Antibiotic resistance of Streptococcus pneumoniae, isolated from nasopharynx of preschool children with acute respiratory tract infection in Lithuania.

Indrė Stacevičienė,Vytautas Usonis,Daiva Vaičiūnienė,Jūratė Kirslienė,Tomas Alasevičius,Sigita Petraitienė

doi:10.1186/s12879-016-1544-9

Indrė Stacevičienė, Vytautas Usonis + Show 4 more

Open Access

https://doi.org/10.1186/s12879-016-1544-9

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Abstract

BackgroundIncreasing 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.MethodsA 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.ResultsAbout 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.ConclusionsThe 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.

Highlights

Increasing pneumococcal resistance to commonly used antibiotics and multidrug resistance is a serious public health concern
The data collected from the 900 study participants during the one-year study period were analysed: 636 patients at the primary care centres (PCC) and 264 at the hospital emergency department (ED)
About a half (56.7 %, n = 208) of Streptococcus pneumoniae (SPn) strains were susceptible to all the antibiotics tested and 76 % (n = 279) were susceptible to penicillin and macrolides

Summary

Introduction

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. Despite the effectiveness of PCV vaccination in different countries, WHO reports that pneumococcal related deaths among children under five years of age remains high [4]. Increasing pneumococcal resistance to commonly used antibiotics such as macrolides or cephalosporins and multidrug resistance is another serious public health concern [5]. Antibiotic susceptibility of SPn has a large variation among European countries. Due to geographical diversity of the resistance of SPn strains dependent on the local antimicrobial policy, epidemiological studies in each geographical region are needed [10]

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