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Invasive disease due to multiply resistant Streptococcus pneumoniae in a Houston, Tex, day-care center
1Department of Pediatrics, University of Texas Medical School, Houston 77030.
Insights
A day-care center outbreak of multiply resistant Streptococcus pneumoniae caused sepsis and meningitis in toddlers. Rifampin treatment reduced carriage but did not fully eradicate the resistant bacteria.
Area of Science:
- Infectious Diseases
- Microbiology
- Public Health
Background:
- Multiply resistant Streptococcus pneumoniae (MRSP) poses a significant public health threat, particularly in settings with close contact like day-care centers.
- Invasive pneumococcal disease, including sepsis and meningitis, can rapidly spread among vulnerable populations such as young children.
Purpose of the Study:
- To investigate the prevalence of MRSP respiratory carriage and disease within a day-care center and its associated household contacts following an outbreak.
- To evaluate the effectiveness of a short-course rifampin treatment in reducing MRSP nasopharyngeal colonization in a day-care setting.
Main Methods:
- Nasopharyngeal cultures were obtained from children, staff, and family members in a day-care center experiencing an MRSP outbreak.
- Isolates were characterized for antibiotic resistance patterns and serotype.
- A 2-day rifampin treatment regimen was administered to day-care attendees and staff to assess its impact on MRSP carriage.
Main Results:
- Streptococcus pneumoniae was isolated from 35% of cultured children, with 34% of these isolates exhibiting resistance to sulfamethoxazole-trimethoprim, oxacillin, and tetracycline, and relative resistance to penicillin.
- All multiply resistant isolates were serotype 14 and shared an identical antibiotic resistance profile.
- Rifampin treatment led to a 70% reduction in positive nasopharyngeal cultures for S pneumoniae, though eradication was not complete.
Conclusions:
- This study documents an outbreak of multiply resistant invasive S pneumoniae in a day-care center, highlighting the high rate of nasopharyngeal colonization among exposed children.
- Short-term rifampin therapy demonstrated partial success in reducing MRSP carriage but did not achieve complete eradication.
- The findings underscore the challenges in controlling the spread of antibiotic-resistant bacteria in congregate settings and the need for further strategies.
Abstract:
Two toddlers who attended the same day-care center were hospitalized hours apart with sepsis and meningitis due to a multiply resistant Streptococcus pneumoniae. We determined the prevalence of multiply resistant S pneumoniae respiratory carriage and disease in infants, toddlers, and staff in the day-care center and in household contacts. The nasopharynges of 82 (96%) of 85 day-care center children, 26 (90%) of 29 day-care center staff, and 28 (90%) of 31 family members were cultured. Streptococcus pneumoniae grew from 29 (35%) of the 82 cultured day-care center children. Ten (34%) of the S pneumoniae isolates were resistant to sulfamethoxazole-trimethoprim, oxacillin, and tetracycline and were relatively resistant to penicillin (minimum inhibitory concentration, 0.5 mg/L). All were serotype 14 and had the same antibiotic resistance pattern. Treatment of 97% of the day-care center children and staff with rifampin (10 mg/kg twice daily for 2 days) resulted in 70% reduction in positive nasopharyngeal cultures for S pneumoniae. No additional disease due to multiply resistant S pneumoniae was identified in the day-care center during a 9-month follow-up period. This report documents that an outbreak of multiply resistant invasive S pneumoniae occurred in a day-care center setting; that nasopharyngeal colonization of exposed children was common; and that rifampin treatment of 2 days only partially eradicated the organism from colonized individuals.