Abstract
BackgroundA nation-wide surveillance study was conducted in Greece in order to provide a representative depiction of pneumococcal carriage in the pre-vaccination era and to evaluate potential risk factors for carriage of resistant strains in healthy preschool children attending daycare centers.MethodsA study group was organized with the responsibility to collect nasopharyngeal samples from children. Questionnaires provided demographic data, data on antibiotic consumption, family and household data, and medical history data. Pneumococcal isolates were tested for their susceptibility to various antimicrobial agents and resistant strains were serotyped.ResultsBetween February and May 2004, from a total population of 2536 healthy children, a yield of 746 pneumococci was isolated (carriage rate 29.41%). Resistance rates differed among geographic regions. Recent antibiotic use in the last month was strongly associated with the isolation of resistant pneumococci to a single or multiple antibiotics. Serotypes 19F, 14, 9V, 23F and 6B formed 70.6% of the total number of resistant strains serotyped.ConclusionRecent antibiotic use is a significant risk factor for the colonization of otherwise healthy children's nasopharynx by resistant strains of S pneumoniae. The heptavalent pneumococcal conjugate vaccine could provide coverage for a significant proportion of resistant strains in the Greek community. A combined strategy of vaccination and prudent antibiotic use could provide a means for combating pneumococcal resistance.
Highlights
A nation-wide surveillance study was conducted in Greece in order to provide a representative depiction of pneumococcal carriage in the pre-vaccination era and to evaluate potential risk factors for carriage of resistant strains in healthy preschool children attending daycare centers
The routine immunization with the heptavalent pneumococcal conjugate vaccine has been shown to decrease the incidence of vaccine-type antibiotic-resistant pneumococci both in invasive diseases; nasopharyngeal colonization was dramatically decreased in vaccinated individuals and their contacts [5]
In the section of recent antibiotic use, parents were asked to provide generic or commercial names of all medications received in the last month or trimester and the appropriate classification was performed by the responsible doctors in the sampling site
Summary
A nation-wide surveillance study was conducted in Greece in order to provide a representative depiction of pneumococcal carriage in the pre-vaccination era and to evaluate potential risk factors for carriage of resistant strains in healthy preschool children attending daycare centers. The development of antibiotic resistance in S pneumoniae over the last two decades has raised a global concern [2], an evolution generally attributed to an extensive consumption of antibiotics [3]. Nasopharyngeal colonization is a prerequisite for progression to pneumococcal disease and an important source of horizontal spread in the community, especially in settings with high crowding index [1]. Antibiotic-resistant pneumococci involve mostly only a few serogroups in the majority of developed countries (6, 9, 14, 19 and 23). The routine immunization with the heptavalent pneumococcal conjugate vaccine has been shown to decrease the incidence of vaccine-type antibiotic-resistant pneumococci both in invasive diseases; nasopharyngeal colonization was dramatically decreased in vaccinated individuals and their contacts [5]
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