RESUMO
The susceptibility of nasopharyngeal Streptococcus pneumoniae to eight antibiotics was studied in 482 children under 5 years of age with community-acquired pneumonia and in 429 healthy pneumococci carriers in Fortaleza, Brazil. Serotyping of strains with pooled and type-specific antisera was also performed. Overall, S. pneumoniae was isolated from 499/911 (55%) children. The carriage rate in children attending day-care centres was higher (72%) than in children with pneumonia (50%) (P<0.001). MIC determination in 441 strains revealed 45% to be intermediate penicillin-resistant and 4% high penicillin-resistant strains. Resistance rates to co-trimoxazole and erythromycin were 42 and 23%, respectively. Serotyping of 211 penicillin-resistant and 58 randomly selected penicillin-susceptible isolates showed that 78% of the strains belonged to paediatric serogroups 6, 14, 19 and 23 (86% of the penicillin-resistant and 51% of the penicillin-susceptible strains, P=0.001). Resistance rates of S. pneumoniae to penicillin and co-trimoxazole in Fortaleza were higher than previously reported in Brazil and associated with paediatric serogroups 6, 14, 19 and 23.
Assuntos
Antibacterianos/farmacologia , Portador Sadio/microbiologia , Creches , Nasofaringe/microbiologia , Pneumonia Pneumocócica/microbiologia , Streptococcus pneumoniae/efeitos dos fármacos , Brasil/epidemiologia , Portador Sadio/epidemiologia , Pré-Escolar , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Feminino , Humanos , Lactente , Masculino , Testes de Sensibilidade Microbiana , Resistência às Penicilinas , Pneumonia Pneumocócica/epidemiologia , Sorotipagem , Streptococcus pneumoniae/classificaçãoRESUMO
Objetivos: comparar as taxas de colonizaçäo e a resistência antimicrobiana de pneumococos em nasofaringe de crianças sadias e com pneumonia. Métodos: estudo de tipo transversal. As crianças sadias foram recrutadas em centros de vacinaçäo (CV) e creches públicas (CP), selecionados aleatoriamente, e aquelas com pneumonia em emergências pediátricas. Foram utilizados swabs flexíveis de alginato para a colheita do material de nasofaringe. O isolamento e a identificaçäo dos pneumococos seguiram procedimentos padronizados. As concentraçöes inibitórias mínimas (CIM) foram determinadas por microdiluiçäo em placas. Resultados: foram estudadas 911 crianças, 429 sadias (60 por cento portadoras de pneumococo, sendo 72 por cento destas recrutadas em CP e 49 por cento em CV) e 482 com pneumonia (50 por cento de portadoras) (p=0,002). De 441 isolados com CIM determinadas, 198 (45 por cento) apresentavam resistência intermediária, e 16 (4 por cento) apresentavam resistência plena à penicilina. As taxas de resistência dos pneumococos isolados de portadores sadios e com pneumonia, respectivamente, foram: penicilina 48 por cento (CV 37 por cento e CP 55 por cento) e 50 por cento (p>0,05); eritromicina: 28 por cento e 19 por cento (p=0,05); cotrimoxazol 81 por cento e 76 por cento (p>0,05); cloranfenicol 6 por cento e 7 por cento (p>0,05), rifampicina 5 por cento e 3 por cento (p>0,05), ceftriaxone 2 e 4 por cento (p>0,05) e vancomicina 0 por cento, para ambos grupos. Foi constatada associaçäo entre as resistências do pneumococo à penicilina, eritromicina e ao cotrimoxazol. Conclusöes: a taxa de portador de pneumococos foi maior em crianças sadias do que naquelas com pneumonia. As resistências dos pneumococos à penicilina e ao cotrimoxazol foram elevadas, sobretudo entre os usuários de creches públicas
RESUMO
OBJECTIVES: To compare colonization rates and antimicrobial resistance of nasopharyngeal pneumococci in healthy carriers and children with pneumonia. METHODS: A cross-sectional study. Healthy subjects of this study were selected from randomly chosen immunization centers and day-care centers, and those with pneumonia were selected in pediatric emergency rooms. Flexible perinasal alginate swabs were employed to collect nasopharyngeal pneumococci specimens. Isolation and identification were performed according to standard procedures. Minimum Inhibitory Concentrations were assessed by microdilution techniques. RESULTS: We studied 911 children, 429 healthy controls (60% of carriers, 72% attending day care centers and 49% recruited in immunization centers) and 482 children with pneumonia (50% of carriers) (P=0.02). The Minimum Inhibitory Concentration of penicillin to 441 isolates detected 198 (45%) of intermediate and 16 (4%) fully resistant pneumococci. Antimicrobial resistance rates of isolates from healthy carriers and children with pneumonia were, respectively: penicillin 48% (37% for immunization centers and 55% for day-care centers) and 50% (P>0.05), erythromycin 28% and 19% (P=0.05); cotrimoxazole 81% and 76% (P>0.05), chloramphenicol 6% and 7% (P>0.05), rifampin 5 and 3% (P>0.05) ceftriaxone 2 and 4% (P>0.05) and vancomycin 0% in both groups. An association among pneumococcal resistance to penicillin, erythromycin and cotrimoxazole was detected. CONCLUSIONS: Pneumococcal carriage rate was higher in healthy children than in children with pneumonia. Penicillin and cotrimoxazole resistance rates were high, especially among those attending day-care centers.