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Burden of bacterial upper respiratory tract pathogens in school children of Nepal
Sangita Thapa1, Shishir Gokhale2, Annavarapu Laxminarasimha Sharma3
1Department of Clinical Microbiology and Immunology, Chitwan Medical College, Bharatpur, Chitwan, Nepal.
Insights
High rates of Streptococcus pneumoniae colonization were found in Nepalese school children, highlighting the need for pneumococcal vaccines. Antibiotic resistance in common respiratory pathogens was also observed.
Area of Science:
- Microbiology
- Epidemiology
- Public Health
Background:
- Respiratory tract infections are a leading cause of global mortality and morbidity.
- Bacterial upper respiratory tract infections are often vaccine-preventable.
- Understanding pathogen prevalence and antibiotic resistance in children is crucial for public health strategies.
Purpose of the Study:
- To determine the prevalence of bacterial upper respiratory tract pathogens in school children.
- To investigate the antibiotic susceptibility patterns (antibiograms) of these isolated pathogens.
- To inform vaccination strategies and public health interventions in Nepal.
Main Methods:
- Pharyngeal and tonsil specimens collected from 204 school children.
- Standard microbiological methods used for bacterial isolation and identification.
- Modified Kirby-Bauer disc diffusion method employed for antibiotic susceptibility testing.
Main Results:
- Streptococcus pneumoniae was the most prevalent pathogen (16.6%), followed by Staphylococcus aureus (14.7%).
- Other identified pathogens included beta-hemolytic streptococci, Streptococcus pyogenes, Corynebacterium diphtheriae, Klebsiella pneumoniae, Haemophilus influenzae, and Neisseria meningitidis.
- High resistance rates observed: Streptococcus pneumoniae to penicillin (91.17%) and Staphylococcus aureus to oxacillin (23.3%).
Conclusions:
- High pharyngeal colonization by Streptococcus pneumoniae in school children necessitates its inclusion in Nepal's routine immunization schedule.
- Despite vaccination, Corynebacterium diphtheriae colonization is possible, posing a transmission risk.
- Findings underscore the importance of continued surveillance of respiratory pathogens and antibiotic resistance in pediatric populations.
Introduction:
Respiratory tract infections are one of the most common human infections in all age group and important cause of mortality and morbidity worldwide. Most bacterial upper respiratory tract infections are vaccine preventable. This study aimed to determine the prevalence of carrier state of bacterial upper respiratory tract pathogens among school children. It also aimed to study their antibiograms.
Methods:
The specimen from posterior pharyngeal wall and tonsils were collected from 204 participants on calcium alginate coated swabs (HiMedia). Isolates were identified by standard microbiological methods and tested for in vitro antibiotic susceptibility testing by modified Kirby-Bauer disc diffusion method.
Results:
In this study, Streptococcus pneumoniae (16.6%) was the most common bacterial pathogen recovered, followed by Staphylococcus aureus (14.7%), β-haemolytic streptococci (non-Group A) (8.8%), Streptococcus pyogenes (5.3%) and Corynebacterium diphtheriae (3.4%). The Gram negative bacteria were Klebsiella pneumoniae (4.9%), Haemophilus influenzae (3.4%) and Neisseria meningitidis (1.4%). Important findings in antibiogram include high resistance of Streptococcus pneumoniae to penicillin (91.17%) and resistance of S. aureus to oxacillin (23.3%).
Conclusion:
Pharyngeal colonisation by S. pneumoniae was found high among school children and this calls for an urgent need to include pneumococcal vaccine in routine national immunisation schedule of Nepal given the high burden of invasive pneumococcal disease. Despite expected universal vaccination, pharyngeal colonisation by C. diphtheriae is possible and there is possibility of transmission of these respiratory pathogens to other healthy children.
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