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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 a high rate of penicillin-nonsusceptible Streptococcus pneumoniae carriage. Surveillance is crucial for monitoring resistant bacteria 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 exists on nasopharyngeal carriage of resistant bacteria in this high-risk pediatric group due to antibiotic use and hospitalizations.
Purpose of the Study:
- To assess Streptococcus pneumoniae nasopharyngeal carriage rates in children with SCD.
- To determine serotype distribution and penicillin resistance of S. pneumoniae.
- To evaluate carriage and antibiotic resistance of Staphylococcus aureus, Moraxella catarrhalis, and Haemophilus influenzae.
Main Methods:
- Prospective trial (DREPANOBACT) conducted in 7 French hospitals.
- Enrolled 300 children with SCD aged 6 months to 15 years.
- Collected data on nasopharyngeal carriage, serotypes, and antibiotic resistance from September 2022 to April 2024.
Main Results:
- S. pneumoniae carriage found in 11% of children, with 66% of strains being penicillin-nonsusceptible.
- Predominant serotypes included 23A, 35B, 11A, and 15C; 75% were non-PCV13 serotypes.
- Carriage rates for S. aureus, M. catarrhalis, and H. influenzae were 31%, 17%, and 11%, respectively; 5% of S. aureus strains were methicillin-resistant.
- 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 of S. pneumoniae, including resistant strains, is significant in children with SCD.
- A high proportion of carried serotypes are not covered by the 13-valent pneumococcal conjugate vaccine.
- Ongoing surveillance of nasopharyngeal carriage is essential to track evolving serotypes and resistance patterns in this population.
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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