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Multiply resistant pneumococcus causing meningitis: its epidemiology within a day-care centre
Abstract:
An 11 month-old infant had meningitis caused by a strain of Streptococcus pneumoniae, serotype 6b, resistant to penicillin, chloramphenicol, and several other antimicrobials. The minimum inhibitory concentrations (MIC) by agar dilution were 1.0 microgram/ml for penicillin and 16 microgram/ml for chloramphenicol. The infant did not respond to high-dose intravenous penicillin G but was cured by a combination of ampicillin, chloramphenicol, and rifampicin. At the infant's day-care centre this multiply resistant strain was isolated from throat cultures of 27% of the children (age less than or equal to 26 months) assigned to the same room as the index case, and from 11% of older children and staff. There was a 33% carriage rate in family contacts of colonised children. Antibiotic use during the previous 2 months was more frequent among the carriers than among non-carriers. No resistant pneumococci were found in on hundred and twenty-five children and staff in six other Denver day-care centres, in 300 consecutive routine throat cultures processed by our clinical microbiology laboratory, or among 150 pneumococcal isolates collected from Denver area hospitals. The carriers were not treated, and there have been no other cases of infection due to this strain. The emergence of multiply resistant pneumococci in the United States indicates the need to screen important pneumococcal isolates for resistance to both penicillin and chloramphenicol, especially in cases of meningitis.
Insights
A multiply-resistant Streptococcus pneumoniae strain caused meningitis in an infant. This resistant strain was found in 27% of children at the infant's daycare, highlighting the need for antimicrobial resistance surveillance.
Area of Science:
- Microbiology
- Infectious Diseases
- Epidemiology
Background:
- Meningitis in infants can be caused by Streptococcus pneumoniae.
- Antimicrobial resistance is a growing global health concern.
- Penicillin and chloramphenicol are common treatments for bacterial meningitis.
Observation:
- An 11-month-old infant presented with meningitis caused by a multidrug-resistant Streptococcus pneumoniae (serotype 6b).
- The infant's isolate showed high minimum inhibitory concentrations (MICs) for penicillin (1.0 µg/ml) and chloramphenicol (16 µg/ml).
- The infant initially did not respond to penicillin G but was successfully treated with ampicillin, chloramphenicol, and rifampicin.
Findings:
- The resistant strain was prevalent in the infant's daycare, with 27% of young children and 11% of older children and staff carrying the bacteria.
- A 33% carriage rate was observed in family contacts of colonized children.
- Antibiotic use in the preceding two months was associated with increased carriage of the resistant strain.
Implications:
- The emergence of multidrug-resistant Streptococcus pneumoniae in the US necessitates enhanced surveillance.
- Clinical microbiology laboratories should screen significant pneumococcal isolates for resistance to penicillin and chloramphenicol.
- Prompt identification and appropriate treatment are crucial for managing infections caused by resistant bacterial strains, especially in vulnerable populations like infants.