Extremely high prevalence of nasopharyngeal carriage of penicillin-resistant Streptococcus pneumoniae among children in Kaohsiung, Taiwan

Resistance (intermediate and high) to penicillin among Streptococcus pneumoniae strains is an emerging problem worldwide. From 1995 to 1997, isolates of S. pneumoniae not susceptible to penicillin were seen with increasing frequency from blood, cerebrospinal fluid, pleural fluid, and middle ear flui...

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Bibliographic Details
Published in:Journal of clinical microbiology 1998-07, Vol.36 (7), p.1933-1937
Main Authors: CHIOU, C.-C. C, LIU, Y.-C, HUANG, T.-S, HWANG, W.-K, WANG, J.-H, LIN, H.-H, YEN, M.-Y, HSIEH, K.-S
Format: Article
Language:English
Subjects:
Ambulatory Care Facilities
Anti-Bacterial Agents - pharmacology
Bacteriology
Biological and medical sciences
Carrier State - epidemiology
Carrier State - microbiology
Child
Child Day Care Centers
Child, Preschool
Epidemiology
Female
Fundamental and applied biological sciences. Psychology
Humans
Male
Microbial Sensitivity Tests
Microbiology
Nasopharynx - microbiology
Penicillin Resistance
Penicillins - pharmacology
Pneumococcal Infections - epidemiology
Pneumococcal Infections - microbiology
Prevalence
Schools
Streptococcus pneumoniae - drug effects
Streptococcus pneumoniae - isolation & purification
Taiwan - epidemiology
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Summary:Resistance (intermediate and high) to penicillin among Streptococcus pneumoniae strains is an emerging problem worldwide. From 1995 to 1997, isolates of S. pneumoniae not susceptible to penicillin were seen with increasing frequency from blood, cerebrospinal fluid, pleural fluid, and middle ear fluid from pediatric patients at the Veterans General Hospital-Kaohsiung. To determine the prevalence of carriage of these penicillin-nonsusceptible S. pneumoniae isolates, we obtained nasopharyngeal swab specimens from 2,905 children (ages, 2 months to 7 years) attending day-care centers or kindergartens or seen in our outpatient clinic. S. pneumoniae was isolated from 611 children, and 584 strains were available for analysis. The oxacillin disc test was used as a screening test to evaluate penicillin susceptibility. The MICs of 11 antibiotics (penicillin, cefaclor, cefuroxime, ceftriaxone, cefotaxime, imipenem, chloramphenicol, clarithromycin, rifampin, vancomycin, and teicoplanin) were determined by the E-test. Only 169 (29%) of the strains were susceptible to penicillin; 175 (30%) strains were intermediately resistant and 240 (41%) were highly resistant. The isolates also demonstrated high rates of resistance to other beta-lactams (46% were resistant to cefaclor, 45% were resistant to cefuroxime, 45% were resistant to ceftriaxone, 31% were resistant to cefotaxime, and 46% were resistant to imipenem). The rate of resistance to macrolide antimicrobial agents was strikingly high; 95% of the isolates were not susceptible to clarithromycin. However, 97% were susceptible to rifampin and 100% were susceptible to the two glycopeptides (vancomycin and teicoplanin). While reports of penicillin-resistant S. pneumoniae increased worldwide through the 1980s, the high prevalence (71%) of resistance reported here is astonishing. Surveillance of nasopharyngeal swab specimen cultures may provide useful information on the prevalence of nonsusceptible strains causing invasive disease. Such information could be used to guide therapy of pneumococcal infections.
ISSN:0095-1137
1098-660X
DOI:10.1128/jcm.36.7.1933-1937.1998