Abstract
To assess the prevalence, the antimicrobials resistance and to identify risk factors of nasopharyngeal colonization by Streptococcus pneumoniae in children with sickle cell disease (SCD) using prophylactic penicillin and immunized with 7-valent pneumococcal conjugate vaccine. A total of 424 swabs were collected from the nasopharynx in 216 children with SCD and 109 samples from the control group, both from 2 to 60 months age range. Isolation and identification of pneumococci followed standard procedures. Minimum inhibitory concentration (MIC) for penicillin was determined by the E-test method. Prevalence of nasopharyngeal colonization by pneumococci in children with SCD was 17%, and 11% in the control group. The risk factors for increased colonization in children with SCD were the presence of more than five people at home, daycare/school attendance and low prophylaxis compliance. The prevalence of strains with penicillin resistance was 57.5% in patients with SCD and 25% in the control group. Conclusions: Prevalence of pneumococci nasopharyngeal colonization was similar among the study groups. Prophylactic use of penicillin may have increased the prevalence of resistant strains. The vaccine did not decrease the colonization with penicillin resistant strains.
Highlights
Children with sickle cell disease (SCD) have increased susceptibility to infections caused by Streptococcus pneumoniae, due to splenic ischemia that runs chronically and determines the hypofunction of this organ, since the first months of life [1]
In 1984, Anglin et al.[16] published the first study evaluating the effect of penicillin prophylaxis on nasopharyngeal colonization, and found a prevalence of 11.1% in patients with sickle cell anemia and 37.1% in control group without prophylaxis
Other authors found colonization rates among children with SCD taking penicillin ranging from 8% to 15.5% [11,17,18]
Summary
Children with sickle cell disease (SCD) have increased susceptibility to infections caused by Streptococcus pneumoniae, due to splenic ischemia that runs chronically and determines the hypofunction of this organ, since the first months of life [1]. The prophylaxis with penicillinsignificantly reduces the risk of serious infection by Streptococcus pneumoniae in children under five years old with SCD; one of the mechanisms involved was the reduction of the colonization of the nasopharynx [2]. The immunization with pneumococcal vaccines is an important tool in protecting these children. The 7-valent pneumococcal conjugate vaccine (PCV 7) was provided free of charge in Brazil by the Ministry of Health since. In Brazil, this vaccine protects against 63% of the serotypes of S. pneumoniae isolated [4]. The 23-valent pneumococcal polysaccharide vaccine does not affect nasopharyngeal colonization [5,6], differing from the PCV 7, which decreases the colonization by the vaccine serotypes [7,8]
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