Streptococcus pneumoniae colonization in the young child: Association with otitis media and resistance to penicillin,☆☆,

Presented in part at the Interscience Conference on Antimicrobial Agents and Chemotherapy in New Orleans, Louisiana, October 1993.
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Abstract

Objective: To determine the nasopharyngeal colonization rate of penicillin-susceptible and penicillin-resistant strains of Streptococcus pneumoniae in young children, and to assess its relationship with the incidence of otitis media. Design: Observational study in 215 children younger than 6 years of age who received care in the Vanderbilt Vaccine Clinic from September 1, 1992, to August 31, 1993. Results: Of 842 nasopharyngeal cultures obtained, results for 44% of the cultures were positive for S. pneumoniae; 73% of the isolates were serotypes 6, 14, 19, or 23. Younger children had significantly higher rates of pneumococcal colonization than older children, with a peak at 1 year of age. By microdilution susceptibility testing, 37% of the cultures with positive results were intermediately or highly resistant to penicillin. Significantly more serotype 19 and 23 isolates were penicillin resistant than organisms of other serotypes. Children younger than 2 years of age had a twofold higher percentage of resistant isolates than those older than 2 years of age. A significant association was noted between nasopharyngeal carriage of S. pneumoniae and acute otitis media (p = 0.0002); however, the incidence of acute otitis media did not differ significantly between children colonized with penicillin-susceptible or penicillin-resistant strains. Unresolved otitis media was diagnosed more often in children who were colonized with resistant organisms than in children colonized with susceptible strains (p = 0.04). Conclusions: There was a high rate of nasopharyngeal carriage of penicillin-resistant S. pneumoniae in this population of young children. Nasopharyngeal colonization was associated with an increased incidence of acute otitis media, and penicillin resistance was associated with an increased incidence of unresolved otitis media. (J PEDIATR 1995;127:533-7)

Section snippets

Population

Two hundred fifteen healthy infants and children younger than 6 years of age and receiving comprehensive care in the National Institutes of Health-funded Vaccine Clinic at Vanderbilt Medical Center were enrolled in the study. The children were recruited into the clinic at birth from the normal newborn nursery of Vanderbilt University Hospital. Informed consent for participation in vaccine trials and epidemiologic studies of infectious diseases was obtained from the parents at the time of

Colonization rates with S. pneumoniae.

From September 1, 1992, to August 31, 1993, 842 nasopharyngeal cultures were obtained from the 215 children in our Vaccine Clinic. At the end of the study, the population group consisted of 25% younger than 1 year of age, 29% ages 1 to 2 years, 23% ages 2 to 3 years, 14% ages 3 to 4 years, and 9% ages 4 to 6 years. Eighty-six percent of the children lived in homes with one or two children; 4% lived in homes with four or more children. Data on day care attendance were not assessed. The

DISCUSSION

Although AOM and nasopharyngeal colonization with S. pneumoniae are both common in young children, the relationship between the two events remains controversial. In some studies of simultaneous nasopharyngeal and tympanocentesis cultures in children with AOM, similar organisms were isolated from the two sites.12 However, because of the high recovery rate of more than one organism from the nasopharynx, cultures from this site may not be clinically useful in predicting the exact middle ear

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From the Department of Pediatrics, Division of Infectious Diseases, and the Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee

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