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Spread of multidrug-resistant Streptococcus pneumoniae among hospitalized children in Slovakia
M R Reichler1, J Rakovsky, M Sláciková
1Childhood and Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Abstract:
A multidrug-resistant serotype 14 strain of Streptococcus pneumoniae was isolated from sterile-site specimens and nasopharyngeal secretions from > 200 children in Slovakia between 1985 and 1990. Nasopharyngeal culture surveys were done to determine the extent of spread and means of transmission of this strain. The resistant strain was isolated from cultures of 8 (33.0%) of 24 children at hospital A and from 1 (0.8%) of 130 children attending outpatient clinics or day care centers (P < .001). One-quarter of the initially uncolonized children at hospital A acquired the resistant strain during hospitalization. Among hospitalized children, frequent antimicrobial drug use (P < .01), prior hospitalization (P < .005), and length of hospital stay (P < .001) were associated with infection with the resistant strain. These findings support limiting broad-spectrum antimicrobial drug use and nonessential hospitalizations in settings were drug-resistant pneumococci are prevalent. Development of a pneumococcal vaccine that is immunogenic in young children is urgently needed.
Insights
A multidrug-resistant Streptococcus pneumoniae strain spread widely in Slovakian children. Hospitalization and frequent antibiotic use increased infection risk, highlighting the need for reduced antimicrobial use and a new pneumococcal vaccine.
Area of Science:
- Microbiology
- Epidemiology
- Public Health
Background:
- A multidrug-resistant serotype 14 strain of Streptococcus pneumoniae was identified.
- This resistant strain was isolated from children in Slovakia between 1985 and 1990.
Purpose of the Study:
- To determine the spread and transmission of the resistant Streptococcus pneumoniae strain.
- To identify risk factors associated with infection by the resistant strain.
Main Methods:
- Nasopharyngeal culture surveys were conducted.
- Comparison of resistant strain isolation rates between hospitalized children and those in outpatient/daycare settings.
- Analysis of factors associated with infection in hospitalized children.
Main Results:
- The resistant strain was significantly more prevalent in hospitalized children (33.0%) compared to outpatient/daycare attendees (0.8%).
- One-quarter of initially uncolonized hospitalized children acquired the resistant strain during their stay.
- Frequent antimicrobial drug use, prior hospitalization, and longer hospital stays were linked to infection with the resistant strain.
Conclusions:
- Findings suggest limiting broad-spectrum antimicrobial use and nonessential hospitalizations where drug-resistant pneumococci are prevalent.
- Urgent development of a pneumococcal vaccine immunogenic in young children is needed.