resistant pneumococci in our country.

Topics: Anti-Bacterial Agents; Child; Child, Preschool; Drug Resistance, Microbial; Erythromycin; Female; Humans; Infant; Infant, Newborn; Lithuania; Macrolides; Male; Microbial Sensitivity Tests; Nasopharynx; Penicillins; Pneumococcal Infections; Pneumococcal Vaccines; Prospective Studies; Respiratory Tract Infections; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination

Our whole genome sequence (WGS) pipeline was assessed for accurate prediction of antimicrobial phenotypes. For 2316 invasive pneumococcal isolates recovered during 2015 we compared WGS pipeline data to broth dilution testing (BDT) for 18 antimicrobials. For 11 antimicrobials categorical discrepancies were assigned when WGS-predicted MICs and BDT MICs predicted different categorizations for susceptibility, intermediate resistance or resistance, ranging from 0.9% (tetracycline) to 2.9% (amoxicillin). For β-lactam antibiotics, the occurrence of at least four-fold differences in MIC ranged from 0.2% (meropenem) to 1.0% (penicillin), although phenotypic retesting resolved 25%-78% of these discrepancies. Non-susceptibility to penicillin, predicted by penicillin-binding protein types, was 2.7% (non-meningitis criteria) and 23.8% (meningitis criteria). Other common resistance determinants included mef (475 isolates), ermB (191 isolates), ermB + mef (48 isolates), tetM (261 isolates) and cat (51 isolates). Additional accessory resistance genes (tetS, tet32, aphA-3, sat4) were rarely detected (one to three isolates). Rare core genome mutations conferring erythromycin-resistance included a two-codon rplD insertion (rplD69-KG-70) and the 23S rRNA A2061G substitution (six isolates). Intermediate cotrimoxazole-resistance was associated with one or two codon insertions within folP (238 isolates) or the folA I100L substitution (38 isolates), whereas full cotrimoxazole-resistance was attributed to alterations in both genes (172 isolates). The two levofloxacin-resistant isolates contained parC and/or gyrA mutations. Of 11 remaining isolates with moderately elevated MICs to both ciprofloxacin and levofloxacin, seven contained parC or gyrA mutations. The two rifampin-resistant isolates contained rpoB mutations. WGS-based antimicrobial phenotype prediction was an informative alternative to BDT for invasive pneumococci.

Topics: Anti-Bacterial Agents; Chloramphenicol; Ciprofloxacin; Clindamycin; Drug Resistance, Multiple, Bacterial; Erythromycin; Genes, Bacterial; Humans; Microbial Sensitivity Tests; Mutation; Penicillin-Binding Proteins; Penicillins; Pneumococcal Infections; RNA, Ribosomal, 23S; Streptococcus pneumoniae; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination; United States

Antimicrobial-resistant pneumococcal strains have been detected worldwide since the 1960s. In Brazil, the first penicillin-nonsusceptible pneumococci (PNSP) were reported in the 1980s, and their emergence and dissemination have been mainly attributed to serogroup 9 and serotype 14 strains, especially those highly related to recognized international clones. In the present study, antimicrobial susceptibility testing and multilocus sequence typing were performed on 315 pneumococcal isolates belonging to serogroup 9 (n = 99) or serotype 14 (n = 216), recovered from patients or asymptomatic carriers between 1988 and 2011 in Brazil, in order to trace changes in antimicrobial resistance and genotypes prior to the full introduction of the pneumococcal conjugate vaccine in the country. Over the 23-year study period, the PNSP levels increased, and four clonal complexes (CC156, CC66, CC15, and CC5401) have played important roles in the evolution and dissemination of pneumococcal isolates belonging to serogroup 9 and serotype 14, as well as in the emergence of antimicrobial resistance, in the pre-pneumococcal-vaccination era. The earliest PNSP strains detected in this study belonged to serotype 9N/ST66 and were single locus variants of the international clone Tennessee

Topics: Anti-Bacterial Agents; Asymptomatic Diseases; Brazil; Clone Cells; Drug Resistance, Multiple, Bacterial; Epidemiological Monitoring; Europe; History, 20th Century; History, 21st Century; Humans; Incidence; Microbial Sensitivity Tests; Multilocus Sequence Typing; Penicillin Resistance; Penicillins; Phylogeny; Phylogeography; Pneumococcal Infections; Pneumococcal Vaccines; Serogroup; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination; United States

Prophylactic intranasal administration of the Toll-like receptor 5 (TLR5) agonist flagellin protects mice against respiratory pathogenic bacteria. We hypothesized that TLR5-mediated stimulation of lung immunity might improve the therapeutic index of antibiotics for the treatment of Streptococcus pneumoniae respiratory infections in mice. Intranasal administration of flagellin was combined with either oral administration of amoxicillin or intraperitoneal injection of trimethoprim-sulfamethoxazole to treat S. pneumoniae-infected animals. Compared with standalone treatments, the combination of antibiotic and flagellin resulted in a lower bacterial load in the lungs and greater protection against S. pneumoniae dissemination and was associated with an early increase in neutrophil infiltration in the airways. The antibiotic-flagellin combination treatment was, however, not associated with any exacerbation of inflammation. Moreover, combination treatment was more efficacious than standalone antibiotic treatments in the context of post-influenza virus pneumococcal infection. Lastly, TLR5 signaling was shown to be mandatory for the efficacy of the combined antibacterial therapy. This report is the first to show that combining antibiotic treatment with the stimulation of mucosal innate immunity is a potent antibacterial strategy against pneumonia.

Topics: Amoxicillin; Animals; Anti-Bacterial Agents; Female; Flagellin; Immunity, Innate; Mice; Mice, Inbred BALB C; Neutrophil Infiltration; Pneumococcal Infections; Streptococcus pneumoniae; Toll-Like Receptor 5; Trimethoprim, Sulfamethoxazole Drug Combination

This study aimed to define the molecular basis of co-trimoxazole resistance in Malawian pneumococci under the dual selective pressure of widespread co-trimoxazole and sulfadoxine/pyrimethamine use.. We measured the trimethoprim and sulfamethoxazole MICs and analysed folA and folP nucleotide and translated amino acid sequences for 143 pneumococci isolated from carriage and invasive disease in Malawi (2002-08).. Pneumococci were highly resistant to both trimethoprim and sulfamethoxazole (96%, 137/143). Sulfamethoxazole-resistant isolates showed a 3 or 6 bp insertion in the sulphonamide-binding site of folP. The trimethoprim-resistant isolates fell into three genotypic groups based on dihydrofolate reductase (encoded by folA) mutations: Ile-100-Leu (10%), the Ile-100-Leu substitution together with a residue 92 substitution (56%) and those with a novel uncharacterized resistance genotype (34%). The nucleotide sequence divergence and dN/dS of folA and folP remained stable from 2004 onwards.. S. pneumoniae exhibit almost universal co-trimoxazole resistance in vitro and in silico that we believe is driven by extensive co-trimoxazole and sulfadoxine/pyrimethamine use. More than one-third of pneumococci employ a novel mechanism of co-trimoxazole resistance. Resistance has now reached a point of stabilizing evolution. The use of co-trimoxazole to prevent pneumococcal infection in HIV/AIDS patients in sub-Saharan Africa should be re-evaluated.

Topics: Amino Acid Sequence; Genotype; Humans; Malawi; Microbial Sensitivity Tests; Molecular Sequence Data; Pneumococcal Infections; Prevalence; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination

To evaluate the susceptibility patterns among Streptococcus pneumoniae recovered during the years 2010-2012 and to correlate these with serotypes.. Pneumococci from invasive sites were serotyped by sequential multiplex PCR and/or Quellung reaction. Etest strips were used to determine the minimal inhibitory concentrations, and the Clinical and Laboratory Standards Institute (CLSI) guidelines were used for interpretation. Genetic determinants of macrolide resistance were assessed by PCR, and the occurrence of the D phenotype was analyzed following the recommendations of the CLSI.. One hundred fifty-nine S. pneumoniae were studied; most were recovered from blood and were associated with serotypes 14, 3, 4, 23F, 20, 7F, 12F, 19A, and 19F. Pneumococcal conjugate vaccine PCV7, PCV10, and PCV13 and 23-valent polysaccharide vaccine serotypes represented 38.2%, 48.7%, 64.5%, and 85.5%, respectively. β-Lactam non-susceptibility (non-meningitis) was basically related to serotype 19A. For meningitis, it was observed in 21.4% (serotypes 14, 3, 9V, 23F, and 24F). Resistance to erythromycin occurred in 8.2% and mefA was the most common macrolide genetic determinant. One isolate was resistant to levofloxacin. Non-susceptibility to trimethoprim-sulfamethoxazole was 37.7% and to tetracycline was 22.0%.. Our population of pneumococci represents a transition era, soon after the introduction of PCV10. Non-susceptible patterns were found to be associated with classical PCV serotypes (especially serotype 14), which is still highly prevalent, and non-PCV10 ones (19A), which may disseminate, occupying the biological niche left by the vaccine serotypes.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Brazil; Child; Child, Preschool; Clindamycin; Drug Resistance, Multiple, Bacterial; Erythromycin; Humans; Infant; Levofloxacin; Macrolides; Microbial Sensitivity Tests; Middle Aged; Pneumococcal Infections; Pneumococcal Vaccines; Serotyping; Streptococcus pneumoniae; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

Streptococcus pneumoniae causes life threatening infections and necessitate for impediment and controlling disease; to conquer this, information is needed about serotype distribution and patterns of antibiotic resistance. The present study was to determine the serotype distribution of S. pneumoniae isolated from the entire age group individual and to correlate this distribution with susceptibility. Cases of pneumococcal infections have been reviewed for serotyping and antibiotic susceptibility. Out of 117 pneumococcal isolates 45 (39%) were penicillin-resistant, 84 (72%) were erythromycin-resistant and 100% were co-trimoxazole resistant. The most frequently isolated serotypes were 23F, 19F, 14, 6B, 5, 6A, 19A and 9V. PCV7, PCV10 and PCV13 coverage was 68%, 79%, 87%, respectively. Similarly, there was similarity in PCV7 coverage for non invasive isolates (64.5%) and invasive isolates (72.2%). The study state that common pneumococcal serotypes were present in similar ways as reported in literature. A continuous survey of pneumococcal infected population is requirement and necessity for success of vaccination.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Bacterial Capsules; Child; Child, Preschool; Drug Resistance, Microbial; Erythromycin; Female; Humans; Infant; Infant, Newborn; Male; Microbial Sensitivity Tests; Middle Aged; Penicillins; Pneumococcal Infections; Saudi Arabia; Serotyping; Severity of Illness Index; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination

Allogeneic hematopoietic stem cell transplantation (alloHSCT) recipients are at high risk of invasive pneumococcal disease (IPD). We investigated the incidence and risk factors of IPD in alloHSCT recipients from 4 regional transplant centers over an 11-year period. This study aimed to inform future improvements in post-transplant care.. We conducted a retrospective nested 1:2 case-control study in patients aged ≥18 years who underwent alloHSCT between 2001 and 2011 in 4 major allogeneic transplant centers. Controls were matched with IPD cases on the basis of conditioning intensity and donor relationship (related or unrelated). Demographics and clinical characteristics of cases and controls were summarized. Univariate analysis of risk factors in matched case-control sets, and multivariate conditional logistic regression to control for confounding, were performed.. In 23 alloHSCT recipients, 26 IPD episodes were identified. The cumulative incidence over 11 years was 2.3% (95% confidence interval [CI] 1.45-3.15) and the incidence density 956 per 100,000 transplant years of follow-up (95% CI 580-1321). Multivariate risk factor analysis and backwards elimination showed a significant positive association between mycophenolate mofetil (MMF), hyposplenism/asplenia, and IPD, whereas trimethoprim-sulfamethoxazole (TMP/SMX) prophylaxis for Pneumocystis jirovecii pneumonia (PJP) was associated with lower odds of IPD cases. Of alloHSCT recipients with IPD, 38.5% required intensive care, and, of deaths documented in cases over the period of review, 30% were attributable to IPD. Serotypes causing IPD matched currently available vaccines in 15/22 (68.1%) episodes.. The incidence of IPD in alloHSCT recipients is an important cause of morbidity and mortality, with rates of disease being many fold higher than the general population. Patients with evidence of hyposplenism/asplenia define a high-risk group in the alloHSCT population for IPD, and the independent association with IPD and MMF in the adjusted model from this study requires further evaluation. The occurrence of post-transplant IPD may be reduced by measures such as vaccination with both 13-valent and 23-valent pneumococcal vaccines. TMP/SMX prophylaxis for the prevention of PJP may offer incidental protection against IPD in alloHSCT recipients.

Topics: Adult; Aged; Anti-Infective Agents; Antibiotic Prophylaxis; Case-Control Studies; Female; Hematopoietic Stem Cell Transplantation; Humans; Immunocompromised Host; Immunosuppressive Agents; Incidence; Male; Middle Aged; Mycophenolic Acid; Pneumococcal Infections; Retrospective Studies; Risk Factors; Serotyping; Spleen; Streptococcus pneumoniae; Transplantation, Homologous; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

The present study evaluates the feasibility of rapid surveillance of community antimicrobial resistance (AMR) patterns of Streptococcus pneumoniae and Haemophilus influenzae in India using nasopharyngeal swabs (NPSs) of school children. It compares the AMR data obtained with that of invasive and nasopharyngeal (NP) isolates studied previously. No one has done such surveillance since our study so we decided to publish and more clearly demonstrate the feasibility of the methodology we did.. This community-based, cross-sectional, cluster sample study had seven centers; each had two sites distant to them. Two hundred sixty school children per center were enrolled. NP swabbing was performed and isolates identified as S. pneumoniae and H. influenzae at each center were sent to reference laboratories.. From January to December 2004, 1,988 NP swabs were processed; 776 S. pneumoniae and 64 H. influenzae were isolated. The AMR patterns for S. pneumoniae to co-trimoxazole varied, with sensitivity as low as 6% in Mumbai, 29% in Chennai and Vellore, and 100% in Delhi and Lucknow. For H. influenzae, sensitivity rates to co-trimoxazole ranged from 22% to 62%. The AMR patterns for both bacteria in the present study with data from invasive and NP isolates studied earlier were similar.. The study demonstrates that it is practical and feasible to rapidly assess the AMR patterns of both S. pneumoniae and H. influenzae in NPSs of school children in different geographic locations all over India.

Topics: Anti-Bacterial Agents; Child; Cluster Analysis; Cross-Sectional Studies; Drug Resistance, Bacterial; Haemophilus Infections; Haemophilus influenzae; Humans; India; Microbial Sensitivity Tests; Nasopharynx; Pneumococcal Infections; Population Surveillance; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination

Among 5,043 invasive pneumococcal disease (IPD) isolates identified through South African national surveillance from 2003 to 2007, we estimated the effect of trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis on antimicrobial resistance. Patients on TMP-SMX prophylaxis were more likely to have a pneumococcal isolate nonsusceptible to TMP-SMX, penicillin, and rifampin. TMP-SMX nonsusceptibility was associated with nonsusceptibility to penicillin, erythromycin, and rifampin and multidrug resistance. This study informs empirical treatment of suspected IPD in patients with a history of TMP-SMX use.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Child; Child, Preschool; Drug Resistance, Multiple, Bacterial; Erythromycin; Female; Humans; Infant; Infant, Newborn; Longitudinal Studies; Male; Middle Aged; Penicillins; Pneumococcal Infections; Population Surveillance; Rifampin; South Africa; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination

Antibiotic resistant and invasive pneumococci may spread temporally and locally in day care centers (DCCs). We examined 267 children attending four DCCs located in the same city and 70 children staying at home in three seasons (autumn, winter, and spring) to determine prevalence, serotype distribution, antibiotic resistance patterns, and transmission of pneumococcal strains colonizing upper respiratory tract of healthy children without antipneumococcal vaccination. By pheno- and genotyping, we determined clonality of pneumococci, including drug-resistant strains. The average carriage of pneumococci in three seasons was 38.2%. 73.4% and 80.4% of the isolates belonged to serotypes present in 10- and 13-valent conjugate vaccine, respectively. Among the pneumococcal strains, 33.3% were susceptible to all antimicrobial tested and 39.2% had decreased susceptibility to penicillin. Multidrug resistance was common (35.7%); 97.5% of drug-resistant isolates represented serotypes included to 10- and 13-valent conjugate vaccine. According to BOX-PCR, clonality definitely was observed only in case of serotype 14. Multivariate analysis determined DCC attendance as strongly related to pneumococcal colonization in all three seasons, but important seasonal differences were demonstrated. In children attending DCCs, we observed dynamic turnover of pneumococcal strains, especially penicillin nonsusceptible and multidrug resistant, which were mostly distributed among serotypes included to available pneumococcal conjugate vaccines.

Topics: Anti-Bacterial Agents; Carrier State; Child Day Care Centers; Child, Preschool; Drug Resistance, Multiple, Bacterial; Female; Genotype; Humans; Male; Microbial Sensitivity Tests; Multivariate Analysis; Odds Ratio; Penicillins; Phenotype; Pneumococcal Infections; Poland; Prevalence; Respiratory System; Respiratory Tract Infections; Seasons; Streptococcus pneumoniae; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

Streptococcus pneumoniae is a worldwide leading cause of morbidity and mortality, while susceptibility towards penicillin and macrolides can be less than 50% in many regions.. A total of 150 isolates of S. pneumoniae causative of invasive diseases in children were characterized, of which 24.6% had a fatal outcome.. The most prevalent serotypes were 19F, 6B, 23F and 14. Resistance to penicillin, erythromycin (mostly of macrolide-lincosamide-streptogramin resistance phenotype) or trimethoprim-sulfamethoxazole was found in more than 40% of the isolates, but no resistance phenotype appeared linked to lethality. Serotype 3 isolates, which were seldom resistant, had a twofold lethality rate compared to the total sample.. Serotyping could provide a better outcome-predicting tool than susceptibility testing. The seven-valent vaccine does not include the most prevalent serotypes found in Mexico.

Topics: Adolescent; Anti-Bacterial Agents; Child; Child, Preschool; Drug Resistance, Bacterial; Female; Humans; Infant; Infant, Newborn; Macrolides; Male; Mexico; Microbial Sensitivity Tests; Penicillins; Pneumococcal Infections; Prevalence; Serotyping; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination

To document trends in invasive pneumococcal disease (IPD) in a central hospital in Malawi during the period of national scale-up of antiretroviral therapy (ART) and cotrimoxazole prophylaxis.. Between 1 January 2000 and 31 December 2009 almost 100,000 blood cultures and 40,000 cerebrospinal fluid (CSF) cultures were obtained from adults and children admitted to the Queen Elizabeth Central Hospital, Blantyre, Malawi with suspected severe bacterial infection.. 4,445 pneumococcal isolates were obtained over the 10 year period. 1,837 were from children: 885 (19.9%) from blood and 952 (21.4%) from CSF. 2,608 were from adults: 1,813 (40.8%) from blood and 795 (17.9%) from CSF. At the start of the surveillance period cotrimoxazole resistance was 73.8% and at the end was 92.6%. Multidrug resistance (MDR) was present in almost one third of isolates and was constant over time. Free ART was introduced in Malawi in 2004. From 2005 onwards there was a decline in invasive pneumococcal infections with a negative correlation between ART scale-up and the decline in IPD (Pearson's correlation r = -0.91; p<0.001).. During 2004-2009, national ART scale-up in Malawi was associated with a downward trend in IPD at QECH. The introduction of cotrimoxazole prophylaxis in HIV-infected groups has not coincided with a further increase in pneumococcal cotrimoxazole or multidrug resistance. These data highlight the importance of surveillance for high disease burden infections such as IPD in the region, which will be vital for monitoring pneumococcal conjugate vaccine introduction into national immunisation programmes.

Topics: Adult; Anti-Retroviral Agents; Antibiotic Prophylaxis; Child; Drug Resistance, Microbial; Humans; Malawi; Pneumococcal Infections; Population Surveillance; Rain; Seasons; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination

All Streptococcus pneumoniae strains isolated from paediatric clinical samples at Heraklion University General Hospital in the 10-year period 2000-2009 were tested for serotype and susceptibility to antimicrobials. Among a total of 258 strains, 159 were isolated in the 5-year period 2000-2004, before the introduction of the heptavalent pneumococcal conjugate vaccine (PCV7), and 99 in the post-PCV7 5-year period 2005-2009. The prevalence of PCV7-included serotypes decreased in the post-PCV7 period (p = 0.0002), but an increase was observed for serotypes 7F (p = 0.002) and 19A (p = 0.004). Pan-susceptibility rates and susceptibility to cotrimoxazole increased in the post-PCV7 period (p = 0.01 and p = 0.008, respectively), but serotype 19A emerged as a contributor to multi-resistance (p = 0.007). PCV7 was followed by decreased S. pneumoniae resistance and prevalence of vaccine-related serotypes but increased prevalence of serotypes 7F and 19A. Continuing surveillance is required after the recent introduction of PCV10 and PCV13.

Topics: Adolescent; Anti-Bacterial Agents; beta-Lactams; Child; Child, Preschool; Chloramphenicol; Clindamycin; Greece; Heptavalent Pneumococcal Conjugate Vaccine; History, 21st Century; Humans; Immunization Programs; Macrolides; Microbial Sensitivity Tests; Pneumococcal Infections; Pneumococcal Vaccines; Quinolones; Serotyping; Streptococcus pneumoniae; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination; Vaccines, Conjugate; Vancomycin

Streptococcus pneumoniae infections constitute a public health problem. In our country there is scarce information regarding isolates from bacteraemic episodes in adult population. The antibiotic susceptibility, serotypes and clonal relationship of 56 isolates of S. pneumoniae from adult patients with bacteraemic infections in Concepcion-Talcahuano, Bio-Bio Region, Chile, were studied. Resistance to tetracycline (21.4%), trimethoprim/ sulfamethoxazole (18%), erythromycin (18%), chloramphenicol (7%) and 1 penicillin resistant isolate from a meningeal focus (2%) was found. Also, all the isolates were susceptible to cefotaxime, levofloxacin, moxifloxacin and vancomycin. A wide variety of capsular serotypes was demonstrated, with predominance of serotypes 1, 5, 23F, 7F and 3. The macrorestriction analysis by pulse field electrophoresis revealed 31 electrophoretic patterns and 12 clonal groups, discarding a predominant clone. According to the results, at least, 80% of the S. pneumoniae serotypes isolated from bacteraemic adult patients are included in the available commercial vaccine.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Chile; Chloramphenicol; Drug Resistance, Multiple, Bacterial; Electrophoresis, Gel, Pulsed-Field; Erythromycin; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Pneumococcal Infections; Serotyping; Streptococcus pneumoniae; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

To ascertain the microbiological consequences of WHO's recommendation for presumptive co-trimoxazole prophylaxis for infants with perinatal HIV exposure.. Using a longitudinal cohort design, we followed HIV-exposed and HIV-unexposed infants trimonthly for up to 18 months per infant. HIV-exposed infants received daily co-trimoxazole prophylaxis from 6 weeks to > or = 12 months of age. Using Streptococcus pneumoniae as our sentinel pathogen, we measured how co-trimoxazole altered nasopharyngeal colonization, pneumococcal resistance to antibiotics and serotype distribution as a function of co-trimoxazole exposure.. From 260 infants followed for 3096 patient-months, we detected pneumococci in 360/1394 (25.8%) samples. HIV-exposed infants were colonized more frequently than HIV-unexposed infants (risk ratio, RR: 1.4; 95% confidence interval, CI: 1.0-1.9, P = 0.04). Co-trimoxazole prophylaxis reduced colonization by ca 7% but increased the risk of colonization with co-trimoxazole-resistant pneumococci within 6 weeks of starting prophylaxis (RR: 3.2; 95% CI: 1.3-7.8, P = 0.04). Prophylaxis with co-trimoxazole led to a small but statistically significant increase of nasopharyngeal colonization with pneumococci not susceptible to clindamycin (RR: 1.6; 95% CI: 1.0-2.6, P = 0.04) but did not increase the risk of non-susceptibility to penicillin (RR: 1.1; 95% CI: 0.7-1.7), erythromycin (RR: 1.0; 95% CI: 0.6-1.7), tetracycline (RR: 0.9; 95% CI: 0.6-1.5) or chloramphenicol (RR: 0.8; 95% CI: 0.3-2.3). Co-trimoxazole prophylaxis did not cause the prevailing pneumococcal serotypes to differ from those that are targeted by the 7-valent conjugate pneumococcal vaccine (RR: 1.0; 95% CI: 0.7-1.6).. Co-trimoxazole prophylaxis modestly suppresses pneumococcal colonization but accelerates infant acquisition of co-trimoxazole- and clindamycin-resistant pneumococci. Co-trimoxazole prophylaxis appears unlikely to compromise the future efficacy of conjugate vaccines.

Topics: Anti-Infective Agents; Antibiotic Prophylaxis; Drug Resistance, Multiple, Bacterial; Female; Humans; Infant; Infant, Newborn; Longitudinal Studies; Male; Microbial Sensitivity Tests; Pneumococcal Infections; Seroepidemiologic Studies; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination; Zambia

The prevalence and cotrimoxazole susceptibility of Streptococcus pneumoniae isolated from sputum of 100 HIV-positive patients attending the Nigeria Institute of Medical Research clinic was investigated using standard microbiological methods. Eleven of the sputum specimens grew Streptococcus pneumoniae. Antimicrobial susceptibility test showed that all the isolates were sensitive to amoxicillin, augmentin, erythromycin and chloramphenicol but were resistant to cotrimoxazole. Continuous surveillance of S pneumoniae in sputum samples of HIV-positive subjects in this environment is necessary in order to regulate treatment regimen, considering that cotrimoxazole is the drug recommended by WHO for respiratory infections in HIV patients.

Topics: Adult; Anti-Infective Agents; Drug Resistance, Bacterial; Female; HIV Infections; Humans; Male; Microbial Sensitivity Tests; Nigeria; Pneumococcal Infections; Population Surveillance; Sputum; Streptococcus pneumoniae; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

We aimed to determine nasopharyngeal colonization rates and antibiotic resistance patterns of Streptococcus pneumoniae isolated from Guatemalan children, and to determine risk factors for colonization and antibiotic nonsusceptibility.. Isolates were obtained from children aged 5 to 60 months attending public and private outpatient clinics and daycare centers during August 2001--June 2002 and outpatient clinics during November 2005--February 2006 in Guatemala City. Minimal inhibitory concentrations of penicillin, trimethoprim-sulfamethoxazole (TMS), cefotaxime, and erythromycin were determined using the E-test.. The overall nasopharyngeal colonization rate for S. pneumoniae was 59.1%. From 2001/2 to 2005/6 TMS nonsusceptibility increased from 42.4% to 60.8% (p<0.05) in public clinics and from 51.4% to 84.0% (p=0.009) in private clinics, and penicillin nonsusceptibility increased from 1.5% to 33.3% in public clinics (p<0.001). Reported antibiotic use was not strictly associated with nonsusceptibility to that same antibiotic. Resistance to three or four antibiotics increased in public clinics from 2001/2 (0%) to 2005/6 (10.7%; p<0.001). Risk factors for nasopharyngeal colonization with penicillin- or TMS-nonsusceptible S. pneumoniae were low family income, daycare center attendance, and recent penicillin use.. Increasing antibiotic nonsusceptibility rates in nasopharyngeal S. pneumoniae isolates from Guatemalan children reflect worldwide trends. Policies encouraging more judicious use of TMS should be considered.

Topics: Ambulatory Care; Anti-Infective Agents; Carrier State; Child Day Care Centers; Child, Preschool; Drug Resistance, Multiple, Bacterial; Guatemala; Humans; Infant; Microbial Sensitivity Tests; Nasopharynx; Penicillins; Pneumococcal Infections; Risk Factors; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination

To investigate risk factors for pneumococcal carriage and non-susceptibility among HIV-infected mineworkers in South Africa.. In a cross-sectional study, HIV clinic attendees were questioned about risk factors for pneumococcal carriage and antimicrobial non-susceptibility. Oropharyngeal and nasopharyngeal swabs were taken for pneumococcal culture, serotyping and susceptibility testing.. Among 856 participants (854 male, median age 41.5years, median CD4 290cells/mm(3)), 294 (34.3%) were receiving cotrimoxazole prophylaxis. Overall, 75/856 (8.8%) carried S. pneumoniae; among those taking vs. not taking cotrimoxazole, 8.2% vs. 9.1% were carriers. Risk factors for pneumococcal carriage were living with a child (adjusted OR 2.12, 95% CI 1.06-4.62) and recent hospitalisation (adjusted OR 1.80; 95% CI 0.98-3.30). Among participants not taking cotrimoxazole, the prevalence of carriage was higher in individuals with lower CD4 counts. Comparing participants taking cotrimoxazole vs. not, 60.9% vs. 22.4% (p=0.001) isolates were non-susceptible to cotrimoxazole and 30.4% vs. 8.2% were non-susceptible to penicillin (p=0.014). Thirty three/72 (45.8%) isolates were paediatric serotypes/groups. Nasopharyngeal compared with oropharyngeal swabs had higher sensitivity in detecting carriage (53/75, 70.7% vs. 31/75, 41.3%), and adding oropharyngeal sampling increased detection from 6.2% to 8.8%.. Non-susceptibility to cotrimoxazole and penicillin was more common among isolates from participants taking cotrimoxazole prophylaxis. Surveillance for antimicrobial susceptibility is important where prophylaxis is used. Treatment for pneumococcal disease should take into account a higher risk of non-susceptibility to antibiotics amongst individuals taking cotrimoxazole prophylaxis.

Topics: Adult; Anti-Bacterial Agents; Carrier State; CD4 Lymphocyte Count; Cross-Sectional Studies; Drug Resistance, Bacterial; Female; HIV Infections; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Pharynx; Pneumococcal Infections; Risk Factors; Serotyping; South Africa; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination

The aim of our study was to evaluate a frequency of isolation and susceptibility to antibiotics of Streptococcus pneumoniae penicillin resistant among 154 strains S. pneumoniae isolated between 2003 and 2006 in University Hospital of Dr. A. Jurasza in Bydgoszcz. Antimicrobial susceptibility was assessed by disc-diffusion method according to the guidelines of Clinical and laboratory Standards Institute and The national Reference Centre for Antimicrobial Susceptibility. Minimal inhibitory concentrations for penicillin and cefotaxime were assessed by E-test method. Study shows increasing isolation of SPPR strains from 8,2% in 2003 to 32,0% in 2006. Strains were mostly isolated from patients ofNeurosurgery and Neurotraumatology Clinic and Rehabilitation Clinic. SPPR strains were mainly isolated from respiratory tract. Over 68% of SPPR showed intermediate resistance to penicillin and 73,3% of strains were susceptible to cefotaxime. Between 2003 and 2006 increased percentage of resistance strains to erythromycin, tetracycline and sulphometoxasol.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Bronchoalveolar Lavage Fluid; Carrier State; Child; Child, Preschool; Erythromycin; Hospitalization; Humans; Microbial Sensitivity Tests; Middle Aged; Penicillin Resistance; Pneumococcal Infections; Retrospective Studies; Species Specificity; Sputum; Streptococcus pneumoniae; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cefotaxime; Child; Child, Preschool; Drug Resistance, Bacterial; Erythromycin; Humans; Infant; Microbial Sensitivity Tests; Penicillin G; Pneumococcal Infections; Serotyping; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination; Turkey

To estimate the incidence and epidemiological characteristics of invasive pneumococcal disease (IPD) in children<5 years of age living in a rural area of southern Mozambique.. As part of the clinical management of children admitted to Manhiça District Hospital, prospective surveillance for invasive bacterial disease was conducted from June 2001 to May 2003. The level of antibiotic resistance of the isolates was also analysed.. Pneumococcus was the most commonly isolated bacterium, accounting for 212 episodes. The estimated crude incidence rate of IPD in the study area among children<5 years of age was 416/100,000 per child-year at risk. The youngest age group (<3 months) had the highest incidence (779/100,000). Cases were detected during both rainy and dry seasons. The most common clinical diagnosis was pneumonia, made in 146/212 (69%) of the episodes of IPD. The overall case fatality rate was 10%, being highest among children with pneumococcal meningitis (5/9=56%). Pneumococcal isolates were highly susceptible to penicillin (86% susceptible and 14% with intermediate resistance) and chloramphenicol (98% susceptible). In contrast, up to 37% of the isolates tested were non-susceptible to cotrimoxazole.. Incidence rates of IPD and associated mortality shown in this study highlight the need for pneumococcal vaccines in rural Africa, which must be effective in infants and young children.

Topics: Age Distribution; Anti-Infective Agents; Child, Preschool; Chloramphenicol; Drug Resistance, Bacterial; Female; Humans; Incidence; Infant; Male; Meningitis, Pneumococcal; Mozambique; Penicillins; Pneumococcal Infections; Pneumonia; Population Surveillance; Prospective Studies; Risk Factors; Rural Health; Sex Distribution; Trimethoprim, Sulfamethoxazole Drug Combination

To determine the carriage rate of Streptococcus pneumoniae and Haemophilus influenzae in healthy Indian schoolchildren. The prevalence of antibiotic resistant strains in the community may be used to assess the trends of antibiotic resistance in invasive strains. Prevalence of resistance to various antimicrobial drugs among S. pneumoniae and H. influenzae was estimated.. Two thousand four hundred subjects, aged 5-10 years, were enrolled from 45 rural and 45 urban schools. A nasopharyngeal swab was collected from each child, after taking informed written consent. Swabs were processed to isolate S. pneumoniae and H. influenzae. All isolates were tested for resistance to chloramphenicol, erythromycin and co-trimoxazole. Streptococcus pneumoniae isolates were also tested against tetracycline and oxacillin while H. influenzae isolates were tested against ampicillin.. Nasopharyngeal carriage of S. pneumoniae and H. influenzae was high in healthy schoolchildren. Stratified analysis showed that nasal carriage of pneumococci in urban children was significantly lower than in rural children [46.8% vs. 53.2%, P<0.001]. Carriage rates of H. influenzae in male and female populations were significantly different (47.8% vs. 52.3%, P<0.04). Penicillin resistance in S. pneumoniae was found low (3.3%), but 22.9% of H. influenzae isolates were ampicillin resistant. Resistance to co-trimoxazole was very high in both S. pneumoniae (81.8%) and H. influenzae (67.3%).. There is high nasopharyngeal carriage of drug resistant S. pneumoniae and H. influenzae in schoolchildren of north India. Currently, in India, co-trimoxazole for 5 days is recommended for treatment of non-severe pneumonia and third generation cephalosporins are drug of choice for management of severe pneumococcal/H. influenzae diseases. We found high co-trimoxazole resistance and low penicillin resistance in pneumococcal isolates. This justifies empirical use of penicillin in management of invasive pneumococcal infections in India.

Topics: Carrier State; Child; Child, Preschool; Drug Resistance, Bacterial; Drug Resistance, Multiple, Bacterial; Female; Haemophilus Infections; Haemophilus influenzae; Humans; India; Male; Nasopharynx; Penicillin Resistance; Pneumococcal Infections; Rural Health; Specimen Handling; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination; Urban Health

We studied all human immunodeficiency virus (HIV)-infected patients with invasive pneumococcal disease who received their diagnosis during 1996-2002 to investigate the incidence of this disease in the highly active antiretroviral therapy era and to study the influence of CD4 lymphocyte count on the clinical presentation and outcome of disease. The overall incidence of invasive pneumococcal disease was 11.3 cases per 100,000 person-years in adult patients without known HIV infection and 677 cases per 100,000 person-years in HIV-infected patients. This incidence remained stable over the study period. Clinical presentation, severity of illness, and number of recurrent episodes were similar in patients with CD4+ cell counts of >200 or < or =200 cells/ microL. Patients receiving trimethoprim-sulfamethoxazole (TMP-SMZ) were more likely to present with TMP-SMZ-resistant pneumococci than were those who were not receiving this agent (76.7% vs. 43.6%; P=.007). The mortality rate was high (21%).

Topics: Acquired Immunodeficiency Syndrome; Adult; AIDS-Related Opportunistic Infections; Animals; Antiretroviral Therapy, Highly Active; Comorbidity; Drug Resistance, Multiple, Bacterial; Female; HIV; HIV Infections; Humans; Male; Microbial Sensitivity Tests; Pneumococcal Infections; Pneumocystis carinii; Pneumonia, Pneumocystis; Streptococcus pneumoniae; Toxoplasma; Toxoplasmosis, Cerebral; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination

An increased risk of invasive pneumococcal infection (IPI) has been described among kidney or heart transplant recipients, but the epidemiology of IPI among lung transplant recipients has not been previously reported. We undertook a single center, retrospective cohort study to define the incidence, timing, clinical, and microbiologic features of IPI in lung transplant patients. Fourteen out of 220 recipients (6.4%) developed IPI at a median of 1.3 years after transplantation (incidence rate: 22.7 cases per 1000 person-years). All patients were receiving trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis at the time of diagnosis, and 10 (71%) had TMP-SMX-resistant isolates. All isolates were from the 23 valent polysaccharide vaccine-associated serogroups. The high incidence of IPI in lung transplant recipients is similar to that reported in kidney and heart recipients. Alternative prevention strategies, including use of the conjugated pneumococcal vaccine, should be explored in future studies.

Topics: Adult; Anti-Bacterial Agents; Bronchoalveolar Lavage; Cohort Studies; Female; Humans; Kidney; Lung Transplantation; Male; Middle Aged; Pneumococcal Infections; Polysaccharides; Retrospective Studies; Risk; Survival Rate; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Vaccines

During the 6-year observation period from 1998 to 2003 in Moscow there was recorded in 2000-2001 a decrease in the emergence of Streptococcos pneumoniae resistance to many antibacterials, while during the following years the respective index increased. The above dynamics in the resistance emergence was likely due to a decrease in the use of antibiotics in 1998-1999. In 2003 the rate of resistance to penicillin was 18.6%, 0.4 and 2.1% of the isolates were resistant to amoxicillin and cefotaxime respectively, the rate of resistance to erythromycin reached 19%, 65.4% of the resistant strains showed M phenotype. High rates of resistance were as well observed with respect to tetracycline (40.1%), co-trimoxazole (29.1%) and chloramphenicol (18.6%). Resistance to levofloxacin and moxifloxacin was detected only in rare strains.

Topics: Amoxicillin; Anti-Bacterial Agents; Cefotaxime; Chloramphenicol; Drug Resistance; Erythromycin; Humans; Moscow; Nonlinear Dynamics; Penicillins; Phenotype; Pneumococcal Infections; Streptococcus pneumoniae; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

Streptococcus pneumoniae is a leading cause of invasive bacterial disease and pneumonia among children. Antimicrobial resistance among pneumococci has increased in recent years and complicates treatment. The introduction of heptavalent pneumococcal conjugate vaccine (PCV7) could reduce acquisition of antimicrobial-resistant pneumococci.. We obtained 1350 nasopharyngeal swabs for culture from 1275 children aged 3-59 months presenting at 3 clinics in Anchorage, Alaska, during the winters of 2000, 2001, and 2002, as PCV7 was being introduced into the routine immunization schedule. We recorded the frequency of use of antibiotics as well as the dates of doses of PCV7 for enrolled children. We used multivariate logistic regression modeling to identify independent risk factors for overall carriage of pneumococci and carriage of PCV7-type pneumococci, cotrimoxazole-nonsusceptible (COT-NS) pneumococci, or penicillin-nonsusceptible (PCN-NS) pneumococci.. The proportion of children who were up-to-date for age, with respect to PCV7 vaccination, increased from 0% in 2000 to 55% in 2002. Carriage of PCV7-type pneumococci decreased by 43% (P<.0001). Risk of carriage of PCV7-type pneumococci was lower in 2002 than in 2000, independent of vaccination status, suggesting an indirect effect of vaccination. Carriage of COT-NS, but not PCN-NS, pneumococci also decreased (38%; P=.02), not only among vaccinated children but also among unvaccinated children without recent use of antibiotics.. Introduction of PCV7 into the routine infant immunization schedule in a community with a high prevalence of antimicrobial-resistant pneumococci appears to reduce transmission of PCV7 vaccine serotypes and COT-NS pneumococci but has no impact on overall carriage of pneumococci or carriage of PCN-NS pneumococci.

Topics: Alaska; Anti-Infective Agents; Carrier State; Child, Preschool; Cross-Sectional Studies; Drug Resistance, Multiple, Bacterial; Female; Heptavalent Pneumococcal Conjugate Vaccine; Humans; Immunization Schedule; Infant; Male; Meningococcal Vaccines; Nasopharynx; Outpatient Clinics, Hospital; Penicillins; Pneumococcal Infections; Pneumococcal Vaccines; Risk Factors; Streptococcus pneumoniae; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urban Population; Vaccination; Vaccines, Conjugate

Among respiratory tract isolates of Streptococcus pneumoniae from children, resistance to penicillins, cephalosporins, macrolides, and trimethoprim-sulfamethoxazole (SXT) increases on an annual basis. Pediatric patients who do not respond to conventional therapy for respiratory tract infections someday may be treated with fluoroquinolones. In this study, MICs of beta-lactams, azithromycin, SXT, and levofloxacin were determined and interpreted by using NCCLS guidelines for isolates of S. pneumoniae (2,834 from children and 10,966 from adults), Haemophilus influenzae (629 from children and 2,281 from adults), and Moraxella catarrhalis (389 from children and 1,357 from adults) collected during the 2000-2001 and 2001-2002 respiratory illness seasons in the United States as part of the ongoing TRUST surveillance studies. Rates of resistance to penicillin, azithromycin, and SXT were > or = 7.5% higher among patients < or = 4 years old than among patients 5 to 10, 11 to 17, and > or = 18 years old in both the 2000-2001 and the 2001-2002 respiratory illness seasons. Levofloxacin resistance was detected in 2 of 2,834 isolates (0.07%) from patients <18 years old. Levofloxacin MICs of 0.25 to 1 micro g/ml accounted for 99.6, 99.5, 99.3, 99.7, 98.4, and 98.0% of isolates from patients < 2, 2 to 4, 5 to 10, 11 to 17, 18 to 64, and > 64 years old. Multidrug resistance was twice as common among patients < or = 4 years old (25.3%) as among patients 5 to 10 years old (13.7%), 11 to 17 years old (11.9%), 18 to 64 years old (12.1%), and > 64 years old (12.4%). The most common multidrug resistance phenotype in S. pneumoniae isolates for all age groups was resistance to penicillin, azithromycin, and SXT (70.3 to 76.6%). For H. influenzae and M. catarrhalis isolates from patients < 2, 2 to 4, 5 to 10, 11 to 17, 18 to 64, and > 64 years old, levofloxacin MICs at which 90% of the isolates were inhibited were 0.015 and 0.03 to 0.06 microg/ml, respectively, in the 2000-2001 and 2001-2002 respiratory illness seasons. In the 2000-2001 and 2001-2002 respiratory illness season surveillance studies in the United States, 99.9% of pediatric isolates of S. pneumoniae were susceptible to levofloxacin. If fluoroquinolones become a treatment option for pediatric patients, careful monitoring of fluoroquinolone susceptibilities will be increasingly important in future surveillance studies.

Topics: Adolescent; Adult; Aged; Anti-Infective Agents; Azithromycin; Child; Child, Preschool; Drug Resistance, Multiple, Bacterial; Gram-Negative Bacterial Infections; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Lactams; Levofloxacin; Microbial Sensitivity Tests; Middle Aged; Moraxella catarrhalis; Ofloxacin; Pneumococcal Infections; Prospective Studies; Respiratory Tract Infections; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination; United States

Pneumococcal pneumonia and meningitis are common infectious disease problems in people who are HIV seropositive in southern Africa. For many years two inexpensive antibiotics, penicillin and trimethoprim-sulphamethoxazole (TMP-SMX) had been effective in treatment, but recently resistance to these agents has been reported from many parts of the world. This study was designed to determine the antimicrobial resistance patterns in invasive pneumococci from hospital patients in Harare, Zimbabwe. A total of 160 isolates of Streptococcus pneumoniae from blood cultures and CSF cultures were examined. The isolates came from adults and children in hospital in Harare between 1994 and 2000. The majority of isolates came from HIV positive adults (74%) and children (75%). Isolates of pneumococci with an MIC of 1.0 mg/l or more were first seen in 1997 and by 2000 they made up 35% of all isolates. Significantly more isolates from HIV seropositive patients (50%) showed reduced susceptibility to penicillin compared with isolates from HIV seronegative patients (16%), and high level resistance (MIC 1.0 mg/l or higher) was found in 16% isolates from HIV positive patients compared with 6% isolates from HIV seronegative patients. Resistance to TMP-SMX was common, with more than 50% isolates from HIV positive and HIV negative patients having reduced susceptibility to this antibiotic combination.

Topics: Adolescent; Adult; Blood; Cerebrospinal Fluid; Child; Child, Preschool; Drug Resistance, Bacterial; Humans; Microbial Sensitivity Tests; Penicillin Resistance; Penicillins; Pneumococcal Infections; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination; Zimbabwe

Nasopharyngeal swabs were taken from 906 Malawian children <5 years old visiting rural health clinics. Pneumococcal colonization was high, 84% among all children, and occurred early, 65% of it in children <3 months old. Among pneumococcal isolates 46% were nonsusceptible to trimethoprim-sulfamethoxazole, and 21% were nonsusceptible to penicillin. Trimethoprim-sulfamethoxazole use in the previous month was a risk factor for trimethoprim-sulfamethoxazole and penicillin nonsusceptibility. Forty-three percent of isolates were serotypes included in the 7-valent pneumococcal conjugate vaccine, and 37% were vaccine-related serotypes, particularly 6A and 19A.

Topics: Chi-Square Distribution; Child, Preschool; Cohort Studies; Drug Resistance, Multiple; Female; Humans; Infant; Malawi; Male; Microbial Sensitivity Tests; Nasopharynx; Penicillins; Pneumococcal Infections; Probability; Sensitivity and Specificity; Serotyping; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination

Persons with acquired immunodeficiency syndrome (AIDS) have a higher incidence of invasive pneumococcal disease (IPD) than other adults, and many receive long-term trimethoprim-sulfamethoxazole (TMP-SMZ) prophylactic therapy. We used 1998-1999 data from the Active Bacterial Core surveillance of the Emerging Infections Program Network to compare IPD infections between adults aged 18-64 years with human immunodeficiency virus (HIV) infection and other adults. Of 2346 patients with IPD, 416 (18%) had HIV or AIDS (HIV/AIDS). Certain serotypes (serotypes 6A, 6B, 9N, 9V, 18C, 19A, 19F, and 23F) were more common among patients with HIV/AIDS than in adults with no underlying disease (P<.05, vs. serotype 4), even when TMP-SMZ-nonsusceptible isolates were excluded. HIV/AIDS (adjusted odds ratio [aOR], 1.93; 95% confidence interval [CI], 1.44-2.59), immunocompromising conditions other than HIV/AIDS (aOR, 1.56; 95% CI, 1.12-2.18), and black race (aOR, 1.50; 95% CI, 1.20-1.88) were independent risk factors for infection with these serotypes. HIV/AIDS was not an independent risk factor for TMP-SMZ nonsusceptibility. Vulnerability to certain serotypes among adults with HIV/AIDS may have implications in prevention strategies.

Topics: Adolescent; Adult; AIDS-Related Opportunistic Infections; Anti-Bacterial Agents; Anti-Infective Agents; Drug Resistance, Bacterial; Female; HIV Infections; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Multivariate Analysis; Pneumococcal Infections; Population Surveillance; Risk Factors; Serotyping; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination; United States

The nasopharyngeal carriage of Streptococcus pneumoniae is an important risk factor for pneumococcal diseases. Data regarding prevalence and serotype distribution of this pathogen are lacking in our population.. longitudinal observational cohort study.. healthy children aged 1-7 years attending day-care centers and schools of a district of a Southern Italy city.. the nasopharyngeal colonization rate of Streptococcus pneumoniae as well as its antibiotic susceptibility was determined.. Of 317 nasopharyngeal cultures obtained, 18.29% of the cultures were positive for Streptococcus pneumoniae; 60.34% of the isolates were serotypes 19A, 19F, 14, 6B, or 23F; 8.62% of the strains were intermediately resistant to penicillin. Erythromycin-resistance was observed in 65.51% of the micro-organisms isolated and particularly serotypes 19, 14, and 6 were more erythromycin-resistant than organisms of other serotypes. Co-trimoxazole resistance was detected in 17.24% of the strains. All the strains resulted uniformly susceptible to cefotaxime and ceftriaxone.. The high rate of nasopharyngeal carriage of Streptococcus pneumoniae, along with the resistance to antibiotics widely used in the community, suggests the importance of an epidemiological surveillance as well as the application of new vaccine strategies.

Topics: Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Cohort Studies; Drug Resistance, Bacterial; Erythromycin; Female; Humans; Infant; Italy; Longitudinal Studies; Male; Microbial Sensitivity Tests; Nasopharynx; Pneumococcal Infections; Serotyping; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination

Although changing patterns in antimicrobial resistance in Streptococcus pneumoniae have prompted several surveillance initiatives in recent years, the frequency with which these studies are needed has not been addressed. To approach this issue, the extent to which resistance patterns change over a 1-year period was examined. In this study we analyzed S. pneumoniae antimicrobial susceptibility results produced in our laboratory with isolates obtained over 2 consecutive years (1997-1998 and 1998-1999) from the same 96 institutions distributed throughout the United States. Comparison of results revealed increases in resistant percentages for all antimicrobial agents studied except vancomycin. For four of the agents tested (penicillin, cefuroxime, trimethoprim-sulfamethoxazole, and levofloxacin), the increases were statistically significant (P < 0.05). Resistance to the fluoroquinolone remained low in both years (0.1 and 0.6%, respectively); in contrast, resistance to macrolides was consistently greater than 20%, and resistance to trimethoprim-sulfamethoxazole increased from 13.3 to 27.3%. Multidrug resistance, concurrent resistance to three or more antimicrobials of different chemical classes, also increased significantly between years, from 5.9 to 11%. The most prevalent phenotype was resistance to penicillin, azithromycin (representative macrolide), and trimethoprim-sulfamethoxazole. Multidrug-resistant phenotypes that included fluoroquinolone resistance were uncommon; however, two phenotypes that included fluoroquinolone resistance not found in 1997-1998 were encountered in 1998-1999. This longitudinal surveillance study of resistance in S. pneumoniae revealed that significant changes do occur in just a single year and supports the need for surveillance at least on an annual basis, if not continuously.

Topics: Anti-Bacterial Agents; Azithromycin; Drug Resistance, Microbial; Drug Resistance, Multiple; Humans; Longitudinal Studies; Microbial Sensitivity Tests; Penicillins; Phenotype; Pneumococcal Infections; Population Surveillance; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination; United States

There are few data on antibiotic-resistant Streptococcus pneumoniae in Uganda. A total of 191 healthy children in Kampala, Uganda were screened for nasopharyngeal carriage of S. pneumoniae; 118 (62%) of the children were carriers. Antimicrobial susceptibility and serotype of 115 strains was determined. Ninety-six (83.5%) of the isolates were of intermediate resistance to penicillin and 19 (16.5%) were susceptible. All strains were susceptible to cefotaxime. The rates of resistance to other drugs were trimethoprim-sulphamethoxazole (83.5%), tetracycline (28.7%) and chloramphenicol (10.4%). All strains were susceptible to rifampicin, erythromycin and clindamycin. Serogroups 6, 9, 14, 19 and 23 accounted for 80% of the isolates. These data show that the rate of carriage of antibiotic-resistant pneumococci by children is high in Kampala, Uganda.

Topics: Anti-Bacterial Agents; Carrier State; Child, Preschool; Drug Resistance, Microbial; Female; Humans; Infant; Infant, Newborn; Male; Microbial Sensitivity Tests; Nasopharyngeal Diseases; Pneumococcal Infections; Prevalence; Serotyping; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination; Uganda

Recurrent pneumococcal bacteremia receives infrequent mention in the literature, usually in association with patients who are immunocompromised.. To examine recurrent cases of pneumococcal bacteremia to determine risk factors and outcomes (mortality rates and emergence of resistance) associated with recurrences.. We retrospectively reviewed all cases of pneumococcal bacteremia identified by our microbiology laboratory from January 1, 1992, through December 31, 1996. Demographic, clinical, and laboratory data were abstracted.. There were 462 bacteremic episodes in 432 patients; 23 of these patients had 30 recurrent episodes. The 5.3% recurrence rate (23/432) is greater than that previously described. The median time to recurrence was 200 days. The mean age of patients with recurrences was 34 years, 70% were women, all were black or Hispanic (in near equal numbers), and 87% were infected with the human immunodeficiency virus (HIV). Human immunodeficiency virus infection, coexistent cancer, and female sex were independent predictors of recurrence. Only patients who were HIV-infected had multiple recurrences. Isolates from recurrent bacteremias were more likely to be penicillin-resistant than were initial bacteremic isolates (relative risk, 2.0; P =.16). Patients with recurrences had a higher (although not statistically significant) mortality rate than those without recurrences (22% vs 16%; P =.33). There was an inverse relationship between severity of illness and likelihood of recurrence.. Rates of recurrent pneumococcal bacteremia may be higher than previously reported. In patients with recurrent pneumococcal bacteremia, the presence of an underlying immunodeficiency should be investigated.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; AIDS-Related Opportunistic Infections; Bacteremia; Child; Child, Preschool; Female; Humans; Infant; Male; Middle Aged; Penicillin Resistance; Pneumococcal Infections; Recurrence; Risk Factors; Survival Rate; Trimethoprim, Sulfamethoxazole Drug Combination

Resistance of Streptococcus pneumoniae (750) to penicillin, erythromycin, chloramphenicol and trimethoprim/sulfamethoxazole isolated in 4 Turkish hospitals between 1996 and 1999 was evaluated according to year of isolation, patients' age groups and specimen. Penicillin susceptibility was determined by E-test strips and the other antibiotics were tested by disk diffusion test following the NCCLS guidelines in each center. Overall high and intermediate resistance to penicillin was 3% and 29%, respectively. There was a significant difference (p<0.001) between the centers with regard to penicillin resistance. However, there was no significant increase in resistance by year. Penicillin resistance varied significantly among children and adults (36% versus 25%) and according to the specimen. Highest rate of penicillin resistance was observed in respiratory specimens (36%) followed by ear exudates (33.5%). In blood isolates, resistance to penicillin was 28.6%. Overall resistance to erythromycin was 8%, to chloramphenicol 5% and to trimethoprim-sulfamethoxazole 47%. Although overall penicillin resistance in these Turkish S. pneumoniae isolates is high, resistance rates vary in each center and have not increased from 1996 to 1999.

Topics: Adult; Anti-Bacterial Agents; Child; Chloramphenicol; Drug Resistance; Erythromycin; Hospitals; Humans; Incidence; Penicillin Resistance; Pneumococcal Infections; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination; Turkey

Topics: Drug Resistance, Multiple; Humans; Macrolides; Microbial Sensitivity Tests; Pneumococcal Infections; Quinolones; Sensitivity and Specificity; Streptococcus pneumoniae; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

To assess the genetic diversity of pneumococci causing serious disease within the United States, restriction profiles of 3 penicillin-binding protein (PBP)-gene amplicons and the dhf amplicon were examined in 241 recent sterile-site isolates from 7 population centers. This analysis provided markers useful for epidemiologic studies and was generally predictive of resistances to beta-lactam antibiotics and trimethoprim-sulfamethoxazole. Eight pulsed-field gel electrophoresis (PFGE) types, each representing 3-40 isolates, accounted for 134 of the 144 beta-lactam-resistant pneumococci (MICs >/=1 microgram/mL for penicillin, cefotaxime, or both). Five of these PFGE types contained subtypes highly related to subtypes of previously characterized pneumococcal clones. Within 4 of these PFGE types, the major composite PBP gene-dhf profile was highly related to the composite profile from the previously characterized related clone. Eight capsular serotypes were found among the 144 beta-lactam-resistant pneumococci. Divergent capsular types among isolates with identical PBP gene-dhf profiles and related PFGE types indicated several instances of capsular serotype switching.

Topics: Amino Acid Sequence; Aminoacyltransferases; Bacterial Capsules; Bacterial Proteins; beta-Lactam Resistance; Carrier Proteins; Cefotaxime; Cephalosporins; Drug Resistance, Microbial; Electrophoresis, Gel, Pulsed-Field; Genes, Switch; Genotype; Hexosyltransferases; Humans; Lactams; Molecular Epidemiology; Molecular Sequence Data; Muramoylpentapeptide Carboxypeptidase; Penicillin Resistance; Penicillin-Binding Proteins; Peptidyl Transferases; Pneumococcal Infections; Predictive Value of Tests; Sequence Homology, Amino Acid; Serotyping; Streptococcus pneumoniae; Tetrahydrofolate Dehydrogenase; Trimethoprim, Sulfamethoxazole Drug Combination; United States

From January 1991 through December 1998, a total of 1046 pneumococcal isolates were received from 23 laboratories participating in the statewide surveillance system. Of these, 1037 were recovered from normally sterile sites (blood and cerebrospinal and pleural fluid) and were available for serotyping and susceptibility testing. Ninety-two percent of these isolates were serotypes represented in the 23-valent pneumococcal polysaccharide vaccine. Serotypes in the 7-valent pneumococcal conjugate vaccine (4, 6B, 9V, 14, 18C, 19F, and 23F) were recovered from 72% of Alaska Natives and 84% of non-Native children <5 years old with invasive disease. Statewide, 7.3% and 3.2% of isolates had intermediate and high levels of resistance to penicillin, respectively; 9.2% were resistant to erythromycin (minimal inhibitory concentration, >/=1 microg/mL) and 19% to trimethoprim/sulfamethoxazole (minimal inhibitory concentration, >/=4/76 microg/mL). Twelve percent of invasive isolates were resistant to >/=2 classes of antibiotics; of these, serotype 6B accounted for 33%, and 63% were recovered from children <5 years old.

Topics: Alaska; Bacterial Vaccines; Child; Child, Preschool; Erythromycin; Humans; Indians, North American; Infant; Penicillin Resistance; Pneumococcal Infections; Polysaccharides, Bacterial; Population Surveillance; Serotyping; Streptococcus pneumoniae; Time Factors; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination

Children with HIV infection are particularly susceptible to invasive pneumococcal disease, yet the effect of HIV infection and its medical management on colonization and resistance to antibiotics are poorly described. To provide a basis for medical practice, we determined the prevalence of nasopharyngeal colonization and antibiotic resistance of Streptococcus pneumoniae in children with HIV infection.. Cross-sectional prevalence sample of children attending the pediatric HIV and pulmonary clinics to examine nasopharyngeal colonization with S. pneumoniae and antibiotic resistance to beta-lactams and trimethoprim-sulfamethoxazole (T/S). Subjects were matched by age and date of clinic visit.. The colonization rate with S. pneumoniae of HIV-infected and -indeterminate children was equal to that of controls (20% vs. 19%). HIV infection, CDC staging or receipt of oral antibiotic therapy did not affect colonization. Isolates from HIV-infected and -indeterminate children were less likely to be penicillin-resistant than those from controls (18% vs. 50%). There was no difference in pneumococcal resistance to T/S among isolates from subjects and controls, despite 72% T/S use in the HIV clinic.. Colonization with S. pneumoniae in HIV disease is no different from that of comparable children. The high incidence of pneumococcal disease and prophylaxis with T/S are not related to nasopharyngeal colonization. Antibiotic prophylaxis of HIV-infected children does not necessarily lead to increased resistance of S. pneumoniae.

Topics: Acquired Immunodeficiency Syndrome; Adolescent; AIDS-Related Opportunistic Infections; Anti-Bacterial Agents; Anti-Infective Agents; Carrier State; Child; Child, Preschool; Cohort Studies; Cross-Sectional Studies; Drug Resistance, Microbial; Female; HIV Infections; Humans; Infant; Lactams; Male; Nasal Mucosa; Nasopharynx; Penicillins; Pneumococcal Infections; Prevalence; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination

Three hundred sixty-two Streptococcus pneumoniae strains were isolated from children under 5 years of age at Dhaka Shishu (Children) Hospital from 1993 to 1997. The strains were isolated from blood (n = 105), CSF (n = 164), ear swab (n = 61), eye swab (n = 20), and pus (n = 12). Of the 362 isolates, 42 (11.6%) showed intermediate resistance (MIC, <0.1 microgram/ml) and only 4 (1.1%) showed complete resistance (MIC, >2.0 microgram/ml) to penicillin. Penicillin resistance exhibited a strong relationship with serotype 14; 47.8% of the penicillin-resistant strains belonged to this type. A remarkably high (64.1%) resistance to co-trimoxazole was observed, along with a significant increase during the time period studied; there was no relationship to capsular type. By way of contrast, penicillin resistance did not show any significant change during the study period. Resistance to chloramphenicol (2.2%) and erythromycin (1.1%) was rare. The high resistance to co-trimoxazole and its increasing trend demand elucidation of the clinical impact of pneumonia treatment by this antimicrobial and reconsideration of the World Health Organization recommendation for co-trimoxazole administration to children with community-acquired pneumonia at the health care worker level in Bangladesh.

Topics: Bangladesh; Child, Preschool; Drug Resistance, Microbial; Humans; Penicillin Resistance; Penicillins; Pneumococcal Infections; Serotyping; Specimen Handling; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination

The Pakistan program for control of acute respiratory tract infections (ARIs) adopted the standard ARI-case-management strategy of the World Health Organization and recommended co-trimoxazole for the management of nonsevere pneumonia. Reports in that country of high in vitro antimicrobial resistance of Streptococcus pneumoniae and Haemophilus influenzae to co-trimoxazole prompted the program to reevaluate its treatment policy. Two community-based studies during 1991-1993 showed in vivo efficacy of co-trimoxazole in 92% and 91% of children with nonsevere pneumonia. A third double-blind trial showed co-trimoxazole and oral amoxicillin to be equally effective in vivo in cases of nonsevere pneumonia, despite high in vitro resistance. Country-wide surveillance from 1991 to 1994 revealed 78.3%-79.9% in vitro resistance to co-trimoxazole among S. pneumoniae isolates and 59.5%-61.0% among H. influenzae isolates. Co-trimoxazole is still recommended by the Pakistan ARI control program. The fact that amoxicillin is three times more expensive and must be administered more frequently is a big impediment to recommending it as a first-line drug for nonsevere pneumonia.

Topics: Acute Disease; Anti-Bacterial Agents; Developing Countries; Drug Resistance, Microbial; Haemophilus Infections; Haemophilus influenzae; Humans; Pakistan; Pneumococcal Infections; Respiratory Tract Infections; Trimethoprim, Sulfamethoxazole Drug Combination

From January 1996 to December 1997, 200 isolates of Streptococcus pneumoniae recovered from 200 patients treated at National Taiwan University Hospital were serotyped and their susceptibilities to 16 antimicrobial agents were determined by the agar dilution method. Sixty-one percent of the isolates were nonsusceptible to penicillin, exhibiting either intermediate resistance (28%) or high-level resistance (33%). About two-fifths of the isolates displayed intermediate or high-level resistance to cefotaxime, ceftriaxone, cefepime, imipenem, and meropenem. Extremely high proportions of the isolates were resistant to erythromycin (82%), clarithromycin (90%), and trimethoprim-sulfamethoxazole (TMP-SMZ) (87%). Among the isolates nonsusceptible to penicillin, 23.8% were resistant to imipenem; more than 60% displayed resistance to cefotaxime, ceftriaxone, cefepime, and carbapenems; 96.7% were resistant to erythromycin; and 100% were resistant to TMP-SMZ. All isolates were susceptible to rifampin and vancomycin. The MICs at which 50% and 90% of the isolates were inhibited were 0.12 and 1 microgram/ml, respectively, for cefpirome, and 0.12 and 0.25 microgram/ml, respectively, for moxifloxacin. Six serogroups or serotypes (23F, 19F, 6B, 14, 3, and 9) accounted for 77.5% of all isolates. Overall, 92.5% of the isolates were included in the serogroups or serotypes represented in the 23-valent pneumococcal vaccine. The incidence of macrolide and TMP-SMZ resistance for S. pneumoniae isolates in Taiwan in this study is among the highest in the world published to date.

Topics: Adolescent; Anti-Bacterial Agents; Child; Child, Preschool; Drug Resistance, Microbial; Erythromycin; Humans; Penicillin Resistance; Pneumococcal Infections; Serotyping; Streptococcus pneumoniae; Taiwan; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination

To determine the level of antibiotic resistance in pneumoniae (S. pneumoniae) isolated from nasal swabs of healthy children.. Cross-sectional community survey.. Survey was undertaken in general practice settings in Canberra during March and April 1998.. Four hundred and sixty-one children under 3 years of age enrolled in general practice trial of clinical practice guidelines for antibiotic use.. Resistance to penicillin, erythromycin, co-trimoxazole, tetracycline, chloramphenicol and cefotaxime among the isolates of S. pneumoniae.. A total of 461 nasal swabs were collected and S. pneumoniae was isolated from 171 (37.1%). Penicillin resistance was found in 12.3% of these isolates, with high level resistance in 0.6%. Resistance rates were higher for cotrimoxazole (44.4%) and erythromycin (18.1%) than for penicillin. Multidrug resistance was found in 19% of these isolates. There was a significant association between the attendance at a day care centre and carriage of pneumococcus (53% vs 32%, odds ratio (OR) 2.4, 95% confidence interval (CI) 1.5-3.7, P < 0.001). Children who attended day care centers and had received antibiotics during the 4 months prior to swab collection were three times more likely to carry an antibiotic-resistant isolate than children who had neither attended a day care centre nor received antibiotics (68% vs 40%, OR 3.1, 95% CI 1.2-8.4, P = 0.02).. The level of antibiotic resistance in pneumococci from healthy children was of concern. Carriage of pneumococcus was significantly higher in children who attended a day care centre. Resistance was significantly correlated with antibiotic use in combination with day-care attendance. These findings warrant more judicious use of antibiotics in children.

Topics: Cefotaxime; Child, Preschool; Chloramphenicol; Cross-Sectional Studies; Drug Resistance, Microbial; Drug Resistance, Multiple; Erythromycin; Humans; Infant; Infant, Newborn; Odds Ratio; Penicillins; Pneumococcal Infections; Prevalence; Risk Factors; South Australia; Statistics, Nonparametric; Streptococcus pneumoniae; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

As part of an intervention project, all patients in Malmöhus county with a culture positive for penicillin-resistant pneumococci, MIC > or =0.5 mg/L (PRP), have been registered since January 1995. Nasopharyngeal specimens were obtained from family members and close contacts of identified carriers. Children were denied attendance at regular day-care until PRP-negative. In 1995 and 1996, PRP were isolated from 882 individuals, 364 of whom had clinical infection and the remaining of whom were asymptomatic carriers. In 49%, the PRP were of serogroup 9, with MIC of penicillin 0.5-2.0 mg/L and resistance to trimethoprim/sulfamethoxazole. Further analyses with serotyping and genetic fingerprinting suggested strongly that most of the isolates belonged to a single serotype 9V clone. Month by month, an apparently continuous spread appeared from one municipality to a neighboring one. In most communities, the serotype 9V PRP appeared and disappeared within a few months. The active procedures of the intervention project may have limited the spread of the clone in the county.

Topics: Child; Child Day Care Centers; Child, Preschool; Contact Tracing; DNA Fingerprinting; Drug Resistance, Multiple; Female; Humans; Male; Microbial Sensitivity Tests; Molecular Epidemiology; Penicillin Resistance; Penicillins; Pneumococcal Infections; Serotyping; Streptococcus pneumoniae; Sweden; Trimethoprim, Sulfamethoxazole Drug Combination

During 1995 and 1996, 393 and 566 strains of Streptococcus pneumoniae, isolated from acute otitis media, were respectively sent to the National Reference Center for Pneumococci by its corresponding centers.. The resistance rates for 1995 and 1996 were respectively: for penicillin: 65.4 and 70.3% (18.6 and 24.9% of intermediately resistant strains, 46.8 and 45.4% of fully resistant strains), for erythromycin: 57.5 and 68.5%, for tetracycline: 43.2 and 42.6%, for trimethoprim-sulfamethoxazole: 47.5 and 50.9%. Minimal inhibitory concentrations (MICs) of various betalactams were determined against a representative sample of strains (n = 99).. Amoxicillin, cefpodoxime and cefuroxime MICs remained low against numerous penicillin resistant strains, indicating that these three oral antibiotics (in combination with clavulanate for amoxicillin) have a useful potential for the treatment of acute otitis media when risk factors for pneumococcal penicillin-resistant infections are detected.

Topics: Acute Disease; Amoxicillin; beta-Lactam Resistance; beta-Lactams; Cefpodoxime; Ceftizoxime; Cefuroxime; Erythromycin; France; Humans; Microbial Sensitivity Tests; Otitis Media; Penicillin Resistance; Penicillins; Pneumococcal Infections; Serotyping; Streptococcus pneumoniae; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

The prevalence of penicillin-resistant Streptococcus pneumoniae in clinical isolates from the Pathology Department of the Singapore General Hospital, in 1995, was 25%. Most of the resistant isolates belonged to serogroup 19 and were resistant to multiple antibiotics. Field-inversion gel electrophoresis (FIGE), after chromosomal digestion with the restriction enzymes Apal and Smal, was performed on all isolates of multiresistant serogroup 19 S. pneumoniae so as to determine whether they were of clonal origin. Twenty-six isolates, including six controls, were studied. Analysis of the FIGE patterns revealed three distinct clusters of closely related strains. The predominant clone comprised ten isolates of multiresistant serogroup 19 S. pneumoniae and also included two controls of a different serogroup. The presence of multiresistant serogroup 19 S. pneumoniae in Singapore, appears to be due to the spread of a small number of clones.

Topics: Adult; Aged; Bacterial Typing Techniques; Child; Child, Preschool; DNA Fingerprinting; DNA, Bacterial; Drug Resistance, Multiple; Electrophoresis, Capillary; Erythromycin; Humans; Infant; Microbial Sensitivity Tests; Middle Aged; Penicillin Resistance; Pneumococcal Infections; Serotyping; Singapore; Streptococcus pneumoniae; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

We conducted a survey to assess the prevalence and geographic distribution of antimicrobial drug resistance among invasive isolates of Streptococcus pneumoniae in Washington State. Sequential sterile-site pneumococcal isolates were submitted from 13 hospital laboratories between 1 October 1995 and 30 January 1997. We serotyped 275 isolates from adults and children and determined minimum inhibitory concentrations (MIC) for commonly used antimicrobial drugs. Data were abstracted from medical records to compare differences in outcome and risk factors for infection. Of the 275 isolates, 73 (26.5%) were nonsusceptible to one or more antimicrobial drugs. Penicillin-nonsusceptible pneumococci (PNSP, MIC > or = 0.1 microgram/ml) accounted for 42 (15.3%) of the 275 isolates including 4 (1.5%) resistant strains (MIC > or = 2 micrograms/ml). The 42 PNSP included serogroups 6, 9, 14, 19, and 23, all of which are represented in the 23-valent pneumococcal vaccine. PNSP were also nonsusceptible to trimethoprim/sulfamethoxazole (92.9%), erythromycin (38.1%), imipenem (28.6%), and ceftriaxone (23.8%). Forty-seven (17.1%) of the 275 isolates were multiple drug-nonsusceptible pneumococci (MDNSP). A significantly greater number of patients < or = 12 years of age were infected with MDNSP compared with those > 12 years. Prior use of antimicrobial drugs and an immunosuppressive disorder were risk factors for infection with PNSP. In summary, pneumococci nonsusceptible to penicillin and other antimicrobial drugs are prevalent among adults with invasive pneumococcal disease in Washington State. A large proportion of PNSP are resistant to other commonly used antimicrobial drugs. Local antibiotic susceptibility data should be considered when designing empiric treatment regimens.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Ceftriaxone; Cephalosporin Resistance; Cephalosporins; Child; Child, Preschool; Drug Resistance, Microbial; Erythromycin; Female; Humans; Imipenem; Infant; Male; Middle Aged; Penicillin Resistance; Pneumococcal Infections; Prevalence; Risk Factors; Serotyping; Streptococcus pneumoniae; Thienamycins; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Washington

We tested 83 penicillin-intermediate (Peni) and 50 penicillin-resistant (Penr) isolates of Streptococcus pneumoniae against eight oral antimicrobials. Clarithromycin's MICs (minimal inhibitory concentration) were generally the same or one to two dilutions less than those of azithromycin. Seventy-two percent of Peni isolates were susceptible to clarithromycin and azithromycin, in contrast to 42% and 40%, respectively, of Penr isolates. Cefuroxime activity exceeded that of cefprozil, which exceeded that of cefaclor, in Peni isolates. For all three cephalosporins, MICs of 90% of isolates tested were > or = 3 dilutions higher for Penr isolates than for Peni isolates. Percentages of Peni isolates susceptible to clindamycin and tetracycline were 92% and 83%, respectively, and 78% and 82% for Penr. Only 49% of Peni isolates and 4% of Penr isolates were susceptible to trimethoprim-sulfamethoxazole. Azithromycin, clarithromycin, cefuroxime, cefprozil, clindamycin, and tetracycline may be useful in treating infections caused by Peni S pneumoniae, but Penr isolates are frequently resistant to both old and newer agents.

Topics: Administration, Oral; Adult; Ambulatory Care; Anti-Bacterial Agents; Azithromycin; Cefaclor; Cefprozil; Cefuroxime; Cephalosporins; Child; Clarithromycin; Clindamycin; Culture Media; Humans; Penicillin Resistance; Pneumococcal Infections; Streptococcus pneumoniae; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

The susceptibility of 108 Streptococcus pneumoniae strains isolated from normally sterile body sites during 1993-1995 in Slovenia has been studied. Overall resistance to penicillin, erythromycin, trimethoprim-sulfamethoxazole, cefuroxime, cefaclor and chloramphenicol was 16.6, 0.9, 26.8, 0, 4.5 and 4.6%, respectively. All penicillin-resistant isolates (intermediate resistance) were susceptible to cefotaxime, ceftriaxone and vancomycin. Isolates less susceptible to penicillin were also significantly less sensitive to chloramphenicol, cefaclor and trimethoprim-sulfamethoxazole than penicillin-sensitive strains. Pneumococci isolated in children were significantly (p < 0.05) more resistant to trimethoprim-sulfamethoxazole than those isolated in adults. The study demonstrated moderate resistance rate of S. pneumoniae to penicillin and trimethoprim-sulfamethoxazole and a low-level resistance rate to erythromycin, cefaclor and chloramphenicol. No straightforward correlation between overall consumption of antibiotics and antimicrobial resistance was found.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Cephalosporins; Child; Chloramphenicol; Drug Resistance, Microbial; Drug Resistance, Multiple; Female; Humans; Male; Microbial Sensitivity Tests; Penicillin Resistance; Pneumococcal Infections; Serotyping; Slovenia; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination

The resistance to beta-lactam and non-beta-lactam antibiotics of 133 nasopharyngeal isolates of Streptococcus pneumoniae recovered from December 1995 to February 1996 from children attending seven day-care centers in southwestern Greece was studied. Reduced susceptibility to one or more anti-microbial agents was found in 70 isolates (53%), as follows: penicillin, 17% intermediate, 12% resistant; cefotaxime, 10.5% intermediate, 1.5% resistant; trimethoprim-sulfamethoxazole, 8% intermediate, 35% resistant; chloramphenicol, 27% resistant; tetracycline, 29% resistant; and erythromycin/clindamycin, 19% resistant. Eighty-seven percent of penicillin-intermediate or -resistant strains belonged to serogroups/serotypes 19, 21, and 23. Fifty-six percent of the antibiotic-resistant pneumococci were multiply resistant, including serogroup 6 strains that were penicillin-susceptible but resistant to all non-beta-lactam drugs tested, as well as serogroup 23 strains resistant to penicillin, chloramphenicol, tetracycline, and trimethoprim-sulfamethoxazole. The high incidence of antibiotic-resistant pneumococci and the divergent and unique resistance patterns found in this study underline the need for global surveillance of S. pneumoniae to document the evolution and spread of resistant strains and to guide therapy.

Topics: Anti-Bacterial Agents; Antigens, Bacterial; Carrier State; Cephalosporin Resistance; Child; Child, Preschool; Chloramphenicol Resistance; Clindamycin; Drug Resistance, Microbial; Drug Resistance, Multiple; Erythromycin; Female; Greece; Humans; Infant; Male; Microbial Sensitivity Tests; Nasopharynx; Penicillin Resistance; Pneumococcal Infections; Streptococcus pneumoniae; Tetracycline Resistance; Trimethoprim, Sulfamethoxazole Drug Combination

Due to the changes in the frequency of penicillin-resistant strains of S. pneumoniae, it is necessary to perform surveillance studies of bacterial resistance. Isolates from the upper respiratory tract of asymptomatic children have been useful. There is no information about the difference between isolates from children with and without upper respiratory tract infection (URTI). The objective of the authors in this paper is to establish the prevalence of carrier-state, serotype and antimicrobial resistance of S. pneumoniae isolates from children with and without acute upper respiratory tract infection (URTI) in a rural area in Mexico. A cross-sectional comparative study was performed in Tlaxcala, Mexico. Children from one month 5 years of age were included. Nasopharyngeal swabs were obtained. Identification was done by international microbiology standards. Serotyping was done by the capsular Quellung test. The susceptibility testing was performed by the agar dilution method. Four-hundred and fifty patients were included. S. pneumoniae was isolated in 134 children (29.7%). Frequency of carriers was greater in patients with URTI (107/323) than without URTI (27/127) (33.1% vs. 21.1% p = 0.012, OR 1.84, IC 95% 1.1-3.08). The six most frequent serotypes were: 6B (16.4%); 19F (11.9%); 19A (6.7%); 14, 23F, and 35 (5.2% each), with no difference among the groups. Only 3% of the strains had high level resistance to penicillin, and 12.6% had intermediate resistance, and for ampicillin 4%, amoxicillin 4%, amoxicillin-clavulanate 4%, ceftriaxone 3%, cefotaxime 1.5%, erythromycin 6%, miocamycin 3%, chloramphenicol 4%, and vancomycin 0%. Trimethoprim-sulfamethoxazole resistance was very high (42%). In conclusion, colonization is higher in children with URTI. Five of the most frequent serotypes identified in this study were the same as those identified in patients with S. pneumoniae invasive diseases in Mexico City. In Tlaxcala, Mexico, beta-lactams could be the drug of choice for the treatment of S. pneumoniae lower respiratory tract infections. It is necessary to perform clinical assays to evaluate the efficacy of trimethoprim-sulfamethoxazole due to the high resistance in vitro.

Topics: Anti-Bacterial Agents; Child, Preschool; Cross-Sectional Studies; Humans; Infant; Microbial Sensitivity Tests; Nasopharynx; Penicillin Resistance; Pneumococcal Infections; Respiratory Tract Infections; Rural Population; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination

The pneumococcus is a frequent cause of pneumonia and other serious infections among young children in developing countries. Defining the pattern of pneumococcal infection in these countries is important so that, with the advent of pneumococcal conjugate vaccines, rational vaccination policies can be developed.. Children younger than 5 years of age who attended clinics in a rural area of The Gambia, West Africa, were screened by assistants during a 2-year period. Children with predefined features suggestive of a diagnosis of pneumonia, meningitis or septicemia were referred to the Medical Research Council Field Station at Basse for investigation.. Of 2898 children investigated 103 cases of invasive pneumococcal disease (70 definite and 33 probable) were identified, suggesting that the incidence of this infection in the study community is at least 554/100,000/year in children younger than 1 year of age and 240/100,000/year in those younger than 5 years, rates many times higher than those found in industrialized societies. The mean age of presentation was 15 months; more boys than girls were affected. Cases of pneumonia were encountered 8 times more frequently than those of meningitis. Antibiotic resistance was rarely found and cases of pneumonia, but not meningitis, responded well to treatment. Case-fatality rates in children with pneumonia and meningitis were 1 and 55%, respectively. The most prevalent pneumococcal serotypes were types 6, 14, 19, 1 and 5.. About 60% of invasive pneumococcal infection in children in this community could potentially be prevented by a nine-valent pneumococcal conjugate vaccine (types 1, 4, 5, 6B, 9, 14, 18, 19F and 23) given at the ages of 2, 3 and 4 months.

Topics: Anti-Bacterial Agents; Bacteremia; Child, Preschool; Chloramphenicol; Female; Gambia; Humans; Incidence; Infant; Infant, Newborn; Male; Meningitis, Pneumococcal; Microbial Sensitivity Tests; Penicillins; Pneumococcal Infections; Pneumonia, Pneumococcal; Prevalence; Rural Population; Seasons; Trimethoprim, Sulfamethoxazole Drug Combination

To study the correlation of antimicrobial consumption with the carriage rate of penicillin resistant and multiresistant pneumococci in children.. Cross sectional and analytical prevalence study.. Five different communities in Iceland.. Prevalence of nasopharyngeal carriage of penicillin resistant pneumococci in children aged under 7 years in relation to antibiotic use as determined by information from parents, patient's records, and total sales of antimicrobials from local pharmacies in four study areas.. Total antimicrobial sales for children (6223 prescriptions) among the four areas for which data were available ranged from 9.6 to 23.2 defined daily doses per 1000 children daily (1.1 to 2.6 courses yearly per child). Children under 2 consumed twice as much as 2-6 year olds (20.5 v 10.9 defined daily doses per 1000 children daily). Nasopharyngeal specimens were obtained from 919 children, representing 15-38% of the peer population groups in the different areas. Pneumococci were carried by 484 (52.7%) of the children, 47 (9.7%) of the isolates being resistant to penicillin or multiresistant. By multivariate analysis age (< 2 years), area (highest antimicrobial consumption), and individual use of antimicrobials significantly influenced the odds of carrying penicillin resistant pneumococci. By univariate analysis, recent antimicrobial use (two to seven weeks) and use of co-trimoxazole were also significantly associated with carriage of penicillin resistant pneumococci.. Antimicrobial use, with regard to both individual use and total antimicrobial consumption in the community, is strongly associated with nasopharyngeal carriage of penicillin resistant pneumococci in children. Control measures to reduce the prevalence of penicillin resistant pneumococci should include reducing the use of antimicrobials in community health care.

Topics: Age Factors; Anti-Bacterial Agents; Carrier State; Child; Child, Preschool; Cross-Sectional Studies; Female; Humans; Iceland; Infant; Infant, Newborn; Male; Multivariate Analysis; Nasopharyngeal Diseases; Nasopharynx; Penicillin Resistance; Pneumococcal Infections; Prevalence; Residence Characteristics; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination

Treatment of childhood pneumonia in developing countries requires knowledge of susceptibility patterns for Streptococcus pneumoniae and Haemophilus influenzae. Between October 1991 and April 1993, a surveillance survey of antimicrobial resistance was performed at two fever hospitals in Egypt; nasopharyngeal swab and blood specimens obtained from 1,635 children with pneumonia were cultured for these organisms. Susceptibility testing of these organisms was performed. At least one of these organisms was isolated from nasopharyngeal swab specimens from 73% of the children; 3.7% of blood cultures were positive. For S. pneumoniae strains, 70.9% of nasopharyngeal isolates were calculated to be susceptible to penicillin vs. 77.6% of blood isolates; the percentages of isolates susceptible to co-trimoxazole were 73.0% and 75.0%, respectively. For H. influenzae strains, 93.0% of nasopharyngeal isolates were calculated to be susceptible to ampicillin vs. 100% of blood isolates; the percentages of isolates susceptible to co-trimoxazole were 84.9% and 100%, respectively. Although most S. pneumoniae and H. influenzae strains associated with childhood pneumonia in Cairo were susceptible to penicillins and co-trimoxazole, antimicrobial resistance did not occur.

Topics: Ampicillin; Ampicillin Resistance; Child, Preschool; Chloramphenicol; Chloramphenicol Resistance; Egypt; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Male; Microbial Sensitivity Tests; Penicillin Resistance; Penicillins; Pneumococcal Infections; Pneumonia; Streptococcus pneumoniae; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination

From January 1986 through December 1990, 672 cases of invasive pneumococcal disease were identified. From these, 574 pneumococcal isolates were recovered from normally sterile sites (blood, cerebrospinal and pleural fluid); 92% were serotypes represented in the 23-valent pneumococcal polysaccharide vaccine. The most common serotypes from children < 2 years old were 4, 6B, 9V, 14, 18C, 19F, and 23F, recovered from 83% of Alaska Native and 75.1% of nonnative children with invasive disease. Moderate penicillin resistance (MIC, 0.1-1.0 micrograms/mL) was found in 3.8% of isolates. All were sensitive to chloramphenicol, vancomycin, rifampin, ceftriaxone, cefotaxime, cephalothin, and cefaclor. However, in the Yukon-Kuskokwim Delta region, 16.9% of isolates were moderately resistant to penicillin, and 10.8% were resistant to erythromycin and 6.2% to trimethoprim-sulfamethoxazole; the number resistant to two or more antibiotics increased significantly during surveillance. All multiply resistant isolates were serotype 6B, and all were from Alaska Native patients < 2 years old.

Topics: Adolescent; Adult; Age Factors; Alaska; Bacteremia; Bacterial Vaccines; Cerebrospinal Fluid; Child; Child, Preschool; Drug Resistance, Microbial; Erythromycin; Humans; Indians, North American; Infant; Penicillin Resistance; Pleura; Pneumococcal Infections; Pneumococcal Vaccines; Serotyping; Streptococcus pneumoniae; Tetracycline Resistance; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: AIDS-Related Opportunistic Infections; Child, Preschool; Drug Resistance, Microbial; Female; Humans; Pneumococcal Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Isolates of serotype 23F Streptococcus pneumoniae with high levels of resistance of penicillin have been commonly recovered in Spain for more than a decade. Recently penicillin-resistant serotype 23F S. pneumoniae strains were also isolated from children attending a day-care center in Cleveland. A number of Spanish and Cleveland isolates were compared by electrophoretic analysis of penicillin-binding protein (PBP) profiles and DNA restriction endonuclease cleavage profiles of the PBP 2X and 2B genes amplified with the polymerase chain reaction and by multilocus enzyme electrophoresis. All strains were identical by these criteria. The findings demonstrate that the Spanish and Cleveland isolates are clonally related and suggest that this antibiotic resistant clone of serotype 23F S. pneumoniae has spread intercontinentally from Spain to the United States.

Topics: Bacterial Proteins; Base Sequence; Carrier Proteins; Chloramphenicol Resistance; DNA Fingerprinting; DNA, Bacterial; Drug Resistance, Microbial; Electrophoresis, Starch Gel; Enzymes; Erythromycin; Hexosyltransferases; Humans; Molecular Sequence Data; Muramoylpentapeptide Carboxypeptidase; Ohio; Oligonucleotides; Penicillin Resistance; Penicillin-Binding Proteins; Penicillins; Peptidyl Transferases; Pneumococcal Infections; Polymerase Chain Reaction; Serotyping; Spain; Streptococcus pneumoniae; Tetracycline Resistance; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Bacteremia; Drug Resistance, Microbial; Humans; Infant; Penicillin Resistance; Pneumococcal Infections; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination

The increasing number of Streptococcus pneumoniae isolates identified as relatively or fully resistant to penicillin or fully resistant to other antimicrobials in the United States supports the need to monitor for this resistance. Thus, 5459 S. pneumoniae isolates submitted to the Centers for Disease Control in 1979-1987 by 35 hospitals in a hospital-based pneumococcal surveillance system were evaluated. The MIC to penicillin or ampicillin was greater than or equal to 0.1 micrograms/ml for 274 (5%) isolates; 1 had an MIC of 4.0 micrograms/ml to penicillin. Seventeen (0.3%) were resistant to erythromycin (MIC, greater than or equal to 8 micrograms/ml), 157 (2.9%) were resistant to tetracycline (MIC, greater than or equal to 16 micrograms/ml), and 34 (0.6%) were resistant to sulfamethoxazole/trimethoprim (MIC, greater than or equal to 76 and 4 micrograms/ml). Isolates relatively resistant to penicillin represented 1.8% of isolates in 1979, 8% in 1982, and 3.6% in 1987. Sixty-five multiply resistant isolates were identified. Pneumococci from the southwestern United States (region 4) were more likely to be relatively resistant to penicillin. Using logistic regression analysis, serotypes 14 and 19A, isolates from region 4, and isolates from middle ear fluid were associated with penicillin resistance (P less than or equal to .008, chi 2. These data confirm that antimicrobial resistance among pneumococcal isolates remained at low levels in the United States through 1987.

Topics: Age Factors; Anti-Bacterial Agents; Drug Resistance, Microbial; Erythromycin; Humans; Penicillin Resistance; Pneumococcal Infections; Serotyping; Streptococcus pneumoniae; Tetracycline Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; United States

We compared rates of antibiotic resistance in strains of Streptococcus pneumoniae recovered from nasopharyngeal secretions of a group of children studied longitudinally in a research day care center between 1978 and 1985 and recovered from usually sterile body fluids of patients at a tertiary care hospital between 1981 and 1985. The prevalence of trimethoprim-sulfamethoxazole (TMP-SMZ) resistance was 11.5% in isolates from the hospital, whereas 30.0% of episodes of nasopharyngeal carriage of S. pneumoniae studied in day care children included TMP-SMZ-resistant isolates. The proportion of episodes of colonization with TMP-SMZ-resistant isolates in the day care study increased from 5.4% before 1981 to 39% between 1981 and 1985. Isolates of S. pneumoniae relatively resistant (MIC greater than or equal to 0.125 micrograms/mL) to penicillin G, amoxicillin, or cefuroxime accounted for 8% of isolates from the hospital and 11.9% of episodes of nasopharyngeal colonization in children in day care. Pneumococci with reduced susceptibility to either TMP-SMZ or a beta-lactam antibiotic were recovered from 68% of 72 children in the day care study.

Topics: Amoxicillin; Carrier State; Cefuroxime; Child Day Care Centers; Child, Preschool; Drug Combinations; Drug Resistance, Microbial; Humans; Infant; Longitudinal Studies; Nasopharynx; Penicillin Resistance; Pneumococcal Infections; Streptococcus pneumoniae; Sulfamethoxazole; Trimethoprim; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Drug Combinations; Drug Resistance, Microbial; Female; Humans; Infant; Pneumococcal Infections; Streptococcus pneumoniae; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Of 191 consecutive clinical isolates of Streptococcus pneumoniae tested for antibiotic susceptibility with the agar dilution technique 87% were fully sensitive to all of 11 antimicrobial agents examined. 90% of the strains were inhibited by 0.016 micrograms/ml of benzylpenicillin, by 0.032 micrograms/ml of ampicillin, cefuroxime, erythromycin, clindamycin or rifampicin, by 0.13 micrograms/ml of cephalothin, oxacillin or doxycycline, by 4.0 micrograms/ml of chloramphenicol and by 8.0 micrograms/ml of cotrimoxazole. 18 strains exhibited a reduced susceptibility to one (11 strains) or more (7 strains) of erythromycin, doxycycline, chloramphenicol and cotrimoxazole. One of these strains also showed a reduced susceptibility to all 5 examined beta-lactam antibiotics, as did another 4 strains. Two of these 5 strains were isolated from small children recently adopted from 2 Asian countries. Cotrimoxazole-resistant strains were significantly more often isolated from children 1 yr of age or less than from older patients. All strains were fully sensitive to clindamycin and rifampicin. The existence of pneumococcal strains with resistance or reduced susceptibility to antibiotics commonly used for treatment of pneumococcal infections is important to bear in mind and necessitates antibiotic susceptibility testing of strains isolated from patients with severe infections.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Cephalosporins; Child; Child, Preschool; Chloramphenicol; Drug Combinations; Erythromycin; Female; Humans; Infant; Male; Middle Aged; Penicillin Resistance; Penicillins; Pneumococcal Infections; Streptococcus pneumoniae; Sulfamethoxazole; Sweden; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Eighty-four isolates of penicillin-resistant pneumococci were tested for susceptibility to vancomycin, rifampicin, cotrimoxazole, and 14 beta-lactam antibiotics by agar and microbroth dilution methods. Twenty-three were from adult patients with pneumococcal disease, 57 from nasopharingeal carriers (preschool children) and four were resistant South African isolates. For all isolates tested, imipenem (N-formimidoyl thienamycin), rifampicin, ceftriaxone and cefotaxime had the greatest activity ( MIC90 : 0 X 12, 0 X 25, 0 X 5 mg/l, respectively). Cefoxitin and latamoxef were the least active of the drugs studied. The remaining beta-lactams tested had less activity than that of penicillin. All strains were inhibited by 1 mg/l of vancomycin and all but one were resistant to cotrimoxazole. The excellent in-vitro activities of the newer beta-lactam agents (ceftriaxone, cefotaxime and, particularly, imipenem ) and vancomycin against penicillin-resistant pneumococci offer a considerable promise for their use in the treatment of pneumococcal meningitis caused by these strains.

Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; beta-Lactams; Carrier State; Child; Drug Combinations; Drug Resistance, Microbial; Humans; Microbial Sensitivity Tests; Penicillin Resistance; Pneumococcal Infections; Rifampin; Streptococcus pneumoniae; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

Topics: Adult; Child; Drug Combinations; Drug Resistance, Microbial; Humans; Penicillin Resistance; Pneumococcal Infections; Streptococcus pneumoniae; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination