Related Experiment Videos
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.
Insights
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.
Objective:
The goals of this prospective study were to define the Streptococcus pneumoniae colonization rate in children with sickle cell disease (SCD) at the Children's Hospital of Philadelphia and to determine the serotype and antibiotic susceptibility of all isolates.
Methods:
Children with SCD followed at the hospital were sampled for colonization with S. pneumoniae by means of a throat or nasopharyngeal swab on one or two occasions. Patient information was obtained when the specimen was collected. Specimens were isolated on gentamicin-blood agar plates and modified Avery broth. Antibiotic susceptibility was determined by a commercially available test (E-test). Isolates were serotyped with the use of type-specific antisera. The relationship between the data noted above and certain clinical parameters was examined.
Results:
A total of 490 specimens were obtained from 278 patients. Twenty-eight patients had a culture positive for S. pneumoniae, resulting in an overall colonization rate of 10%. Thirty-three percent (11/33) of all isolates were resistant to penicillin-seven intermediately resistant and four highly resistant. Twelve percent of isolates were also resistant to cefotaxime. Eight different serotypes were identified; all but one are included in the current 23-valent pneumococcal vaccine. Penicillin prophylaxis did not increase the rate of colonization with resistant strains of pneumococcus.
Conclusion:
Our results do not support a change in the current use of penicillin prophylaxis nor in the acute management of the febrile child with SCD.