Abstract
BackgroundThe Taiwan19F-14 Streptococcus pneumoniae clone and its variants are being found with increasing frequency in the Asia-Pacific region. A 5-year old child with S. pneumoniae meningitis caused by a high-level penicillin resistant strain (MIC = 4 μg/ml) was admitted to a hospital in southern Taiwan. We carried out a study to determine the potential source of this strain.MethodsNasopharyngeal cultures were obtained from all children attending the same kindergarten as the index case. To determine their relatedness all isolates were compared by serotype, antimicrobial susceptibility profile and pulsed field gel electrophoresis (PFGE).ResultsA high proportion of the children including the index case (32/78, 41.0%) carried S. pneumoniae in their nasopharynx (NP). The most common serotype was 19F (13/32, 40.6%). The PFGE types of the 19F serotype isolates obtained from the patient's blood, CSF and NP were identical and were related to 11 other serotype 19F NP isolates including 10 that were indistinguishable from the Taiwan19F-14 clone. All 14 isolates had similar high-level penicillin and multi-drug resistance. The serotypes of the other 19 NP isolates included 6A (2), 6B (10), 23F (5), 9V (1) and 3 (1). The overall rate of penicillin resistance in these S. pneumoniae from these children was 87.5% (28/32), with an MIC50 of 2 and MIC90 of 4 ug/ml. In addition, multi-drug resistant-isolates (isolates resistant to 3 different classes of antimicrobials) accounted for 87.5% (28/32) of all isolates.ConclusionThe high carriage rate of high-level penicillin- and multi-drug- resistant S. pneumoniae in a kindergarten associated with a case of pneumococcal meningitis emphasizes the need for restraint in antibiotic use and consideration of childhood immunization with conjugate pneumococcal vaccine to prevent the further spread of resistant S. pneumoniae in Taiwan.
Highlights
The Taiwan19F-14 Streptococcus pneumoniae clone and its variants are being found with increasing frequency in the Asia-Pacific region
There has been an alarming increase in recent years in the prevalence of penicillin- resistant S. pneumoniae and pneumococcal meningitis caused by penicillin non-susceptible
Far pneumococcal meningitis caused by high-level penicillin resistant strains (MIC = 4 ug/ml) accounts for only a small portion of the cases reported from various countries around the world [1,2,3,4,5,6]
Summary
The Taiwan19F-14 Streptococcus pneumoniae clone and its variants are being found with increasing frequency in the Asia-Pacific region. A 5-year old child with S. pneumoniae meningitis caused by a high-level penicillin resistant strain (MIC = 4 μg/ml) was admitted to a hospital in southern Taiwan. Far pneumococcal meningitis caused by high-level penicillin resistant strains (MIC = 4 ug/ml) accounts for only a small portion of the cases reported from various countries around the world [1,2,3,4,5,6]. A case of pneumococcal meningitis caused by a high-level penicillin resistant S. pneumoniae 19F recently occurred in a 5year old boy in southern Taiwan. We decided to determine whether the source of his infection might be kindergarten children with whom he had close contact This was based on the knowledge that spread of multi-drug-resistant clones of S. pneumoniae occurs in the day-care center and kindergarten settings [710]. The most common clones include Spanish 23F, Taiwan 23F and 19F
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