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Updated: May 29, 2025
Experimental Human Pneumococcal Carriage
Published on: February 15, 2013
Nasopharyngeal Carriage and Antibiotic Resistance in Children With Sickle Cell Disease: The DREPANOBACT French
Luu-Ly Pham1,2, Emmanuelle Varon3,4, Stéphane Bonacorsi2,4,5
1From the Pediatrics Department, Jean Verdier Hospital, AP-HP, Sorbonne Paris-Nord University, Bondy.
Insights
Children with sickle cell disease (SCD) have high rates of resistant Streptococcus pneumoniae nasopharyngeal carriage. Surveillance is crucial to monitor evolving serotypes and resistance patterns in this vulnerable population.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Hematology
Background:
- Children with sickle cell disease (SCD) face increased risk of invasive bacterial infections, especially from Streptococcus pneumoniae.
- Limited data exist on nasopharyngeal carriage of bacteria in children with SCD, a group prone to resistant strains due to antibiotic use and hospitalizations.
Purpose of the Study:
- To assess the nasopharyngeal carriage rate of Streptococcus pneumoniae in children with SCD.
- To determine serotype distribution and penicillin resistance of S. pneumoniae.
- To evaluate carriage and antibiotic resistance rates for Staphylococcus aureus, Moraxella catarrhalis, and Haemophilus influenzae.
Main Methods:
- Prospective trial (DREPANOBACT) conducted in 7 French hospitals.
- Enrolled 300 children aged 6 months to 15 years with SCD.
- Collected data on bacterial carriage, serotypes, and antibiotic resistance patterns.
Main Results:
- Streptococcus pneumoniae carriage found in 11% of children, with 66% of strains being penicillin-nonsusceptible.
- Predominant serotypes were often non-PCV13, with limited coverage by PCV20 and PCV21.
- Carriage rates for S. aureus (31%), M. catarrhalis (17%), and H. influenzae (11%) were reported, with 5% MRSA.
- Younger age (≤5 years) associated with S. pneumoniae, M. catarrhalis, and H. influenzae carriage; older age (≥11 years) associated with S. aureus.
Conclusions:
- Nasopharyngeal carriage surveillance in children with SCD is essential.
- Monitoring changes in predominant serotypes and antibiotic resistance is critical for this high-risk group.
Background:
Children with sickle cell disease (SCD) are susceptible to invasive bacterial infections, particularly those caused by Streptococcus pneumoniae. Data concerning nasopharyngeal carriage remain scarce in this population at high risk of resistant bacteria owing to antibiotic pressure and frequent hospitalizations.
Methods:
We conducted this prospective trial, DREPANOBACT, in 7 French hospitals to assess the nasopharyngeal carriage rate for S. pneumoniae among children with SCD aged 6 months-15 years between September 2022 and April 2024. The secondary aim was to determine the serotype distribution and proportion of penicillin nonsusceptible S. pneumoniae isolates and the carriage and antibiotic resistance rates for Staphylococcus aureus, Moraxella catarrhalis and Haemophilus influenzae.
Results:
In total, 300 children were enrolled [median age, 8 years (interquartile range: 4-12 years)]. S. pneumoniae carriage accounted for 32 cases (11%), including 21 penicillin nonsusceptible S. pneumoniae strains (66%). The main serotypes were 23A (n = 4), 35B (n = 4), 11A (n = 3) and 15C (n = 3). Overall, 75% of the serotypes were non-13-valent pneumococcal conjugate vaccine (PCV) serotypes, with 19% and 53% covered by PCV20 and PCV21, respectively. The carriage rates for S. aureus, M. catarrhalis and H. influenzae were 31%, 17% and 11%, respectively. Methicillin resistance was observed in 5% of S. aureus strains. Age ≤5 years was significantly associated with S. pneumoniae, M. catarrhalis, and H. influenzae carriage, while age ≥11 years was associated with S. aureus carriage.
Conclusions:
Surveillance of nasopharyngeal carriage in children with SCD is warranted to monitor changes in predominant serotypes and resistance patterns.
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