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Gili Regev-Yochay, MD; Ron Dagan, MD; Meir Raz, MD; Yehuda Carmeli, MD, MPH; Bracha Shainberg, PhD; Estela Derazne, MSc; Galia Rahav, MD; Ethan Rubinstein, MD

JAMA. 2004;292:716-720.

Context  Widespread pneumococcal conjugate vaccination may bring about epidemiologic changes in upper respiratory tract flora of children. Of particular significance may be an interaction between Streptococcus pneumoniae and Staphylococcus aureus, in view of the recent emergence of community-acquired methicillin-resistant S aureus.

Objective  To examine the prevalence and risk factors of carriage of S pneumoniae and S aureus in the prevaccination era in young children.

Design, Setting, and Patients  Cross-sectional surveillance study of nasopharyngeal carriage of S pneumoniae and nasal carriage of S aureus by 790 children aged 40 months or younger seen at primary care clinics in central Israel during February 2002.

Main Outcome Measures  Carriage rates of S pneumoniae (by serotype) and S aureus; risk factors associated with carriage of each pathogen.

Results  Among 790 children screened, 43% carried S pneumoniae and 10% carried S aureus. Staphylococcus aureus carriage among S pneumoniae carriers was 6.5% vs 12.9% in S pneumoniae noncarriers. Streptococcus pneumoniae carriage among S aureus carriers was 27.5% vs 44.8% in S aureus noncarriers. Only 2.8% carried both pathogens concomitantly vs 4.3% expected dual carriage (P = .03). Risk factors for S pneumoniae carriage (attending day care, having young siblings, and age older than 3 months) were negatively associated with S aureus carriage.

Conclusions  Streptococcus pneumoniae carriage, specifically of vaccine-type strains, is negatively associated with S aureus carriage in children. The implications of these findings in the pneumococcal vaccine era require further investigation.

Author Affiliations: Sheba Medical Center, Tel Hashomer (Drs Regev-Yochay, Rahav, and Rubinstein and Ms Derazne), and Sourasky Medical Center (Dr Carmeli), Sackler School of Medicine, Tel-Aviv University, and Tel-Aviv, Israel; and Soroka University Medical Center and Faculty of Health Science, Ben Gurion University of the Negev, Beer-Sheva, Israel (Dr Dagan).

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