Streptococcus pneumoniae isolated from the nasal carriage and its antibiotic susceptibility profiles in children
Background and objective: The prevalence of Streptococcus pneumoniae and resistance to antibiotics has become a public health problem in different countries of the world. This study aimed to investigate the occurrence of Streptococcus pneumoniae nasal carriage among children, and their antibiotics susceptibility profiles.
Methods: A nasal swab was obtained from 1092 healthy children aged from 6 to13 years in Erbil Parks, Kurdistan region, Iraq. The swabs were cultured on appropriate culture media to isolate Streptococcus pneumoniae and to examine their susceptibility to antibiotics. The antibiotic susceptibility testing was performed using the standard disk-diffusion method.
Results: Streptococcus pneumoniae was isolated from 224 (20.51%) of the specimens; 57.59%, and 56.25% of isolates were resistant to penicillin and ampicillin, respectively, while 3.57% and 4.46% were resistant to clarithromycin and moxifloxacin, respectively. None of the isolates had resistant to vancomycin.
Conclusion: There is a high prevalence of penicillin and another β-lactam drug resistance among isolates of Streptococcus pneumoniae from the nasal carriage of children in our region.
Benbachir M, Elmdaghri N, Belabbes H, Haddioui G, Benzaid H, Zaki B. Eleven-year surveillance of antibiotic resistance in Streptococcus pneumoniae in Casablanca (Morocco). Microb Drug Resist 2012; 18(2):157–60.
Parry CM, Diep TS, Wain J, Hoa NTT, Gainsborough M, Nga D, et al. Nasal carriage in Vietnamese children of Streptococcus pneumoniae resistant to multiple antimicrobial agents. Antimicrob Agents Chemother 2000; 44(3):484–8.
O’BRIEN KL, Nohynek H, Group WPVTCW. Report from a WHO Working Group: standard method for detecting upper respiratory carriage of Streptococcus pneumoniae. Pediatr Infect Dis 2003; 22(2):e1–11.
Charlson ES, Bittinger K, Haas AR, Fitzgerald AS, Frank I, Yadav A, et al. Topographical continuity of bacterial populations in the healthy human respiratory tract. Am J Respir Crit Care Med 2011; 184(8):957–63.
Petraitiene S, Alasevicius T, Staceviciene I, Vaiciuniene D, Kacergius T, Usonis V. The influence of Streptococcus pneumoniae nasopharyngeal colonization on the clinical outcome of the respiratory tract infections in preschool children. BMC Infect Dis 2015; 15:403.
Abdullahi O, Karani A, Tigoi CC, Mugo D, Kungu S, Wanjiru E, et al. The prevalence and risk factors for pneumococcal colonization of the nasopharynx among children in Kilifi District, Kenya. PloS One 2012; 7(2):e30787.
Laufer AS, Metlay JP, Gent JF, Fennie KP, Kong Y, Pettigrew MM. Microbial communities of the upper respiratory tract and otitis media in children. MBio 2011; 2(1):e00245–10.
Bogaert D, de Groot R, Hermans P. Streptococcus pneumoniae colonisation: the key to pneumococcal disease. Lancet Infect Dis 2004; 4(3):144–54.
Trzciński K, Li Y, Weinberger DM, Thompson CM, Cordy D, Bessolo A, et al. Effect of serotype on pneumococcal competition in a mouse colonization model. M Bio 2015; 6(5):e00902–15.
Bogaert D, van Belkum A, Sluijter M, Luijendijk A, de Groot R, Rümke H, et al. Colonisation by Streptococcus pneumoniae and Staphylococcus aureus in healthy children. Lancet 2004; 363(9424):1871–2.
Regev-Yochay G, Raz M, Dagan R, Porat N, Shainberg B, Pinco E, et al. Nasopharyngeal carriage of Streptococcus pneumoniae by adults and children in community and family settings. Clin Infect Dis 2004; 38(5):632– 9.
Wright AK, Ferreira DM, Gritzfeld JF, Wright AD, Armitage K, Jambo KC, et al. Human nasal challenge with Streptococcus pneumoniae is immunising in the absence of carriage. PLoS Pathog 2012; 8(4):e1002622.
Magalhães APGdO, Pinto AdS. Antimicrobial resistance and serotyping of Streptococcus pneumoniae isolated from pediatric patients in Belo Horizonte, MG, Brazil. BJM 2003; 34(3):210–2.
Alanis AJ. Resistance to antibiotics: are we in the post-antibiotic era? Arch Invest Med 2005; 36(6):697–705.
Laxminarayan R, Duse A, Wattal C, Zaidi AK, Wertheim HF, Sumpradit N, et al. Antibiotic resistance—the need for global solutions. Lancet Infect Dis 2013; 13(12):1057–98.
Weber FT, Dias C, Costa Md. Antimicrobial susceptibility of Streptococcus pneumoniae and genotypic characterization of erythromycin-resistant strains in Porto Alegre, Brazil. BJM 2010; 41(1):1–5.
Naba MR, Araj GF, Baban TA, Tabbarah ZA, Awar GN, Kanj SS. Emergence of fluoroquinolone-resistant Streptococcus pneumoniae in Lebanon: a report of three cases. J Infect Public Health 2010; 3(3):113–7.
Hortal M, Lovgren M, De la Hoz F, Agudelo C, Brandileone M, Camou T, et al. Antibiotic resistance in Streptococcus pneumoniae in six Latin American countries: 1993-1999 surveillance. Microb Drug Resist 2001; 7(4):391–401.
El Ashkar S, Osman M, Rafei R, Mallat H, Achkar M, Dabboussi F, et al. Molecular detection of genes responsible for macrolide resistance among Streptococcus pneumoniae isolated in North Lebanon. J Infect Public Health 2017; 10(6):745–8.
Schultsz C, Campbell JI, Chau NVV, Diep TS, Hoang NVM, Nga TTT, et al. Changes in the nasal carriage of drug-resistant Streptococcus pneumoniae in urban and rural Vietnamese schoolchildren. Trans R Soc Trop Med Hyg 2007; 101(5):484–92.
Villanova P. Performance standards for antimicrobial disk susceptibility tests. NCCLS Approved Standard 7th ed NCCLS 2000; 20:M2–A7.
Lee NY, Song J-H, Kim S, Peck KR, Ahn K-M, Lee S-I, et al. Carriage of antibiotic-resistant pneumococci among Asian children: a multinational surveillance by the Asian Network for Surveillance of Resistant Pathogens (ANSORP). Clin Infect Dis 2001; 32(10):1463–9.
Kellogg JA, Bankert DA, Elder CJ, Gibbs JL, Smith MC. Identification of Streptococcus pneumoniae revisited. J Clin Microbiol 2001; 39(9):3373–5.
Jorgensen JH, Turnidge JD. Susceptibility test methods: dilution and disk diffusion methods. Manual of Clinical Microbiology 11th ed. Washington, DC:ASM Press; 2015. P. 1253–73.
Reller LB, Weinstein M, Jorgensen JH, Ferraro MJ. Antimicrobial susceptibility testing: a review of general principles and contemporary practices. CID 2009; 49(11):1749–55.
Margolis E, Yates A, Levin BR. The ecology of nasal colonization of Streptococcus pneumoniae, Haemophilusinfluenzae and Staphylococcus aureus: the role of competition and interactions with host's immune response. BMC Microbiol 2010; 10(1):1.
Syrjänen RK, Kilpi TM, Kaijalainen TH, Herva EE, Takala AK. Nasopharyngeal carriage of Streptococcus pneumoniae in Finnish children younger than 2 years old. J Infect Dis 2001; 184(4):451–9.
van der Poll T, Opal SM. Pathogenesis, treatment, and prevention of pneumococcal pneumonia. Lancet 2009; 374(9700):1543-56.
Johnston C, Caymaris S, Zomer A, Bootsma HJ, Prudhomme M, Granadel C, et al. Natural genetic transformation generates a population of merodiploids in Streptococcus pneumoniae. PLoS Genet 2013; 9(9):e1003819.
Ma X, Zhao R, Ma Z, Yao K, Yu S, Zheng Y, et al. Serotype distribution and antimicrobial resistance of Streptococcus pneumoniae isolates causing invasive diseases from Shenzhen Children’s Hospital. PloS One 2013; 8(6):e67507.
Warda K, Oufdou K, Zahlane K, Bouskraoui M. Antibiotic resistance and serotype distribution of nasopharyngeal isolates of Streptococcus pneumoniae from children in Marrakech region (Morocco). J Infect Public Health 2013; 6(6):473–81.
Quagliarello A, Parry CM, Hien TT, Farrar JJ. Factors associated with carriage of penicillin-resistant Streptococcus pneumoniae among Vietnamese children: a rural-urban divide. J Health Popul Nutr 2003; 21(4):316–24.
Thummeepak R, Leerach N, Kunthalert D, Tangchaisuriya U, Thanwisai A, Sitthisak S. High prevalence of multi-drug resistant Streptococcus pneumoniae among healthy children in Thailand. J Infect Public Health 2015; 8(3):274–81.
Harbarth S, Albrich W, Brun-Buisson C. Outpatient antibiotic use and prevalence of antibiotic-resistant pneumococci in France and Germany: sociocultural perspective. Emerg Infect Dis 2002; 8(12):1460–7.
Taha AB, Hama KH, Ismail IB. Assessment of Antibiotics Misuse among People in Erbil City. Kufa Journal for Nursing Sciences 2014; 4(3):23–35.
Ehara N, Fukushima K, Kakeya H, Mukae H, Akamatsu S, Kageyama A, et al. A novel method for rapid detection of Streptococcus pneumoniae antigen in sputum and its application in adult respiratory tract infections. J Med Microbiol 2008; 57(7):820–6.
García-Rey C, Aguilar L, Baquero F, Casal J, Dal-Ré R. Importance of local variations in antibiotic consumption and geographical differences of erythromycin and penicillin resistance in Streptococcus pneumoniae. J Clin Microbiol 2002; 40(1):159–64.
Coenen S, Ferech M, Haaijer-Ruskamp FM, Butler CC, Vander Stichele RH, Verheij TJ, et al. European Surveillance of Antimicrobial Consumption (ESAC): quality indicators for outpatient antibiotic use in Europe. Qual Saf Health Care 2007; 16(6):440–5.
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