Nasopharyngeal carriage, serotype distribution and antimicrobial resistance of Streptococcus pneumoniae among children from Brazil before the introduction of the 10-valent conjugate vaccine

BMC Infectious Diseases

Lúcia Martins Teixeira²  Rosana Rocha Barros³  Claudete Araújo Cardoso¹  Havana Gomes Rodrigues³  Laís de Souza Gouveia Moreira³  Roberta dos Anjos Barreto³  Mariane Alves Corrêa³  Tatiana Castro Abreu Pinto²  Felipe Piedade Gonçalves Neves³ 

[1] Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, RJ, Brazil;Instituto de Microbiologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil;Instituto Biomédico, Universidade Federal Fluminense, Niterói, RJ, Brazil

关键词: Pneumococcal conjugate vaccines;    Antimicrobial resistance;    Serotypes;    Nasopharyngeal carriage;    Streptococcus pneumoniae;   

Others  :  1147058
DOI  :  10.1186/1471-2334-13-318

 received in 2013-01-25, accepted in 2013-07-11,  发布年份 2013

【 摘 要 】

Background

Streptococcus pneumoniae remains a major cause of childhood morbidity and mortality worldwide. Nasopharyngeal colonization plays an important role in the development and transmission of pneumococcal diseases, and infants and young children are considered to be the main reservoir of this pathogen. The aim of this study was to evaluate the rates and characteristics associated with nasopharyngeal carriage, the distribution of serotypes and the antimicrobial resistance profiles of Streptococcus pneumoniae among children in a large metropolitan area in Brazil before the introduction of the 10-valent pneumococcal conjugate vaccine.

Methods

Between March and June 2010, nasopharyngeal swabs were collected from 242 children aged <6 years attending one day care center and the emergency room of a pediatric hospital. Pneumococcal isolates were identified by conventional methods and serotypes were determined by a sequential multiplex PCR assay and/or the Quellung reaction. The antimicrobial susceptibilities of the pneumococci were assessed by the disk diffusion method. MICs for erythromycin and penicillin were also performed. Erythromycin resistance genes were investigated by PCR.

Results

The overall colonization rate was 49.2% and it was considerably higher among children in the day care center. Pneumococcal carriage was more common among day care attenders and cohabitants with young siblings. The most prevalent serotypes were 6B, 19F, 6A, 14, 15C and 23F, which accounted for 61.2% of the isolates. All isolates were susceptible to clindamycin, levofloxacin, rifampicin and vancomycin. The highest rate of non-susceptibility was observed for sulphamethoxazole-trimethoprim (51.2%). Penicillin non-susceptible pneumococci (PNSP) accounted for 27.3% of the isolates (MICs of 0.12-4 μg/ml). Penicillin non-susceptibility was strongly associated with serotypes 14 and 23F. Hospital attendance and the presence of respiratory or general symptoms were frequently associated with PNSP carriage. The two erythromycin-resistant isolates (MICs of 2 and 4 μg/ml) belonged to serotype 6A, presented the M phenotype and harbored the mef(A/E) gene.

Conclusions

Correlations between serotypes, settings and penicillin non-susceptibility were observed. Serotypes coverage projected for the 10-valent pneumococcal conjugate vaccine was low (45.5%), but pointed out the potential reduction of PNSP nasopharyngeal colonization by nearly 20%.

【 授权许可】

   
2013 Neves et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Centers for Disease Control and Prevention: Vaccine preventable deaths and the global immunization vision and strategy, 2006–2015. Morb Mortal Wkly Rep 2006, 55:511-515.
• [2]O’Brien KL, Wolfson LJ, Watt JP, Henkle E, Deloria-Knoll M, McCall N, Lee E, Mulholland K, Levine OS, Cherian T, for the Hib and Pneumococcal Global Burden of Disease Study Team: Burden of disease caused by Streptococcus pneumoniae in children younger than 5 years: global estimates. Lancet 2009, 374:893-902.
• [3]Quadros CA: From global to regional: the importance of pneumococcal disease in Latin America. Vaccine 2009, 27S:C29-C32.
• [4]Rudan I, Boschi-Pinto C, Biloglav Z, Mulholland K, Campbell H: Epidemiology and etiology of childhood pneumonia. Bull World Health Organ 2008, 86:408-416.
• [5]Ministério da Saúde do Brasil: Proposta para introdução da vacina pneumocócica 10-valente (conjugada) no calendário básico de vacinação da criança. Brasília: Incorporação Março - 2010; 2010. http://portal.saude.gov.br/portal/arquivos/pdf/intro_pneumococica10_val_04_02_10_ver_final.pdf webcite
• [6]Ministério da Saúde do Brasil: Sistema de Informação de Agravos de Notificação. http://dtr2004.saude.gov.br/sinanweb/tabnet/dh?sinannet/meningite/bases/meninbrnet.def webcite
• [7]Pan American Health Organization: Informe Regional de Sireva II, 2010: datos por país y por grupos de edad sobre las características de los aislamientos de Streptococcus pneumoniae, Haemophilus influenzae y Neisseria meningitidis em processos invasores. Washington, DCs; 2011. http://new.paho.org/hq/index.php?option=com_content&view=category&layout=blog&id=3609&It webcite
• [8]Sih TM: Acute otitis media in Brazilian children: analysis of microbiology and antimicrobial susceptibility. Ann Otol Rhinol Laryngol 2001, 110:662-666.
• [9]World Health Organization: Pneumococcal vaccines - WHO position paper. Wkly Epidemiol Rec 2012, 87:129-144.
• [10]Weinberger DM, Malley R, Lipsitch M: Serotype replacement in disease after pneumococcal vaccination. Lancet 2011, 378:1962-1973.
• [11]Dias CA, Teixeira LM, Carvalho MG, Beall B: Sequential multiplex PCR for determining capsular serotypes of pneumococci recovered from Brazilian children. J Med Microbiol 2007, 56:1185-1188.
• [12]Centers for Disease Control and Prevention: PCR deduction of pneumococcal serotypes – Latin America clinical specimens. 2010. http://www.cdc.gov/ncidod/biotech/strep/protocols.htm webcite
• [13]Jin P, Xiao M, Kong F, Oftadeh S, Zhou F, Liu C, Gilbert GL: Simple, accurate, serotype-specific PCR assay to differentiate Streptococcus pneumoniae serotypes 6A, 6B, and 6C. J Clin Microbiol 2009, 47:2470-2474.
• [14]Cherian T, Lalitha MK, Manoharan A, Thomas K, Yolken RH, Steinhoff MC: PCR-enzyme immunoassay for detection of Streptococcus pneumoniae DNA in cerebrospinal fluid samples from patients with culture-negative meningitis. J Clin Microbiol 1998, 36:3605-3608.
• [15]Clinical and Laboratory Standards Institute: Performance Standards for Antimicrobial Susceptibility Testing. Wayne, Pa, USA: Twenty-first Informational Supplement. M100-S21; 2011.
• [16]Mendonça-Souza CR, Carvalho MG, Barros RR, Dias CA, Sampaio JL, Castro AC, Facklam RR, Teixeira LM: Occurrence and characteristics of erythromycin-resistant Streptococcus pneumoniae strains isolated in three major Brazilian states. Microb Drug Resist 2004, 10:313-320.
• [17]Hsieh YC, Chiu CH, Chang KY, Huang YC, Chen CJ, Kuo CY, Chen PY, Huang KP, Lin TY: The impact of the heptavalent pneumococcal conjugate vaccine on risk factors for Streptococcus pneumoniae carriage in children. Pediatr Infect Dis J 2012, 31:e163-e168.
• [18]Wroe PC, Lee GM, Finkelstein JA, Pelton SI, Hanage WP, Lipsitch M, Stevenson AE, Rifas-Shiman SL, Kleinman K, Dutta-Linn MM, Hinrichsen VL, Lakoma M, Huang SS: Pneumococcal carriage and antibiotic resistance in young children before 13-valent conjugate vaccine. Pediatr Infect Dis J 2012, 31:249-254.
• [19]Bogaert D, De Groot R, Hermans PW: Streptococcus pneumoniae colonisation: the key to pneumococcal disease. Lancet Infect Dis 2004, 4:144-154.
• [20]Borges Laval C, de Andrade ALSS, Pimenta FC, de Andrade JG, de Oliveira RM, Silva AS, de Lima EC, Di Fabio JL, Casagrande ST, Brandileone MCC: Serotypes of carriage and invasive isolates of Streptococccus pneumoniae in Brazilian children in the era of pneumococcal vaccines. Clin Microbiol Infect 2006, 12:50-55.
• [21]Almeida E, Andrade JG, Andrade AL, Franco CM, Silva S, Oliveira CR, Pimenta FC, Lamaro-Cardoso J, Brandão AP, Almeida SC, Calix JJ, Nahm MH, De Cunto Brandileone MC: Survey of nonsusceptible nasopharyngeal Streptococcus pneumoniae isolates in children attending day-care centers in Brazil. Pediatr Infect Dis J 2010, 29:77-79.
• [22]Liñares J, Ardanuy C, Pallares R, Fenoll A: Changes in antimicrobial resistance, serotypes and genotypes in Streptococcus pneumoniae over a 30-year period. Clin Microbiol Infect 2010, 16:402-410.
• [23]Moore MR, Hyde TB, Hennessy TW, Parks DJ, Reasonover AL, Harker-Jones M, Gove J, Bruden DL, Rudolph K, Parkinson A, Butler JC, Schuchat A: Impact of a conjugate vaccine on community-wide carriage of nonsusceptible Streptococcus pneumoniae in Alaska. J Infect Dis 2004, 190:2031-2038.
• [24]Frazão N, Brito-Avo A, Simas C, Saldanha J, Mato R, Nunes S, Sousa NG, Carriço JA, Almeida JS, Santos-Sanches I, de Lencastre H: Effect of the sevenvalent conjugate pneumococcal vaccine on carriage and drug resistance of Streptococcus pneumoniae in healthy children attending day-care centers in Lisbon. Pediatr Infect Dis J 2005, 24:243-252.
• [25]Cho EY, Kang HM, Lee J, Kang JH, Choi EH, Lee HJ: Changes in serotype distribution and antibiotic resistance of nasopharyngeal isolates of Streptococcus pneumoniae from children in Korea, after optional use of the 7-valent conjugate vaccine. J Korean Med Sci 2012, 27:716-722.
• [26]Velasquez PA, Parussolo L, Cardoso CL, Tognim MC, Garcia LB: High prevalence of children colonized with penicillin-resistant Streptococcus pneumoniae in public day-care centers. J Pediatr (Rio J) 2009, 85:516-522.
• [27]Yoshioka CR, Martinez MB, Brandileone MC, Ragazzi SB, Guerra ML, Santos SR, Shieh HH, Gilio AE: Analysis of invasive pneumonia-causing strains of Streptococcus pneumoniae: serotypes and antimicrobial susceptibility. J Pediatr (Rio J) 2011, 87:70-75.