PEDIATRICS Vol. 99 No. 4 April 1997, pp. e7 (doi:10.1542/peds.99.4.e7)
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PEDIATRICS Vol. 99 No. 4 April 1997, p. e7
Copyright ©1997 by the American Academy of Pediatrics

ELECTRONIC ARTICLE:
Nasopharyngeal Carriage of Penicillin-resistant Streptococcus pneumoniae in Children With Sickle Cell Disease

Received Mar 27, 1996; accepted Sep 27, 1996.

Najat C. Daw*, Judith A. Wilimas*, Dagger , §, Winfred C. Wang*, Dagger , §, Gerald J. PresburyDagger , §, Royce E. Joyner§, Sylvia C. Harris*, Yvonne Davis§, Gang Chenpar , and P. Joan ChesneyDagger , §

From the Departments of * Hematology/Oncology and par  Biostatistics, St Jude Children's Research Hospital, Dagger  Department of Pediatrics, University of Tennessee, and § LeBonheur Children's Medical Center, Memphis.

Objective.  We studied the prevalence of nasopharyngeal (NP) carriage, antimicrobial susceptibilities, and serotypes of Streptococcus pneumoniae (SP) in children with sickle cell disease (SCD) in the Mid-South. In addition, we examined risk factors for NP carriage of penicillin-resistant SP (PRSP).

Study Design.  Between July 1994 and December 1995, we obtained NP cultures from 312 children with SCD followed at the Mid-South Sickle Cell Center, 208 (67%) of whom were receiving penicillin prophylaxis.

Results.  Among the 312 patients, colonization with SP occurred in 42 (13%), 30 (71%) of whom were receiving penicillin prophylaxis. Twenty-three of the 42 SP isolates (55%) were resistant to penicillin; 5 of the 23 (22%) were highly resistant. PRSP organisms were also resistant to cefotaxime (43%), trimethoprim-sulfamethoxazole (57%), and erythromycin (22%). Serotypes 6A, 6B, 14, 19A, and 23F accounted for 19 (90%) of 21 resistant strains. Children who were treated with antibiotics during the preceding month were more likely to carry PRSP than children who were not treated.

Conclusions.  There is a high prevalence of NP carriage of PRSP in children with SCD in the Mid-South, which raises concerns regarding the continued effectiveness of penicillin prophylaxis in these children. Further studies on the antimicrobial susceptibilities of resistant organisms and the relationship between NP carriage of SP and invasive disease are needed before developing new recommendations for prophylaxis and treatment. Streptococcus pneumoniae, penicillin resistance, colonization, sickle cell disease.


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