Pneumococcal nasopharyngeal carriage and antimicrobial susceptibility profile in children under five insouthern Ethiopia.

Siraj Hussen,Solomon Asnake,Birkneh Tilahun Tadesse,Demelash Wachamo

doi:10.12688/f1000research.27583.2

Abstract

Background: Streptococcus pneumonia causes high morbidity and mortality, particularly in children under five. Nasopharyngeal (NP) carriage predisposes individuals to pneumococcal infection and horizontal spread within the community. Overuse of antibiotics has been linked to increased risk of antimicrobial resistance to S. pneumonia. We investigated NP carriage rate and resistance to commonly prescribed antibiotics in under-five children visiting a public referral center in southern Ethiopia. Methods: In total, 413 under 5 children who visited the outpatient department for a health check-up, immunization or acute mild illnesses underwent NP sampling. Parent/caregiver surveys were administered at the clinic. Sterile plastic applicator rayon tipped swabs were used for NP sampling. Antimicrobial susceptibility testing was performed using modified the disk diffusion method. Results: S. pneumonia NP carriage was observed in 39% [95% confidence interval (CI): 34.4-43.8]. Living with one or more sibling (AOR (adjusted odds ratio) 1.95: 95% CI: 1.01, 3.76), age group of 3-23 months (AOR 2.31: 95% CI: 1.07, 4.98), co-sleeping with family (AOR 2.09, 95% CI: 1.16, 3.79), attendance at kindergarten/day-care (AOR 1.84: 95% CI: 1.09, 3.11) and malnutrition independently increased S. pneumonia carriage at the individual level. S. pneumonia was highly resistant to Oxacillin (38.5%), Tetracycline (37.3%), and Trimethoprim-sulfamethoxazole (34.2%). Multi-drug resistance was observed in 42.2% of isolates. Conclusions: A high streptococcal NP carriage rate was observed in under-five children. The high level of resistance to commonly used antibiotics calls for enhancing national surveillance of resistance patterns and enforce antibiotic stewardship efforts.

Highlights

Streptococcus pneumonia is a Gram-positive extracellular pathogen associated with high morbidity and mortality in children all over the world, in developing countries like Ethiopia[1]
A high streptococcal NP carriage rate was observed in under-five children
The high level of resistance to commonly used antibiotics calls for enhancing national surveillance of resistance patterns and enforce antibiotic stewardship efforts

Summary

Introduction

Streptococcus pneumonia (pneumococcus) is a Gram-positive extracellular pathogen associated with high morbidity and mortality in children all over the world, in developing countries like Ethiopia[1]. In Africa, pneumococcal disease is estimated to cause nearly half a million deaths among children under-five years annually[3]. The World Health Organization (WHO) in 2010 estimated 541,000 global child deaths due to pneumococcal infections in under-five years children[3]. 3. O'Brien KL, Wolfson LJ, Watt JP, et al.: Burden of disease caused by Streptococcus pneumoniae in children younger than 5 years: global estimates. Streptococcus pneumonia causes high morbidity and mortality, in children under five. We investigated NP carriage rate and resistance to commonly prescribed antibiotics in under-five children visiting a public referral center in southern Ethiopia. Multi-drug resistance was observed in 42.2% of isolates

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