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Antibiotic-resistant pneumococci in pediatric disease
1Department of Medical Microbiology, University of the Witwatersrand Medical School, South African Institute for Medical Research, Johannesburg, South Africa.
Insights
Surveillance of pneumococcal resistance in nasal swabs predicts systemic resistance. Conjugate vaccines may reduce resistant strains, but testing for cephalosporin resistance is crucial for meningitis treatment.
Area of Science:
- Microbiology
- Infectious Diseases
- Vaccinology
Background:
- Pneumococcal resistance surveillance in nasopharyngeal isolates predicts systemic resistance.
- Increasing resistance shifts serotype distribution towards vaccine-included types.
- Pneumococcal conjugate vaccines may reduce carriage and prevalence of resistant strains.
Purpose of the Study:
- To assess the utility of nasopharyngeal isolate surveillance for pneumococcal resistance.
- To evaluate the impact of conjugate vaccines on resistant strain prevalence.
- To highlight the importance of resistance testing for meningitis and other infections.
Main Methods:
- Surveillance of pneumococcal resistance in nasopharyngeal isolates.
- Analysis of serotype distribution shifts in invasive pneumococcal disease.
- Evaluation of treatment efficacy for various infections caused by Streptococcus pneumoniae.
Main Results:
- Nasopharyngeal resistance surveillance is a practical predictor of systemic resistance.
- Conjugate vaccines may decrease the prevalence of resistant pneumococcal strains.
- Penicillin or ampicillin are inappropriate for penicillin-resistant Streptococcus pneumoniae (PRP) meningitis; cephalosporins may fail.
- Testing CSF isolates for both penicillin and cephalosporin resistance is vital.
Conclusions:
- Nasopharyngeal surveillance effectively monitors pneumococcal resistance trends.
- Conjugate vaccines show promise in controlling resistant strains.
- Comprehensive antibiotic resistance testing is essential for effective treatment of serious pneumococcal infections like meningitis.
Abstract:
The surveillance of pneumococcal resistance in nasopharyngeal isolates is a practical way to determine the prevalence of resistant strains and is a reasonable predictor of resistance in systemic isolates. The increasing prevalence of resistance is shifting the distribution of invasive pneumococcal serotypes toward those included in conjugate vaccines. If these vaccines reduce carriage, they may eliminate or greatly reduce the prevalence of resistant strains. Meningitis is the most important infection caused by PRP for which penicillin or ampicillin therapy is inappropriate. Although the extended spectrum cephalosporins will be effective for most cases of PRP meningitis, it is clear that such therapy is not foolproof. It is important for the laboratory to test CSF isolates not only for penicillin resistance but also for resistance to the cephalosporins. beta-Lactam antibiotics can still be considered appropriate empiric therapy for otitis media, pneumonia, or sepsis. However, occasional treatment failures with these agents may necessitate use of alternative therapeutic strategies.