High prevalence of antibiotic resistance in nasopharyngeal bacterial isolates from healthy children in rural Uganda: A cross-sectional study

Elizeus Rutebemberwa,Betty Mpeka,George Pariyo,Stefan Peterson,Edison Mworozi,Freddie Bwanga,Karin Källander

doi:10.3109/03009734.2015.1072606

Elizeus Rutebemberwa, Betty Mpeka + Show 5 more

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https://doi.org/10.3109/03009734.2015.1072606

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Abstract

Background: In Uganda, the main causes of death in children under 5 years of age are malaria and pneumonia—often due to delayed diagnosis and treatment. In preparation for a community case management intervention for pneumonia and malaria, the bacterial composition of the nasopharyngeal flora and its in vitro resistance were determined in children aged five or under to establish baseline resistance to commonly used antibiotics.Methods: In a population-based survey in April 2008, nasopharyngeal specimens were collected from 152 randomly selected healthy children under 5 years of age in the Iganga/Mayuge Health and Demographic Surveillance Site (HDSS). Medical history and prior treatment were recorded. Demographic characteristics and risk factors for carriage of resistant strains were obtained from the HDSS census. Bacteria were isolated and analysed for antibiotic susceptibility using disk diffusion and E test.Results: Streptococcus pneumoniae (S. pneumoniae) carriage was 58.6%, and, while most (80.9%) isolates had intermediate resistance to penicillin, none was highly resistant. Whereas no isolate was resistant to erythromycin, 98.9% were resistant to trimethoprim-sulphamethoxazole (co-trimoxazole).Conclusions: In vitro resistance in S. pneumoniae to co-trimoxazole treatment was high, and the majority of isolates had intermediate resistance to penicillin. To inform treatment policies on the clinical efficacy of current treatment protocols for pneumonia in health facilities and at the community level, routine surveillance of resistance in pneumonia pathogens is needed as well as research on treatment efficacy in cases with resistant strains. Improved clinical algorithms and diagnostics for pneumonia should be developed.

Highlights

Worldwide in 2013, 935,000 children younger than 5 years of age die of pneumonia, and in sub-Saharan Africa an estimated 16% of child deaths are attributed to pneumonia [1]
Bacteria such as Streptococcus pneumoniae, Haemophilus influenzae type b (Hib), and Staphylococcus aureus are responsible for the majority of these infections, and viruses, parasites, and fungi can cause pneumonia
A sample of 152 households with children younger than 5 years of age was selected from the Health and Demographic Surveillance Site (HDSS) population register using simple random sampling

Summary

Introduction

Worldwide in 2013, 935,000 children younger than 5 years of age die of pneumonia, and in sub-Saharan Africa an estimated 16% of child deaths are attributed to pneumonia [1]. Bacteria such as Streptococcus pneumoniae, Haemophilus influenzae type b (Hib), and Staphylococcus aureus are responsible for the majority of these infections, and viruses, parasites, and fungi can cause pneumonia (Received 15 February 2015; revised 8 July 2015; accepted 9 July 2015) ISSN 0300-9734 print/ISSN 2000-1967 online ß 2015 Taylor & Francis. Conclusions: In vitro resistance in S. pneumoniae to co-trimoxazole treatment was high, and the majority of isolates had intermediate resistance to penicillin. Improved clinical algorithms and diagnostics for pneumonia should be developed

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