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Carriage of penicillin-resistant pneumococci in Malawian children
A Yomo1, V R Subramanyam, R Fudzulani
1Department of Medical Microbiology, University of Liverpool, UK.
Insights
Pneumococcal carriage in Malawian children under 5 was 47.5%, highest in infants 3-12 months. Penicillin resistance was observed, but isolates remained sensitive to cefotaxime.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Streptococcus pneumoniae (pneumococcus) is a leading cause of childhood illness and death globally.
- Understanding pneumococcal carriage is crucial for developing effective prevention strategies, especially in resource-limited settings.
Purpose of the Study:
- To determine the prevalence of pneumococcal carriage in young children in Malawi.
- To identify risk factors associated with carriage.
- To assess the antimicrobial susceptibility of pneumococcal isolates.
Main Methods:
- Prospective study involving 200 Malawian children under 5 years of age.
- Collection of nasopharyngeal and throat swabs for pneumococcal detection.
- Antimicrobial susceptibility testing of isolated pneumococci.
Main Results:
- Overall pneumococcal carriage rate was 47.5%.
- Carriage was highest in children aged 3-12 months.
- Nasopharyngeal swabs were more effective than throat swabs for detection.
- Intermediate penicillin resistance was found in 22% of carrier isolates and clinical isolates.
- All isolates were sensitive to cefotaxime, but some showed increased cefuroxime MICs.
Conclusions:
- Pneumococcal carriage is common in young Malawian children, with infants being most affected.
- Nasopharyngeal swabbing is superior for detecting carriage.
- Emerging penicillin resistance warrants continued surveillance, though current resistance to third-generation cephalosporins is low.
Abstract:
In a prospective study of pneumococcal carriage in 200 Malawian children under 5 years of age, 47.5% were carriers. The carriage rate was highest in those aged 3-12 months and did not vary with family size, nor was it higher in those who had recently been admitted to hospital. Nasopharyngeal swabs were significantly more efficient than throat swabs in detecting carriers (p < 0.001) but nasopharyngeal swabs alone would have missed seven (8%) carriers. Pneumococcal isolates from 22% of carriers and from eight cases of meningitis and one of empyema showed intermediate resistance to penicillin (MIC 0.1-1.0 mg/l). All were sensitive to the 3rd-generation cephalosporin cefotaxime but one of the penicillin-resistant pneumococci and two of the clinical isolates had increased MICs of cefuroxime (0.5 mg/l).