Article

Carriage of multidrug-resistant Streptococcus pneumoniae and impact of chemoprophylaxis during an outbreak of meningitis at a day care center.

Tennessee Department of Health, Communicable and Environmental Disease Services, Nashville, TN 37247-5281, USA.
Clinical Infectious Diseases (impact factor: 9.15). 12/1999; 29(5):1257-64. DOI:10.1086/313451 pp.1257-64
Source: PubMed

ABSTRACT Three cases of meningitis due to multidrug-resistant serotype 14 Streptococcus pneumoniae occurred at a day care center (DCC) over 5 days. Cultures of nasopharyngeal samples were done at the index DCC, 2 comparison DCCs, and a pediatrics practice. Isolates were serotyped and subtyped by pulsed-field gel electrophoresis (PFGE) with SmaI. Pneumococcal carriage rates ranged from 44%-65% at the 3 DCCs and 29% in the pediatrics practice. Carriage of multidrug-resistant serotype 14 S. pneumoniae was noted in 13%-19% of children at the 3 DCCs. An outbreak strain was identified by PFGE at the index DCC and 1 other DCC; a closely related strain was found in the third DCC. Carriage of the outbreak strain was associated with being age 0-24 months, antibiotic use, upper respiratory tract infections, and otitis media. DCC contacts of the ill children were offered chemoprophylaxis with rifampin and clindamycin, which produced a profound but transient decrease in carriage. No additional cases occurred.

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Keywords

2 comparison DCCs
 
3 DCCs
 
5 days
 
age 0-24 months
 
antibiotic use
 
day care center
 
DCC contacts
 
ill children
 
index DCC
 
multidrug-resistant serotype 14 S. pneumoniae
 
multidrug-resistant serotype 14 Streptococcus pneumoniae
 
nasopharyngeal samples
 
otitis media
 
outbreak strain
 
pediatrics practice
 
Pneumococcal carriage rates
 
profound
 
pulsed-field gel electrophoresis
 
third DCC
 
upper respiratory tract infections
 

A S Craig