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Colonization with antibiotic-resistant Streptococcus pneumoniae in children with sickle cell disease
R W Steele1, R Warrier, P J Unkel
1Division of Infectious Diseases, Department of Pediatrics, Louisiana State University School of Medicine, New Orleans, USA.
Insights
Children with sickle cell disease (SCD) show high rates of penicillin-resistant Streptococcus pneumoniae colonization. This highlights the need for new strategies to prevent pneumococcal infections in this vulnerable population.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Hematology
Background:
- Children with sickle cell disease (SCD) are at high risk for severe pneumococcal infections.
- Penicillin prophylaxis is standard for SCD patients, but rising penicillin resistance is a global concern.
- Understanding Streptococcus pneumoniae colonization and resistance patterns in SCD is crucial for effective prevention.
Purpose of the Study:
- To determine the prevalence of nasopharyngeal colonization with Streptococcus pneumoniae in children with SCD.
- To evaluate the antimicrobial susceptibility of S. pneumoniae strains isolated from these children.
- To assess the impact of penicillin prophylaxis on colonization and resistance.
Main Methods:
- Nasopharyngeal cultures were collected from children with SCD.
- Colonization rates were compared to background rates in day care attendees.
- Isolated S. pneumoniae strains were tested for susceptibility to penicillin and other antibiotics.
Main Results:
- 12% of children with SCD were colonized with S. pneumoniae.
- Penicillin resistance was observed in 62% of isolates, with 29% showing high-level resistance.
- Penicillin resistance was linked to penicillin prophylaxis and colonization was associated with younger age and day care attendance.
Conclusions:
- Despite reduced overall colonization due to prophylaxis and vaccination, a higher proportion of remaining S. pneumoniae strains are resistant to penicillin and other antibiotics.
- New strategies are needed for preventing pneumococcal disease in children with SCD.
- Early management of suspected pneumococcal infections in this population requires updated approaches.
Objective:
Because of susceptibility to severe pneumococcal infection, children with sickle cell disease (SCD) routinely receive penicillin prophylaxis. Increasing rates of penicillin resistance have been reported throughout the world. Our objective was to assess the prevalence of nasopharyngeal colonization with Streptococcus pneumoniae and to assess the antimicrobial susceptibility of the organisms in children with SCD.
Study Design:
Nasopharyngeal cultures for S. pneumoniae were obtained from all children with SCD attending clinics in a statewide university-based network. Background colonization rates were determined in children attending day care centers in some of the same locations. All recovered S. pneumoniae organisms were tested for susceptibility to penicillin, and all resistant strains were examined for susceptibility to other antibiotics.
Results:
Overall nasopharyngeal pneumococcal colonization rates among children with SCD were 12%. Colonization was associated with age less than 2 years (p <0.001) and day care attendance for more than 20 hr/wk (p = 0.00005). More than half of these strains (62%) were resistant to penicillin, 33% having intermediate resistance (minimal inhibitory concentration 0.06 to 1 microgram/ml) and 29%, high level resistance (minimal inhibitory concentration > or = 2.0 microgram/ml). Penicillin resistance was associated with penicillin prophylaxis (p <0.01). Many of these organisms were also resistant to other classes of antibiotics.
Conclusions:
Although penicillin prophylaxis and pneumococcal vaccine for patients with SCD have reduced overall nasopharyngeal colonization and disease caused by S. pneumoniae (p <0.001), a higher percentage of colonizing strains are now resistant both to penicillin and to other antimicrobial agents (p <0.01). Newer strategies for preventing disease and early management of suspected pneumococcal infection in these children must be developed.