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Pneumococcal colonization in children with sickle cell disease [see comment]
C F Norris1, S R Mahannah, K Smith-Whitley
1Division of Hematology, Children's Hospital of Philadelphia, Pennsylvania 19104, USA.
The Journal of Pediatrics
|December 1, 1996
Summary
In children with sickle cell disease (SCD), Streptococcus pneumoniae colonization occurred in 10% of cases. Penicillin prophylaxis did not increase colonization with resistant pneumococcal strains, supporting current treatment guidelines.
Area of Science:
- Pediatrics
- Infectious Diseases
- Hematology
Background:
- Sickle cell disease (SCD) increases susceptibility to infections, particularly from encapsulated bacteria like Streptococcus pneumoniae.
- Pneumococcal colonization is a precursor to invasive pneumococcal disease.
Purpose of the Study:
- To determine the colonization rate of Streptococcus pneumoniae in children with SCD.
- To identify the serotypes and antibiotic susceptibility of pneumococcal isolates in this population.
- To assess the impact of penicillin prophylaxis on colonization with resistant strains.
Main Methods:
- Prospective study involving throat or nasopharyngeal swabs from children with SCD.
- Bacterial isolation, antibiotic susceptibility testing (E-test), and serotyping of Streptococcus pneumoniae.
- Analysis of clinical parameters in relation to colonization data.
Main Results:
- Overall colonization rate of 10% (28/278 patients).
- 33% of isolates showed penicillin resistance; 12% were cefotaxime resistant.
- Eight serotypes identified, with most covered by the 23-valent pneumococcal vaccine.
- Penicillin prophylaxis did not correlate with increased colonization by resistant strains.
Conclusions:
- The findings do not necessitate changes to current penicillin prophylaxis protocols for children with SCD.
- Current acute management strategies for febrile children with SCD remain supported by these results.