 |
|
Emergence of a Multiresistant Serotype 19A Pneumococcal Strain Not Included in the 7-Valent Conjugate Vaccine as an Otopathogen in Children
Michael E. Pichichero, MD;
Janet R. Casey, MD
JAMA. 2007;298:1772-1778.
Context Concern has been raised about the possible emergence of a bacterial strain that is untreatable by US Food and Drug Administration (FDA)–approved antibiotics and that causes acute otitis media (AOM) in children.
Objective To monitor continuing shifts in the strains of Streptococcus pneumoniae that cause AOM, with particular attention to capsular serotypes and antibiotic susceptibility, following the introduction of a pneumococcal 7-valent conjugate vaccine (PCV7).
Design, Setting, and Patients Prospective cohort study using tympanocentesis to identify S pneumoniae strains that caused AOM in children receiving PCV7 between September 2003 and June 2006. All children were from a Rochester, New York, pediatric practice.
Main Outcome Measure Determination of serotypes and antibiotic susceptibility of S pneumoniae causing AOM.
Results Among 1816 children in whom AOM was diagnosed, tympanocentesis was performed in 212, yielding 59 cases of S pneumoniae infection. One strain of S pneumoniae belonging to serotype 19A was a new genotype and was resistant to all antibiotics approved by the FDA for use in children with AOM. This strain was identified in 9 cases (2 in 2003-2004, 2 in 2004-2005, and 5 in 2005-2006). Four children infected with this strain had been unsuccessfully treated with 2 or more antibiotics, including high-dose amoxicillin or amoxicillin-clavulanate and 3 injections of ceftriaxone; 3 had recurrent AOM; and for 2 others, the infection was their first in life. The first 4 cases required tympanostomy tube insertion after additional unsuccessful antibiotic therapies. Levofloxacin was used in the subsequent 5 cases, with resolution of infection without surgery.
Conclusion In the years following introduction of PCV7, a strain of S pneumoniae has emerged in the United States as an otopathogen that is resistant to all FDA-approved antibiotics for treatment of AOM in children.
Author Affiliations: University of Rochester and Legacy Pediatrics, Rochester, New York.
RELATED ARTICLE
Antimicrobial Resistance: It's Not Just for Hospitals
Elizabeth A. Bancroft
JAMA. 2007;298(15):1803-1804.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
A Second Pilus Type in Streptococcus pneumoniae Is Prevalent in Emerging Serotypes and Mediates Adhesion to Host Cells
Bagnoli et al.
J. Bacteriol. 2008;190:5480-5492.
ABSTRACT
| FULL TEXT
Prevalence of Serotype 19A Streptococcus pneumoniae among Isolates from U.S. Children in 2005-2006 and Activity of Faropenem
Critchley et al.
Antimicrob. Agents Chemother. 2008;52:2639-2643.
ABSTRACT
| FULL TEXT
Pneumococcal Mastoiditis in Children and the Emergence of Multidrug-Resistant Serotype 19A Isolates
Ongkasuwan et al.
Pediatrics 2008;122:34-39.
ABSTRACT
| FULL TEXT
Antistreptococcal Activity of AR-709 Compared to That of Other Agents
Smith et al.
Antimicrob. Agents Chemother. 2008;52:2279-2282.
ABSTRACT
| FULL TEXT
Over the counter medicines: proceed with caution
Ferner and Beard
BMJ 2008;336:694-696.
FULL TEXT
Changes in Serotypes and Antimicrobial Susceptibility of Invasive Streptococcus pneumoniae Strains in Cleveland: a Quarter Century of Experience
Jacobs et al.
J. Clin. Microbiol. 2008;46:982-990.
ABSTRACT
| FULL TEXT
Multiresistant Pneumococci in Otitis Media
Schiff
AAP Grand Rounds 2008;19:4-4.
FULL TEXT
Treatment of Common Pediatric Infections: The Pros and Cons of Fluoroquinolones
JWatch Pediatrics 2007;2007:2-2.
FULL TEXT
Pneumococcal Otopathogen Not Vulnerable to Approved Antibiotics and Vaccine
JWatch Emergency Med. 2007;2007:3-3.
FULL TEXT
Serotype 19A S. pneumoniae: A Growing Problem for Children
JWatch Infect. Diseases 2007;2007:1-1.
FULL TEXT
New Worries About Multidrug-Resistant Bacteria
JWatch General 2007;2007:2-2.
FULL TEXT
Antimicrobial Resistance: It's Not Just for Hospitals
Bancroft
JAMA 2007;298:1803-1804.
FULL TEXT
|
