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. 1997;75(5):453–462.

Nasopharyngeal carriage of community-acquired, antibiotic-resistant Streptococcus pneumoniae in a Zambian paediatric population.

A Woolfson 1, R Huebner 1, A Wasas 1, S Chola 1, P Godfrey-Faussett 1, K Klugman 1
PMCID: PMC2487017  PMID: 9447779

Abstract

The emergence of antibiotic-resistant Streptococcus pneumoniae is an international health problem. Apart from South Africa few data on pneumococcal resistance are available for sub-Saharan Africa. This study examines the nasopharyngeal carriage and prevalence of antibiotic resistance in pneumococci isolated from 260 Zambian children aged < 6 years. Pneumococci were isolated from 71.9% of the children; the odds of carrying organisms were twice as high among children < 2 years of age compared with older children. Antibacterial resistance was found in 34.1% of the isolates; resistance to tetracycline, penicillin, sulfamethoxazole + trimethoprim, and chloramphenicol occurred in 23.0%, 14.3%, 12.7%, and 3.9% of the isolates, respectively. Only 4% of the isolates were resistant to three drugs. High-level resistance was found in all isolates resistant to tetracycline; but only intermediate level penicillin resistance was found. A total of 11.1% of the isolates demonstrated intermediate resistance to sulfamethoxazole + trimethoprim. Children aged < 6 months were less likely to carry antibiotic-resistant organisms. Antibiotic resistance in S. pneumoniae appears to be an emerging public health problem in Zambia, and the national policy for the empirical treatment of pneumococcal meningitis and acute respiratory tract infections may need to be re-evaluated. The establishment of ongoing surveillance to monitor trends in pneumococcal resistance should be considered.

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Selected References

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  1. Catalano M., Almiron M. A., Romeo A. M., Caruso E., Murtagh P., Harisiadi J. Comparison between parental report and results of microbiologic agar assay for presence of antibiotic in urine of Argentinian children with acute lower respiratory tract infection. Rev Infect Dis. 1990 Nov-Dec;12 (Suppl 8):S998–1000. doi: 10.1093/clinids/12.supplement_8.s998. [DOI] [PubMed] [Google Scholar]
  2. Douglas R. M., Paton J. C., Duncan S. J., Hansman D. J. Antibody response to pneumococcal vaccination in children younger than five years of age. J Infect Dis. 1983 Jul;148(1):131–137. doi: 10.1093/infdis/148.1.131. [DOI] [PubMed] [Google Scholar]
  3. Frederiksen B., Henrichsen J. Throat carriage of Streptococcus pneumoniae and Streptococcus pyogenes among infants and children in Zambia. J Trop Pediatr. 1988 Jun;34(3):114–117. doi: 10.1093/tropej/34.3.114. [DOI] [PubMed] [Google Scholar]
  4. Friedland I. R., Klugman K. P. Antibiotic-resistant pneumococcal disease in South African children. Am J Dis Child. 1992 Aug;146(8):920–923. doi: 10.1001/archpedi.1992.02160200042023. [DOI] [PubMed] [Google Scholar]
  5. Garenne M., Ronsmans C., Campbell H. The magnitude of mortality from acute respiratory infections in children under 5 years in developing countries. World Health Stat Q. 1992;45(2-3):180–191. [PubMed] [Google Scholar]
  6. Gray B. M., Converse G. M., 3rd, Dillon H. C., Jr Epidemiologic studies of Streptococcus pneumoniae in infants: acquisition, carriage, and infection during the first 24 months of life. J Infect Dis. 1980 Dec;142(6):923–933. doi: 10.1093/infdis/142.6.923. [DOI] [PubMed] [Google Scholar]
  7. Hansman D. Chloramphenicol-resistant pneumococci in West Africa. Lancet. 1978 May 20;1(8073):1102–1103. doi: 10.1016/s0140-6736(78)90950-9. [DOI] [PubMed] [Google Scholar]
  8. Jackson M. A., Shelton S., Nelson J. D., McCracken G. H., Jr Relatively penicillin-resistant pneumococcal infections in pediatric patients. Pediatr Infect Dis. 1984 Mar-Apr;3(2):129–132. doi: 10.1097/00006454-198403000-00010. [DOI] [PubMed] [Google Scholar]
  9. Klugman K. P., Koornhof H. J., Kuhnle V. Clinical and nasopharyngeal isolates of unusual multiply resistant pneumococci. Am J Dis Child. 1986 Nov;140(11):1186–1190. doi: 10.1001/archpedi.1986.02140250112045. [DOI] [PubMed] [Google Scholar]
  10. Koornhof H. J., Wasas A., Klugman K. Antimicrobial resistance in Streptococcus pneumoniae: a South African perspective. Clin Infect Dis. 1992 Jul;15(1):84–94. doi: 10.1093/clinids/15.1.84. [DOI] [PubMed] [Google Scholar]
  11. Mastro T. D., Nomani N. K., Ishaq Z., Ghafoor A., Shaukat N. F., Esko E., Leinonen M., Henrichsen J., Breiman R. F., Schwartz B. Use of nasopharyngeal isolates of Streptococcus pneumoniae and Haemophilus influenzae from children in Pakistan for surveillance for antimicrobial resistance. Pediatr Infect Dis J. 1993 Oct;12(10):824–830. doi: 10.1097/00006454-199310000-00006. [DOI] [PubMed] [Google Scholar]
  12. Mufson M. A., Kruss D. M., Wasil R. E., Metzger W. I. Capsular types and outcome of bacteremic pneumococcal disease in the antibiotic era. Arch Intern Med. 1974 Sep;134(3):505–510. [PubMed] [Google Scholar]
  13. Murray B. E. Can antibiotic resistance be controlled? N Engl J Med. 1994 Apr 28;330(17):1229–1230. doi: 10.1056/NEJM199404283301710. [DOI] [PubMed] [Google Scholar]
  14. Neu H. C. The crisis in antibiotic resistance. Science. 1992 Aug 21;257(5073):1064–1073. doi: 10.1126/science.257.5073.1064. [DOI] [PubMed] [Google Scholar]
  15. Percival A. Increased incidence of tetracycline-resistant pneumococci in Liverpool in 1968. Lancet. 1969 May 17;1(7603):998–1000. doi: 10.1016/s0140-6736(69)91799-1. [DOI] [PubMed] [Google Scholar]
  16. Siber G. R. Pneumococcal disease: prospects for a new generation of vaccines. Science. 1994 Sep 2;265(5177):1385–1387. doi: 10.1126/science.8073278. [DOI] [PubMed] [Google Scholar]

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