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Kielbik K, Grywalska E, Glowniak A, Mielnik-Niedzielska G, Korona-Glowniak I. The Molecular Epidemiology of Pneumococcal Strains Isolated from the Nasopharynx of Preschool Children 3 Years after the Introduction of the PCV Vaccination Program in Poland. Int J Mol Sci 2023; 24:ijms24097883. [PMID: 37175589 PMCID: PMC10178342 DOI: 10.3390/ijms24097883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/19/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
The genetic mechanisms of resistance, clonal composition, and the occurrence of pili were analyzed in 39 pneumococcal strains isolated from healthy children in the southeastern region of Poland. Strains with resistance to combinations of erythromycin, clindamycin, and tetracycline were found in clonal groups (CGs) related to Tennessee 23F-4 and Taiwan 19F-14 clones. Capsular switching possibly occurred in the Spain 9V-3 clone and its variants to serotypes 35B and 6A, as well as DLVs of Tennessee 23F-4 to serotype 23A. The double-locus variants of Colombia 23F-26 presented serotype 23B. The major transposons carrying the erythromycin and tetracycline resistance genes were Tn6002 (66.6%), followed by Tn916 (22.2%) and Tn2009 (11.1%). The macrolide efflux genetic assembly (MEGA) element was found in 41.7% of all erythromycin-resistant isolates. The majority of the isolates carrying the PI-1 gene belonged to the CGs related to the Spain 9V-3 clone expressing serotypes 35B and 6A, and the presence of both PI-1 and PI-2 was identified in CG4 consisting of the isolates related to the Taiwan 19F-14 clone expressing serotypes 19F and 19A. Importantly, in the nearest future, the piliated strains of serogroups 23B, 23A, and 35B may be of concern, being a possible origin of the emerging clones of piliated non-vaccine pneumococcal serotypes in Poland. This study reveals that nasopharyngeal carriage in children is an important reservoir for the selection and spreading of new drug-resistant pneumococcal clones in the community after the elimination of vaccine serotypes.
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Affiliation(s)
- Karolina Kielbik
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Medical University of Lublin, 20-093 Lublin, Poland
| | - Ewelina Grywalska
- Department of Clinical Immunology, Faculty of Medicine, Medical University of Lublin, 20-093 Lublin, Poland
| | - Andrzej Glowniak
- Department of Cardiology, Medical University of Lublin, 20-093 Lublin, Poland
| | - Grażyna Mielnik-Niedzielska
- Department of Pediatric Otolaryngology, Phoniatrics and Audiology, Medical University of Lublin, 20-093 Lublin, Poland
| | - Izabela Korona-Glowniak
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Medical University of Lublin, 20-093 Lublin, Poland
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Kielbik K, Pietras A, Jablonska J, Bakiera A, Borek A, Niedzielska G, Grzegorczyk M, Grywalska E, Korona-Glowniak I. Impact of Pneumococcal Vaccination on Nasopharyngeal Carriage of Streptococcus pneumoniae and Microbiota Profiles in Preschool Children in South East Poland. Vaccines (Basel) 2022; 10:vaccines10050791. [PMID: 35632547 PMCID: PMC9143411 DOI: 10.3390/vaccines10050791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 11/16/2022] Open
Abstract
In 2017, Poland introduced the 10-valent pneumococcal conjugate vaccine (PCV) into its national immunization schedule. This prospective study was conducted between March and June 2020 to determine the impact of vaccination on prevalence of the nasopharyngeal carriage of S. pneumoniae in 176 healthy children and to determine how conjugate vaccines indirectly affect colonization of nasopharyngeal microbiota. Pneumococcal isolates were analyzed by serotyping and antimicrobial resistance tests. Nasopharyngeal microbiota were detected and identified using the culture method and real-time PCR amplification primers and hydrolysis-probe detection with the 16S rRNA gene as the target. In the vaccinated group of children, colonization was in 24.2% of children, compared to 21.4% in the unvaccinated group. Serotypes 23A and 23B constituted 41.5% of the isolates. Serotypes belonging to PCV10 and PCV13 constituted 4.9% and 17.1% of the isolates, respectively. S. pneumoniae isolates were resistant to penicillin (34.1%), erythromycin (31.7%), and co-trimoxazole (26.8%). Microbial DNA qPCR array correlated to increased amounts of Streptococcus mitis and S. sanguinis in vaccinated children, with reduced amounts of C. pseudodiphtericum, S. aureus, and M. catarrhalis. Introduction of PCV for routine infant immunization was associated with significant reductions in nasopharyngeal carriage of PCV serotypes and resistant strains amongst vaccine serotypes, yet carriage of non-PCV serotypes increased modestly, particularly serotype 23B.
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Affiliation(s)
- Karolina Kielbik
- Department of Pharmaceutical Microbiology, Medical University of Lublin, 20-093 Lublin, Poland; (A.B.); (A.B.)
- Correspondence: (K.K.); (I.K.-G.)
| | - Aleksandra Pietras
- Department of Pediatric Otolaryngology, Phoniatrics and Audiology, Medical University of Lublin, 20-093 Lublin, Poland; (A.P.); (J.J.); (G.N.)
| | - Joanna Jablonska
- Department of Pediatric Otolaryngology, Phoniatrics and Audiology, Medical University of Lublin, 20-093 Lublin, Poland; (A.P.); (J.J.); (G.N.)
| | - Adrian Bakiera
- Department of Pharmaceutical Microbiology, Medical University of Lublin, 20-093 Lublin, Poland; (A.B.); (A.B.)
| | - Anna Borek
- Department of Pharmaceutical Microbiology, Medical University of Lublin, 20-093 Lublin, Poland; (A.B.); (A.B.)
| | - Grazyna Niedzielska
- Department of Pediatric Otolaryngology, Phoniatrics and Audiology, Medical University of Lublin, 20-093 Lublin, Poland; (A.P.); (J.J.); (G.N.)
| | - Michal Grzegorczyk
- Department of Rehabilitation and Physiotherapy, Medical University of Lublin, 20-081 Lublin, Poland;
| | - Ewelina Grywalska
- Department of Experimental Immunology, Medical University of Lublin, 20-093 Lublin, Poland;
| | - Izabela Korona-Glowniak
- Department of Pharmaceutical Microbiology, Medical University of Lublin, 20-093 Lublin, Poland; (A.B.); (A.B.)
- Correspondence: (K.K.); (I.K.-G.)
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Miellet WR, van Veldhuizen J, Litt D, Mariman R, Wijmenga-Monsuur AJ, Badoux P, Nieuwenhuijsen T, Thombre R, Mayet S, Eletu S, Sheppard C, van Houten MA, Rots NY, Miller E, Fry NK, Sanders EAM, Trzciński K. It Takes Two to Tango: Combining Conventional Culture With Molecular Diagnostics Enhances Accuracy of Streptococcus pneumoniae Detection and Pneumococcal Serogroup/Serotype Determination in Carriage. Front Microbiol 2022; 13:859736. [PMID: 35509314 PMCID: PMC9060910 DOI: 10.3389/fmicb.2022.859736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background The specificity of molecular methods for the detection of Streptococcus pneumoniae carriage is under debate. We propose a procedure for carriage surveillance and vaccine impact studies that increases the accuracy of molecular detection of live pneumococci in polymicrobial respiratory samples. Methods Culture and qPCR methods were applied to detect pneumococcus and pneumococcal serotypes in 1,549 nasopharyngeal samples collected in the Netherlands (n = 972) and England (n = 577) from 946 toddlers and 603 adults, and in paired oropharyngeal samples collected exclusively from 319 Dutch adults. Samples with no live pneumococci isolated at primary diagnostic culture yet generating signal specific for pneumococcus in qPCRs were re-examined with a second, qPCR-guided culture. Optimal Cq cut-offs for positivity in qPCRs were determined via receiver operating characteristic (ROC) curve analysis using isolation of live pneumococci from the primary and qPCR-guided cultures as reference. Results Detection of pneumococcus and pneumococcal serotypes with qPCRs in cultured (culture-enriched) nasopharyngeal samples exhibited near-perfect agreement with conventional culture (Cohen’s kappa: 0.95). Molecular methods displayed increased sensitivity of detection for multiple serotype carriage, and implementation of qPCR-guided culturing significantly increased the proportion of nasopharyngeal and oropharyngeal samples from which live pneumococcus was recovered (p < 0.0001). For paired nasopharyngeal and oropharyngeal samples from adults none of the methods applied to a single sample type exhibited good agreement with results for primary and qPCR-guided nasopharyngeal and oropharyngeal cultures combined (Cohens kappa; 0.13–0.55). However, molecular detection of pneumococcus displayed increased sensitivity with culture-enriched oropharyngeal samples when compared with either nasopharyngeal or oropharyngeal primary cultures (p < 0.05). Conclusion The accuracy of pneumococcal carriage surveillance can be greatly improved by complementing conventional culture with qPCR and vice versa, by using results of conventional and qPCR-guided cultures to interpret qPCR data. The specificity of molecular methods for the detection of live pneumococci can be enhanced by incorporating statistical procedures based on ROC curve analysis. The procedure we propose for future carriage surveillance and vaccine impact studies improves detection of pneumococcal carriage in adults in particular and enhances the specificity of serotype carriage detection.
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Affiliation(s)
- Willem R Miellet
- Department of Pediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht (UMCU), Utrecht, Netherlands.,Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Janieke van Veldhuizen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - David Litt
- Respiratory and Vaccine Preventable Bacterial Reference Unit (RVPBRU), Public Health England - National Infection Service, London, United Kingdom
| | - Rob Mariman
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Alienke J Wijmenga-Monsuur
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Paul Badoux
- Regional Laboratory of Public Health (Streeklab) Haarlem, Haarlem, Netherlands
| | - Tessa Nieuwenhuijsen
- Department of Pediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht (UMCU), Utrecht, Netherlands
| | - Rebecca Thombre
- Respiratory and Vaccine Preventable Bacterial Reference Unit (RVPBRU), Public Health England - National Infection Service, London, United Kingdom
| | - Sanaa Mayet
- Respiratory and Vaccine Preventable Bacterial Reference Unit (RVPBRU), Public Health England - National Infection Service, London, United Kingdom
| | - Seyi Eletu
- Respiratory and Vaccine Preventable Bacterial Reference Unit (RVPBRU), Public Health England - National Infection Service, London, United Kingdom
| | - Carmen Sheppard
- Respiratory and Vaccine Preventable Bacterial Reference Unit (RVPBRU), Public Health England - National Infection Service, London, United Kingdom
| | | | - Nynke Y Rots
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Elizabeth Miller
- Immunisation and Countermeasures Division, Public Health England (PHE) - National Infection Service, London, United Kingdom
| | - Norman K Fry
- Respiratory and Vaccine Preventable Bacterial Reference Unit (RVPBRU), Public Health England - National Infection Service, London, United Kingdom.,Immunisation and Countermeasures Division, Public Health England (PHE) - National Infection Service, London, United Kingdom
| | - Elisabeth A M Sanders
- Department of Pediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht (UMCU), Utrecht, Netherlands.,Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Krzysztof Trzciński
- Department of Pediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht (UMCU), Utrecht, Netherlands
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Pneumococcal carriage in unvaccinated children at the time of vaccine implementation into the national immunization program in Poland. Sci Rep 2022; 12:5858. [PMID: 35393439 PMCID: PMC8991213 DOI: 10.1038/s41598-022-09488-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 03/14/2022] [Indexed: 11/08/2022] Open
Abstract
We investigated pneumococcal carriage among unvaccinated children under five years of age at a time when the conjugate polysaccharide vaccine (PCV) was introduced in Poland into the national immunization program (NIP). Paired nasopharyngeal swab (NPS) and saliva samples collected between 2016 and 2020 from n = 394 children were tested with conventional culture and using qPCR. The carriage rate detected by culture was 25.4% (97 of 394), by qPCR 39.1% (155 of 394), and 40.1% (158 of 394) overall. The risk of carriage was significantly elevated among day care center attendees, and during autumn/winter months. Among isolates cultured, the most common serotypes were: 23A, 6B, 15BC, 10A, 11A. The coverage of PCV10 and PCV13 was 23.2% (23 of 99) and 26.3% (26 of 99), respectively. Application of qPCR lead to detection of 168 serotype carriage events, with serogroups 15, 6, 9 and serotype 23A most commonly detected. Although the highest number of carriers was identified by testing NPS with qPCR, saliva significantly contributed to the overall number of detected carriers. Co-carriage of multiple serotypes was detected in 25.3% (40 of 158) of carriers. The results of this study represent a baseline for the future surveillance of effects of pneumococcal vaccines in NIP in Poland.
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Day care attendance during the first 12 months of life and occurrence of infectious morbidities and symptoms. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2018.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Oliveira PDD, Bertoldi AD, Silva BGCD, Rodrigues Domingues M, Neumann NA, Silveira MFD. Day care attendance during the first 12 months of life and occurrence of infectious morbidities and symptoms. J Pediatr (Rio J) 2019; 95:657-666. [PMID: 31679611 DOI: 10.1016/j.jped.2018.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 05/17/2018] [Accepted: 05/25/2018] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE To investigate the occurrence of infectious morbidities according to day care attendance during the first year of life. METHODS This was a cross-sectional analysis of data from the 12-month follow-up of a medium-sized city birth cohort from children born in 2015, in the Southern Brazil. Main exposure variables were day care attendance from 0 to 11 months of age, type of day care center (public or private), and age at entering day care. Health outcomes were classified as follows: "non-specific respiratory symptoms," "upper respiratory tract infection," "lower respiratory tract infection," "flu/cold," "diarrhea," or "no health problem," considering the two weeks prior to the interview administered at 12 months of life. Associations were assessed using Poisson regression adjusted by demographic, behavioral, and socioeconomic variables. RESULTS The sample included 4018 children. Day care attendance was associated with all classifications of health outcomes mentioned above, except for flu/cold. These were stronger among children who entered day care at an age closer to the outcome time-point. An example are the results for lower respiratory tract infection and diarrhea, with adjusted prevalence ratios of 2.79 (95% CI: 1.67-4.64) and 2.04 (95% CI: 1.48-2.82), respectively, for those who entered day care after 8 months of age when compared with those who never attended day care. CONCLUSIONS The present study consistently demonstrated the association between day care attendance and higher occurrence of infectious morbidities and symptoms at 12 months of life. Hence, measures to prevent infectious diseases should give special attention to children attending day care centers.
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Affiliation(s)
- Paula Duarte de Oliveira
- Universidade Federal de Pelotas, Programa de Pós-graduação em Epidemiologia, Pelotas, RS, Brazil.
| | - Andréa Dâmaso Bertoldi
- Universidade Federal de Pelotas, Programa de Pós-graduação em Epidemiologia, Pelotas, RS, Brazil
| | | | - Marlos Rodrigues Domingues
- Universidade Federal de Pelotas, Programa de Pós-graduação em Epidemiologia, Pelotas, RS, Brazil; Universidade Federal de Pelotas, Programa de Pós-graduação em Educação Física, Pelotas, RS, Brazil
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Popovic S, Hadnadjev M, Gajic I, Mijac V, Kekic D, Smitran A, Ranin L, Opavski N. Characterization of macrolide-resistant non-invasive pneumococci in the pre-vaccine era in Serbia. Acta Microbiol Immunol Hung 2018; 65:477-488. [PMID: 30010393 DOI: 10.1556/030.65.2018.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Numerous reports have confirmed that increased macrolide use in the treatment of respiratory tract infection has contributed to the emergence of antibiotic resistance worldwide. Studies have also shown that pneumococcal vaccine can reduce pneumococcal resistance. The aim of this study was to determine the prevalence of co-resistance to penicillin and other antibiotics in macrolide-resistant (MR) non-invasive pneumococcal isolates and to evaluate serotype distribution in resistant strains in the pre-vaccine era in Serbia. About 80% of MR isolates expressed the MLS phenotype with very high resistance to both erythromycin and clindamycin. A total of 132 (84.1%) MR isolates were multiresistant, i.e., they were resistant to erythromycin, penicillin, tetracycline, and trimethoprim-sulfamethoxazole. Among 157 MR pneumococci, 11 different serotypes were found. Four serotypes, 19F, 14, 6B, and 23F, accounted for 77.7% of all MR pneumococcal isolates. Among isolates with the cMLS phenotype, serotypes 19F and 14 were predominant, whereas serotype 6A was the most common among those with the M phenotype, followed by 14. In conclusion, co-resistance to macrolides and penicillin in our non-invasive pneumococcal isolates is high. The majority of tested strains (∼80%) belonged to the four serotypes (19F, 14, 6B, and 23F) that are included in all conjugate vaccine formulations.
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Affiliation(s)
- Suncica Popovic
- 1 Institute of Microbiology and Immunology, Medical Faculty University of Belgrade, Belgrade, Republic of Serbia
| | - Mirjana Hadnadjev
- 2 Department of Microbiology, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Republic of Serbia
| | - Ina Gajic
- 1 Institute of Microbiology and Immunology, Medical Faculty University of Belgrade, Belgrade, Republic of Serbia
| | - Vera Mijac
- 1 Institute of Microbiology and Immunology, Medical Faculty University of Belgrade, Belgrade, Republic of Serbia
| | - Dusan Kekic
- 1 Institute of Microbiology and Immunology, Medical Faculty University of Belgrade, Belgrade, Republic of Serbia
| | - Aleksandra Smitran
- 3 Faculty of Medicine, Department of Microbiology, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Lazar Ranin
- 1 Institute of Microbiology and Immunology, Medical Faculty University of Belgrade, Belgrade, Republic of Serbia
| | - Natasa Opavski
- 1 Institute of Microbiology and Immunology, Medical Faculty University of Belgrade, Belgrade, Republic of Serbia
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Stacevičienė I, Petraitienė S, Vaičiūnienė D, Alasevičius T, Kirslienė J, Usonis V. Antibiotic resistance of Streptococcus pneumoniae, isolated from nasopharynx of preschool children with acute respiratory tract infection in Lithuania. BMC Infect Dis 2016; 16:216. [PMID: 27206423 PMCID: PMC4875676 DOI: 10.1186/s12879-016-1544-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 05/06/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increasing pneumococcal resistance to commonly used antibiotics and multidrug resistance is a serious public health concern. Data on distribution of resistant Streptococcus pneumoniae (SPn) strains among children in Lithuania are limited. We evaluated the circulation of SPn serotypes and antimicrobial susceptibility among preschool children in Lithuania before the introduction of universal infant pneumococcal vaccination. METHODS A prospective study was carried out from February 2012 to March 2013 in five cities of Lithuania. A total of 900 children under six years of age who presented to primary care centre or a hospital emergency department with acute respiratory tract infection were enrolled in the study. Nasopharyngeal swabs were obtained and cultured for SPn. Positive samples (n = 367) were serotyped and tested for antimicrobial susceptibility. Associations of pneumococcal non-susceptibility with study site, season, age, sex, attendance of day care centre and treatment with antimicrobials (between one and six months prior the study) were evaluated. RESULTS About a half (56.7 %) of SPn strains were susceptible to all the antibiotics tested. Pneumococcal non-susceptibility to penicillin, erythromycin, clindamycin and trimethoprim-sulphamethoxazole was 15.8, 21.3, 16.9 and 27.3 %, respectively. None of the tested isolates was resistant to norfloxacin or vancomycin. We found a geographical variation of pneumococcal resistance within the cities of the country. Age, sex, the attendance of day care centre and treatment with antimicrobials prior the study was not significantly associated with a carriage of non-susceptible SPn strains. Among non-susceptible SPn serotypes 67.9 %-82.4 % were present in currently available pneumococcal conjugate vaccines. CONCLUSIONS The rates of nasopharyngeal SPn susceptibility to penicillin and macrolides are still high among preschool children in Lithuania, however they are lower compared with previous studies. A strict policy with respect to antibiotic prescription together with widespread use of vaccination could potentially reduce the carriage rate of antibiotic-resistant pneumococci in our country.
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Affiliation(s)
- Indrė Stacevičienė
- Clinic of Children's Diseases, Faculty of Medicine, Vilnius University, Santariskiu Str. 4, Vilnius, Lithuania.,Children's Hospital, Affiliate of Vilnius University Hospital Santariskiu Klinikos, Santariskiu Str. 7, Vilnius, Lithuania
| | - Sigita Petraitienė
- Clinic of Children's Diseases, Faculty of Medicine, Vilnius University, Santariskiu Str. 4, Vilnius, Lithuania.,Children's Hospital, Affiliate of Vilnius University Hospital Santariskiu Klinikos, Santariskiu Str. 7, Vilnius, Lithuania
| | - Daiva Vaičiūnienė
- Clinic of Children's Diseases, Faculty of Medicine, Vilnius University, Santariskiu Str. 4, Vilnius, Lithuania.,Children's Hospital, Affiliate of Vilnius University Hospital Santariskiu Klinikos, Santariskiu Str. 7, Vilnius, Lithuania
| | - Tomas Alasevičius
- Clinic of Children's Diseases, Faculty of Medicine, Vilnius University, Santariskiu Str. 4, Vilnius, Lithuania.,Children's Hospital, Affiliate of Vilnius University Hospital Santariskiu Klinikos, Santariskiu Str. 7, Vilnius, Lithuania
| | - Jūratė Kirslienė
- Children's Hospital, Affiliate of Vilnius University Hospital Santariskiu Klinikos, Santariskiu Str. 7, Vilnius, Lithuania
| | - Vytautas Usonis
- Clinic of Children's Diseases, Faculty of Medicine, Vilnius University, Santariskiu Str. 4, Vilnius, Lithuania. .,Children's Hospital, Affiliate of Vilnius University Hospital Santariskiu Klinikos, Santariskiu Str. 7, Vilnius, Lithuania.
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Farida H, Severin JA, Gasem MH, Keuter M, Wahyono H, van den Broek P, Hermans PWM, Verbrugh HA. Nasopharyngeal carriage of Streptococcus pneumonia in pneumonia-prone age groups in Semarang, Java Island, Indonesia. PLoS One 2014; 9:e87431. [PMID: 24498104 PMCID: PMC3909120 DOI: 10.1371/journal.pone.0087431] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 12/24/2013] [Indexed: 12/17/2022] Open
Abstract
Introduction Streptococcus pneumoniae is a worldwide occurring pathogen Nasopharyngeal carriage of Streptococcus pneumoniae precedes pneumonia and other pneumococcal diseases in the community. Little is known about S. pneumoniae carriage in Indonesia, complicating strategies to control pneumococcal diseases. We investigated nasopharyngeal carriage of S. pneumoniae in Semarang, Indonesia. Methods A population-based survey was performed in Semarang, Indonesia. Nasopharyngeal swabs and questionnaires were taken from 496 healthy young (6–60 month-old) children and 45–70 year-old adults. Results Forty-three percent of children aged 6–60 months and 11% of adults aged 45–75 years carried S. pneumoniae. Determinants of carriage were being a child (OR 7.7; 95% CI = 4.5–13.0), passive smoking (OR 2.1; 95% CI = 1.3–3.4), and contact with toddler(s) at home (OR 3.0; 95% CI = 1.9–4.7). The most frequent serotypes found were 6A/B and 15B/C. The current commercially available vaccines cover <50% serotypes found in children. Twenty-four percent of S. pneumoniae strains were penicillin non-susceptible, and 45% were resistant to cotrimoxazol. Conclusions The limited coverage of commercially available vaccines against the serotypes found in this population, and the high proportion of non-susceptibility to penicillin and cotrimoxazol suggest the need for region-specific information and strategies to control S. pneumoniae.
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Affiliation(s)
- Helmia Farida
- Department of Microbiology, Faculty of Medicine Diponegoro University - Dr. Kariadi Hospital, Semarang, Indonesia
- * E-mail:
| | - Juliëtte A. Severin
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - M. Hussein Gasem
- Department of Internal Medicine, Dr. Kariadi Hospital - Faculty of Medicine Diponegoro University, Semarang, Indonesia
| | - Monique Keuter
- Department of General Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Hendro Wahyono
- Department of Microbiology, Faculty of Medicine Diponegoro University - Dr. Kariadi Hospital, Semarang, Indonesia
| | - Peterhans van den Broek
- Department of Infectious Diseases, Leiden University Medical Centre, Leiden, the Netherlands
| | - Peter W. M. Hermans
- Nijmegen Institute for Infection, Inflammation, and Immunity (N4i), Nijmegen, the Netherlands
- Laboratory of Paediatric Infectious Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
- Crucell - Johnson and Johnson, Leiden, the Netherlands
| | - Henri A. Verbrugh
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, the Netherlands
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Niedzielski A, Korona-Glowniak I, Malm A. High prevalence of Streptococcus pneumoniae in adenoids and nasopharynx in preschool children with recurrent upper respiratory tract infections in Poland--distribution of serotypes and drug resistance patterns. Med Sci Monit 2013; 19:54-60. [PMID: 23328644 PMCID: PMC3628867 DOI: 10.12659/msm.883742] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Streptococcus pneumoniae is one of the major bacterial pathogens colonizing nasopharynx, and often causes upper respiratory tract infections in children. We investigated the prevalence of S. pneumoniae in nasopharynx and adenoid core in 57 children aged 2-5 years who underwent adenoidectomy for recurrent pharyngotonsillitis, and we determined serotypes and antibiotic resistance patterns of the isolated pneumococci. MATERIAL/METHODS The nasopharyngeal specimens obtained before adenoidectomy and the adenoids after the surgery were cultured for pneumococci. All isolates were serotyped by means of Quellung reaction. Susceptibility to antibiotics was determined according to EUCAST recommendations. RESULTS S. pneumoniae colonization was observed in 40 (70.2%) children. From 29 (50.9%) children S. pneumoniae was isolated both from nasopharynx and adenoid core; 2 or 3 different isolates were identified in 8 (14.0%) children. In 8 (14.0%) children pneumococci were obtained from adenoid core only and in 3 (5.3%) children from nasopharynx only. Among the isolates, 35.3% were susceptible to all tested antimicrobials and 45.1% had decreased susceptibility to penicillin. Multidrug resistance was present in 52.9% of the isolates. The most frequent was serotype 19F (25.5%). The prevalence of serotypes included in pneumococcal conjugate vaccines PCV10 and PCV13 was 51.0% and 62.7%, respectively. CONCLUSIONS The adenoids, like the nasopharynx, can be regarded as a reservoir of pneumococci, including multidrug resistant strains, especially in children with indication for adenoidectomy due to recurrent respiratory tract infections refractory to antibiotic therapy. Good vaccine coverage among the isolated pneumococci confirmed the validity of the routine immunization by PCVs in young children.
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Affiliation(s)
- Artur Niedzielski
- Department of Pediatric Otolaryngology, Phoniatrics and Audiology, Medical University of Lublin, Lublin, Poland
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