Risk factors for carriage of  Streptococcus pneumoniae  in children

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Abstract

Background

During the past decades Streptococcus pneumoniae has developed significant resistance to many classes of antimicrobial drugs. Potential risk factors for colonization of the nasopharynx by Streptococcus pneumoniae in children and for carriage of drug resistant strains were examined.

Methods

Between 2007 and 2008 nasopharyngeal swabs were collected from 402 children 6 months to 5 years old visiting the public sector immunization centers and outpatient departments as well as offices of paediatricians from private practice in Nicosia district in Cyprus. Information on demographic characteristics and potential risk factors of participating children were collected using a standardized questionnaire distributed to parents.

Results

In multivariable analyses we found that attendance at day care center, having siblings in the family and having both parents originating from Cyprus, statistically increased the risk of pneumococcal colonization. Full immunization with PCV7 appears to be a protective factor against colonization by pneumococcus. Previous administration of antimicrobials during the last month prior to specimen collection appeared to be the most consistent risk factor for carrying a non susceptible strain of Streptococcus pneumoniae to either penicillin or erythromycin. Factors such as age, nationality, previous or current breastfeeding, passive exposure to cigarette smoke and attendance in a day care center do not appear as independent risk factors for colonization by non susceptible strains.

Conclusions

Prudent use of antibiotics especially for upper respiratory tract infections in children as well as increased vaccination coverage by the pneumococcal conjugate vaccines could prove effective in reducing levels of colonization by drug resistant pneumococcal strains.

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Most cited references 23

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Herd immunity and serotype replacement 4 years after seven-valent pneumococcal conjugate vaccination in England and Wales: an observational cohort study.

Elizabeth Miller, Nicholas Andrews, Pauline Waight … (2011)

The seven-valent pneumococcal conjugate vaccine (PCV7) has reduced vaccine-type (VT) invasive pneumococcal disease but increases in non-vaccine-type (NVT) disease have varied between countries. We assess the effect of the PCV7 vaccination on VT and NVT disease in England and Wales. The study cohort was the population of England and Wales from July, 2000, to June, 2010. We calculated incidence rate ratios (IRRs) to compare incidences of VT and NVT disease before (2000-06) and after (2009-10) the introduction of PCV7. We used data from the national surveillance database. Cases included in our analysis were restricted to those confirmed by culture linked with isolates referred for serotyping at the national reference centre by laboratories in England and Wales. We adjusted for potential bias from missing data (serotype and age of patient) and changes in case ascertainment rates during the study period. 5809 cases of invasive pneumococcal disease were reported in 2009-10, giving an incidence of 10·6 per 100,000 population in 2009-10, which, when compared with the adjusted average annual incidence of 16·1 in 2000-06, gives an overall reduction of 34% (95% CI 28-39). VT disease decreased in all age groups, with reductions of 98% in individuals younger than 2 years and 81% in those aged 65 years or older. NVT disease increased by 68% in individuals younger than 2 years and 48% in those aged 65 years or older, giving an overall reduction in invasive pneumococcal disease of 56% in those younger than 2 years and 19% in those aged 65 years or older. After vaccine introduction, more NVT serotypes increased in frequency than decreased, which is consistent with vaccine-induced replacement. Key serotypes showing replacement were 7F, 19A, and 22F. Increases in NVT invasive pneumococcal disease were not associated with antimicrobial resistance. Despite much serotype replacement, a substantial reduction in invasive pneumococcal disease in young children can be achieved with PCV7 vaccination, with some indirect benefit in older age groups. Further reductions should be achievable by use of higher valency vaccines. Robust surveillance data are needed to properly assess the epidemiological effect of multivalent pneumococcal disease vaccines. Health Protection Agency. Copyright © 2011 Elsevier Ltd. All rights reserved.

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Effect of introduction of the pneumococcal conjugate vaccine on drug-resistant Streptococcus pneumoniae.

Moe Kyaw, Ruth Lynfield, William Schaffner … (2006)

Five of seven serotypes in the pneumococcal conjugate vaccine, introduced for infants in the United States in 2000, are responsible for most penicillin-resistant infections. We examined the effect of this vaccine on invasive disease caused by resistant strains. We used laboratory-based data from Active Bacterial Core surveillance to measure disease caused by antibiotic-nonsusceptible pneumococci from 1996 through 2004. Cases of invasive disease, defined as disease caused by pneumococci isolated from a normally sterile site, were identified in eight surveillance areas. Isolates underwent serotyping and susceptibility testing. Rates of invasive disease caused by penicillin-nonsusceptible strains and strains not susceptible to multiple antibiotics peaked in 1999 and decreased by 2004, from 6.3 to 2.7 cases per 100,000 (a decline of 57 percent; 95 percent confidence interval, 55 to 58 percent) and from 4.1 to 1.7 cases per 100,000 (a decline of 59 percent; 95 percent confidence interval, 58 to 60 percent), respectively. Among children under two years of age, disease caused by penicillin-nonsusceptible strains decreased from 70.3 to 13.1 cases per 100,000 (a decline of 81 percent; 95 percent confidence interval, 80 to 82 percent). Among persons 65 years of age or older, disease caused by penicillin-nonsusceptible strains decreased from 16.4 to 8.4 cases per 100,000 (a decline of 49 percent). Rates of resistant disease caused by vaccine serotypes fell 87 percent. An increase was seen in disease caused by serotype 19A, a serotype not included in the vaccine (from 2.0 to 8.3 per 100,000 among children under two years of age). The rate of antibiotic-resistant invasive pneumococcal infections decreased in young children and older persons after the introduction of the conjugate vaccine. There was an increase in infections caused by serotypes not included in the vaccine. Copyright 2006 Massachusetts Medical Society.

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Changes in antimicrobial resistance, serotypes and genotypes in Streptococcus pneumoniae over a 30-year period.

J Liñares, C Ardanuy, R Pallares … (2010)

Over the past three decades, antimicrobial resistance in Streptococcus pneumoniae has dramatically increased worldwide. Non-susceptibility to penicillin in S. pneumoniae was first described in Australia in 1967, and later in New Guinea (1974), South Africa (1977), and Spain (1979). Most of these strains showed resistance to multiple antibiotics and belonged to serotypes 6A, 6B, 19A, 19F, and 23F. By the late 1980s and 1990s, the emergence and rapid dissemination of antibiotic-resistant pneumococci was observed in southern and eastern Europe, North America, South America, Africa, and Asia. Great geographical variability, both in serotype distribution and in the prevalence of resistant pneumococci, has been reported. However, the highest rates of resistance to penicillin and erythromycin worldwide were found in serotypes 6B, 6A, 9V, 14, 15A, 19F, 19A, and 23F. The introduction of the seven-valent pneumococcal conjugate vaccine (PCV7) in the 2000s and a reduction in antimicrobial use were associated with a significant decline in the incidence of invasive pneumococcal infections and in rates of antibiotic resistance in the USA. However, an increase in the incidence of infections caused by non-PCV7 serotypes, especially multiresistant serotype 19A pneumococci, has been observed in many countries over the last 5 years. The dynamic character of serotypes and antibiotic resistance in S. pneumoniae should be controlled by a policy of prudent antibiotic use and by implementation of the new generation of conjugate vaccines.

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Author and article information

Contributors

Maria G. Koliou: +357 2240 5000 , +357 99646 929 , mkoliou@spidernet.com.cy

Kyriaki Andreou: koulla_29@hotmail.com

Demetris Lamnisos: D.Lamnisos@euc.ac.cy

Giagkos Lavranos: g.lavranos@euc.ac.cy

Paris Iakovides: drparis@spidernet.com.cy

Christos Economou: yiasemin@logos.net.cy

Elpidoforos S. Soteriades: esoteria@hsph.harvard.edu

Journal

Journal ID (nlm-ta): BMC Pediatr

Journal ID (iso-abbrev): BMC Pediatr

Title: BMC Pediatrics

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2431

Publication date (Electronic): 26 April 2018

Publication date PMC-release: 26 April 2018

Publication date Collection: 2018

Volume: 18

Electronic Location Identifier: 144

Affiliations

[1 ]ISNI 0000 0004 4684 9173, GRID grid.416318.9, Department of Paediatrics, , Archbishop Makarios III Hospital, ; Nicosia, Cyprus

[2 ]ISNI 0000000121167908, GRID grid.6603.3, School of Medicine, , University of Cyprus, ; Nicosia, Cyprus

[3 ]ISNI 0000 0004 0580 3152, GRID grid.426429.f, Cyprus Institute of Biomedical Sciences (CIBS), ; Nicosia, Cyprus

[4 ]The Hull IVF Unit, Hull, UK

[5 ]GRID grid.440838.3, Department of Health Sciences, School of Sciences, , European University Cyprus, ; Nicosia, Cyprus

[6 ]Private practice, Nicosia, Cyprus

[7 ]ISNI 000000041936754X, GRID grid.38142.3c, Harvard School of Public Health, Department of Environmental Health, Environmental and Occupational Medicine and Epidemiology (EOME), ; Boston, USA

Article

Publisher ID: 1119

DOI: 10.1186/s12887-018-1119-6

PMC ID: 5921789

PubMed ID: 29699525

SO-VID: 64804324-d81c-453d-abc0-bf2d7208450f

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 23 December 2016

Date accepted : 18 April 2018

Funding

Funded by: A.G. Leventis Foundation (CY)

Funded by: Radiomarathonios foundation Cyprus

Custom metadata

ScienceOpen disciplines: Pediatrics

Keywords: streptococcus pneumoniae,colonization,risk factors,drug resistance,vaccination,cyprus

Data availability:

ScienceOpen disciplines: Pediatrics

Keywords: streptococcus pneumoniae, colonization, risk factors, drug resistance, vaccination, cyprus

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Risk factors for carriage of Streptococcus pneumoniae in children

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Abstract

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Conclusions

Related collections

Estudio del peso al nacer

Most cited references 23

Herd immunity and serotype replacement 4 years after seven-valent pneumococcal conjugate vaccination in England and Wales: an observational cohort study.

Effect of introduction of the pneumococcal conjugate vaccine on drug-resistant Streptococcus pneumoniae.

Changes in antimicrobial resistance, serotypes and genotypes in Streptococcus pneumoniae over a 30-year period.

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Cited by 18

Most referenced authors 347