High carriage rate of high-level penicillin-resistant <it>Streptococcus pneumoniae </it>in a Taiwan kindergarten associated with a case of pneumococcal meningitis

• Main Authors: Lin Yu, Huang I Fei, Cheng Ming, Lee Wei, Lauderdale Tsai-Ling, Hseih Kai, Huang I-Wen, Chiou Christine C
• Format: Article
• Language: English
• Published: BMC 2005-11-01
• Series: BMC Infectious Diseases
• Online Access: http://www.biomedcentral.com/1471-2334/5/96
• ISSN: 1471-2334

<p>Abstract</p> <p>Background</p> <p>The Taiwan^19F-14 <it>Streptococcus pneumoniae </it>clone and its variants are being found with increasing frequency in the Asia-Pacific region. A 5-year old child <it>with S. pneumoniae </it>meningitis caused by a high-level penicillin resistant strain (MIC = 4 μg/ml) was admitted to a hospital in southern Taiwan. We carried out a study to determine the potential source of this strain.</p> <p>Methods</p> <p>Nasopharyngeal cultures were obtained from all children attending the same kindergarten as the index case. To determine their relatedness all isolates were compared by serotype, antimicrobial susceptibility profile and pulsed field gel electrophoresis (PFGE).</p> <p>Results</p> <p>A high proportion of the children including the index case (32/78, 41.0%) carried <it>S. pneumoniae </it>in their nasopharynx (NP). The most common serotype was 19F (13/32, 40.6%). The PFGE types of the 19F serotype isolates obtained from the patient's blood, CSF and NP were identical and were related to 11 other serotype 19F NP isolates including 10 that were indistinguishable from the Taiwan^19F-14 clone. All 14 isolates had similar high-level penicillin and multi-drug resistance. The serotypes of the other 19 NP isolates included 6A (2), 6B (10), 23F (5), 9V (1) and 3 (1). The overall rate of penicillin resistance in these <it>S. pneumoniae </it>from these children was 87.5% (28/32), with an MIC₅₀of 2 and MIC₉₀of 4 ug/ml. In addition, multi-drug resistant-isolates (isolates resistant to 3 different classes of antimicrobials) accounted for 87.5% (28/32) of all isolates.</p> <p>Conclusion</p> <p>The high carriage rate of high-level penicillin- and multi-drug- resistant <it>S. pneumoniae </it>in a kindergarten associated with a case of pneumococcal meningitis emphasizes the need for restraint in antibiotic use and consideration of childhood immunization with conjugate pneumococcal vaccine to prevent the further spread of resistant <it>S. pneumoniae </it>in Taiwan.</p>