Trends in antibiotic resistance of Streptococcus pneumoniae and Haemophilus influenzae isolated from nasopharyngeal flora in children with acute otitis media in France before and after 13 valent pneumococcal conjugate vaccine introduction

BMC Infectious Diseases

Corinne Levy¹  Emmanuelle Varon²  Stéphane Bonacorsi⁴  Stéphane Béchet³  Andreas Werner¹  Annie Elbez³  Catherine Doit⁴  Robert Cohen¹  François Angoulvant⁵ 

[1]AFPA, Association Française de Pédiatrie Ambulatoire, Chambéry, France

[2]National Reference Center for Pneumococci, Laboratoire de Microbiologie, AP-HP, Hopital Européen Georges-Pompidou, Paris, France

[3]ACTIV, Association Clinique et Thérapeutique Infantile du Val de Marne, Saint-Maur des Fossés, France

[4]Service de Microbiologie, AP-HP, Hôpital Robert-Debré, Paris, 75019, France

[5]Service d’Accueil des Urgences Pédiatriques, AP-HP, Hôpital Necker-Enfants-Malades, Université Paris Descartes Sorbonne Paris Cité, ECEVE - INSERM UMR1123, Paris, France

关键词: Haemophilus influenzae;    Betalactamase;    Blnar;    Guideline;    Antibiotic;    Otitis media;    PCV;    Conjugate vaccine;    Streptococcus pneumoniae;   

Others  :  1230400
DOI  :  10.1186/s12879-015-0978-9

 received in 2015-03-18, accepted in 2015-06-05,  发布年份 2015

【 摘 要 】

Background

After the implementation of pneumococcal conjugate vaccines (PCVs), the marked shift in Streptococcus pneumoniae (Pnc) serotype distribution led to a modification in pneumococcal antibiotic susceptibility. In 2011, the pattern of antibiotic prescription in France for acute otitis media in infants was greatly modified, with decreased use of third-generation cephalosporins and amoxicillin–clavulanate replaced by amoxicillin alone. To assess antibiotic strategies, here we measured the antibiotic susceptibility of Pnc and Haemophilus influenzae (Hi) isolated from nasopharyngeal flora in infants with acute otitis media in the 13-valent PCV (PCV13) era in France.

Methods

From November 2006 to June 2013, 77 pediatricians obtained nasopharyngeal swabs from infants (6 to 24 months old) with acute otitis media. The swabs were sent for analysis to the national reference centre for pneumococci in France. Demographics, medical history, and physical examination findings were recorded.

Results

We examined data for 7200 children, 3498 in the pre-PCV13 period (2006–2009) and 3702 in the post-PCV13 period (2010–2013). The Pnc carriage rate decreased from 57.9 % to 54.2 % between the 2 periods, and the proportion of pneumococcal strains with reduced susceptibility to penicillin or resistant to penicillin decreased from 47.1 % to 39 % (P < 0.0001). The Hi carriage rate increased from 48.2 % to 52.4 %, with the proportion of ß-lactamase–producing strains decreasing from 17.1 % to 11.9 % and the proportion of ß-lactamase–nonproducing, ampicillin-resistant strains remaining stable, from 7.7 % to 8.2 %. We did not identify any risk factor associated with carriage of ß-lactamase–producing Hi strains (such as daycare center attendance, otitis-prone condition or recent antibiotic use).

Conclusion

In France, the nasopharyngeal carriage rate of reduced-susceptibility pneumococcal strains and ß-lactamase–producing Hi strains decreased in children with acute otitis media after 2010, the year the PCV13 was introduced. Accordingly, amoxicillin as the first-line drug for acute otitis media requiring antibiotics remains a valid choice.

【 授权许可】

   
2015 Angoulvant et al.

【 图 表 】

Fig. 1.

【 参考文献 】

• [1]Sabuncu E, David J, Bernede-Bauduin C, Pepin S, Leroy M, Boelle PY et al.. Significant reduction of antibiotic use in the community after a nationwide campaign in France, 2002–2007. PLoS Med. 2009; 6:e1000084.
• [2]Gehanno P, Panajotopoulos A, Barry B, Nguyen L, Levy D, Bingen E et al.. Microbiology of otitis media in the Paris, France, area from 1987 to 1997. Pediatr Infect Dis J. 2001; 20:570-3.
• [3]Azria R, Barry B, Bingen E, Cavallo JD, Chidiac C, Francois M et al.. Antibiotic stewardship. Med Mal Infect. 2012; 42:460-87.
• [4]Lieberthal AS, Carroll AE, Chonmaitree T, Ganiats TG, Hoberman A, Jackson MA et al.. The diagnosis and management of acute otitis media. Pediatrics. 2013; 131:e964-99.
• [5]Wald ER, DeMuri GP. Commentary: antibiotic recommendations for acute otitis media and acute bacterial sinusitis in 2013–the conundrum. Pediatr Infect Dis J. 2013; 32:641-3.
• [6]Ben-Shimol S, Givon-Lavi N, Leibovitz E, Raiz S, Greenberg D, Dagan R. Near-Elimination of Otitis Media Caused by 13-Valent Pneumococcal Conjugate Vaccine (PCV) Serotypes in Southern Israel Shortly After Sequential Introduction of 7-Valent/13-Valent PCV. Clin Infect Dis. 2014; 59:1724-32.
• [7]Casey JR, Kaur R, Friedel VC, Pichichero ME. Acute otitis media otopathogens during 2008–2010 in Rochester NY. Pediatr Infect Dis J. 2013; 32:805-9.
• [8]Vergison A. Microbiology of otitis media: a moving target. Vaccine. 2008; 26 Suppl 7:G5-10.
• [9]van Dongen TM, van der Heijden GJ, van Zon A, Bogaert D, Sanders EA, Schilder AG. Evaluation of concordance between the microorganisms detected in the nasopharynx and middle ear of children with otitis media. Pediatr Infect Dis J. 2013; 32:549-52.
• [10]Levy C, Varon E, Picard C, Béchet S, Martinot A, Bonacorsi S et al.. Trends of pneumococcal meningitis in children after introduction of the 13-valent pneumococcal conjugate vaccine in France. Pediatr Infect Dis J. 2014; 33:1216-21.
• [11]Cohen R, Bingen E, Levy C, Thollot F, Boucherat M, Derkx V et al.. Nasopharyngeal flora in children with acute otitis media before and after implementation of 7 valent pneumococcal conjugate vaccine in France. BMC Infect Dis. 2012; 12:52. BioMed Central Full Text
• [12]Cohen R, Levy C, Bonnet E, Grondin S, Desvignes V, Lecuyer A et al.. Dynamic of pneumococcal nasopharyngeal carriage in children with acute otitis media following PCV7 introduction in France. Vaccine. 2010; 28:6114-21.
• [13]Levy C, Thollot F, Corrard F, Lecuyer A, Martin P. Boucherat M et al [Acute otitis media in ambulatory practice: epidemiological and clinical characteristics after 7 valent pneumococcal conjugate vaccine (PCV7) implementation]. Arch Pediatr. 2011; 18:712-8.
• [14]Angoulvant F, Pereira M, Perreaux F, Soussan V, Pham LL, Trieu TV et al.. Impact of unlabeled French antibiotic guidelines on antibiotic prescriptions for acute respiratory tract infections in 7 Pediatric Emergency Departments, 2009–2012. Pediatr Infect Dis J. 2014; 33:330-3.
• [15]Levy C, Pereira M, Guedj R, Abt-Nord C, Gelbert NB, Cohen R et al.. Impact of 2011 French guidelines on antibiotic prescription for acute otitis media in infants. Med Mal Infect. 2014; 44:102-6.
• [16]Paradise JL. On classifying otitis media as suppurative or nonsuppurative, with a suggested clinical schema. J Pediatr. 1987; 111:948-51.
• [17]Cohen R, Levy C, de La Rocque F, Gelbert N, Wollner A, Fritzell B et al.. Impact of pneumococcal conjugate vaccine and of reduction of antibiotic use on nasopharyngeal carriage of nonsusceptible pneumococci in children with acute otitis media. Pediatr Infect Dis J. 2006; 25:1001-7.
• [18]Wayne P. Performance standards for antimicrobial susceptibility testing: 18th informational supplement: Clinical and Laboratory Standards Institute; 2008.
• [19]Norskov-Lauritsen N, Ridderberg W, Erikstrup LT, Fuursted K. Evaluation of disk diffusion methods to detect low-level beta-lactamase-negative ampicillin-resistant Haemophilus influenzae. APMIS. 2011; 119:385-92.
• [20]Cohen R, Levy C, Bonnet E, Thollot F, Boucherat M, Fritzell B et al.. Risk factors for serotype 19A carriage after introduction of 7-valent pneumococcal vaccination. BMC Infect Dis. 2011; 11:95. BioMed Central Full Text
• [21]Dagan R, Leibovitz E, Greenberg D, Bakaletz L, Givon-Lavi N. Mixed pneumococcal-nontypeable Haemophilus influenzae otitis media is a distinct clinical entity with unique epidemiologic characteristics and pneumococcal serotype distribution. J Infect Dis. 2013; 208:1152-60.
• [22]Martin JM, Hoberman A, Paradise JL, Barbadora KA, Shaikh N, Bhatnagar S et al.. Emergence of Streptococcus pneumoniae serogroups 15 and 35 in nasopharyngeal cultures from young children with acute otitis media. Pediatr Infect Dis J. 2014; 33:e286-90.
• [23]Cohen R, Levy C, Bingen E, Koskas M, Nave I, Varon E. Impact of 13-valent pneumococcal conjugate vaccine on pneumococcal nasopharyngeal carriage in children with acute otitis media. Pediatr Infect Dis J. 2012; 31:297-301.
• [24]Dommergues MA, Hentgen V. Decreased paediatric antibiotic consumption in France between 2000 and 2010. Scand J Infect Dis. 2012; 44:495-501.
• [25]Palmu AA, Jokinen J, Nieminen H, Rinta-Kokko H, Ruokokoski E, Puumalainen T et al.. Effect of pneumococcal Haemophilus influenzae protein D conjugate vaccine (PHiD-CV10) on outpatient antimicrobial purchases: a double-blind, cluster randomised phase 3–4 trial. Lancet Infect Dis. 2014; 14:205-12.
• [26]Mizrahi A, Cohen R, Varon E, Bonacorsi S, Bechet S, Poyart C et al.. Non typable-Haemophilus influenzae biofilm formation and acute otitis media. BMC Infect Dis. 2014; 14:400. BioMed Central Full Text
• [27]Costerton JW, Stewart PS, Greenberg EP. Bacterial biofilms: a common cause of persistent infections. Science. 1999; 284:1318-22.
• [28]Swords WE. Nontypeable Haemophilus influenzae biofilms: role in chronic airway infections. Front Cell Infect Microbiol. 2012; 2:97.
• [29]Caeymaex L, Varon E, Levy C, Béchet S, Derkx V, Desvignes V et al.. Characteristics and outcomes of acute otitis media in children carrying streptococcus pneumoniae or haemophilus influenzae in their nasopharynx as a single otopathogen after introduction of the heptavalent pneumococcal conjugate vaccine. Pediatr Infect Dis J. 2014; 33:533-6.