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Streptococcus pneumoniae antibiotic resistance in Northern Territory children in day care
S Skull1, T Shelby-James, P Morris
1Centre for Disease Control Darwin, Casuarina, Northern Territory, Australia.
Insights
Antimicrobial resistance in Streptococcus pneumoniae (SP) is rising in Australian children attending daycare. Penicillin resistance was found in 30% of isolates, with high levels observed in Northern Territory children.
Area of Science:
- Microbiology
- Epidemiology
- Pediatrics
Background:
- Increasing antimicrobial resistance in Streptococcus pneumoniae (SP) is a global concern.
- Evidence suggests this trend may be emerging in Australia.
- Understanding SP carriage and resistance in vulnerable populations, like children in daycare, is crucial.
Purpose of the Study:
- To describe Streptococcus pneumoniae (SP) carriage and antimicrobial resistance levels.
- To assess resistance patterns in children attending urban daycare centers in the Northern Territory.
- To provide baseline data for monitoring antimicrobial resistance trends.
Main Methods:
- A prospective cohort study involving 250 children in nine Darwin daycare centers.
- Fortnightly nasopharyngeal swabs collected over six months (March-September 1997).
- Parental interviews regarding antibiotic administration and confirmation of resistance via E-test.
Main Results:
- Streptococcus pneumoniae (SP) was detected in 52% of swabs and isolated from 92% of children.
- Penicillin resistance identified in 30% of isolates (20% intermediate, 5% high-level).
- High rates of resistance observed for ceftriaxone (19%), co-trimoxazole (45%), erythromycin (17%), tetracycline (17%), and chloramphenicol (13%). Multiresistance found in 17% of isolates.
Conclusions:
- Penicillin resistance levels in Northern Territory daycare children are significantly higher than the Australian average.
- The findings suggest an increasing national trend of penicillin resistance.
- Urgent monitoring and intervention strategies are needed to combat rising antimicrobial resistance in pediatric populations.
Background:
There is evidence that the rapid rise in Streptococcus pneumoniae (SP) antimicrobial resistance seen in other countries may have commenced in Australia. Streptococcus pneumoniae carriage and resistance levels are described for urban Northern Territory children in day care.
Methods:
A prospective cohort study was conducted of 250 children in nine Darwin day care centres between 24 March and 15 September 1997. Each fortnight nasopharyngeal swabs were collected from children, and parents were interviewed about medications administered.
Results:
Streptococcus pneumoniae was detected in 52% (1028/1974) of all nasopharyngeal swabs. Streptococcus pneumoniae was isolated from 92% (231/250) of children at some time. Penicillin resistance was found in 30% (312/1028) of isolates using a screening test. Of these, 256 (82%) had resistance confirmed by E-test. Two hundred and one (20% of all isolates) had intermediate penicillin resistance and 55 (5% of all isolates) had high level resistance. Ceftriaxone resistance was found in 19% of children's first isolates. Resistance to other antibiotics was also common: co-trimoxazole 45%, erythromycin 17%, tetracycline 17% and chloramphenicol 13%. A total of 17% (172/1028) of the isolates were multiresistant. The average fortnightly proportion of children given antibiotics was 16% (405/2476).
Conclusion:
Levels of intermediate and high level penicillin resistance in this day care population are consistent with previous data from the Northern Territory, and considerably higher than the rest of Australia. The national trend of increasing pencillin resistance is likely to continue.