Rising Pneumococcal Antibiotic Resistance in the Post–13-Valent Pneumococcal Conjugate Vaccine Era in Pediatric Isolates From a Primary Care Setting

Abstract Background Antibiotic-resistant Streptococcus pneumoniae strains may cause infections that fail to respond to antimicrobial therapy. Results reported from hospitalized patients with invasive, bacteremic infections may not be the same as those observed in a primary care setting where young children receive care for noninvasive infections. Young children experience the highest burden of pneumococcal disease. The aim of this study was to determine the antibiotic susceptibility of S. pneumoniae strains isolated from children in a primary care setting in the post–13-valent pneumococcal conjugate vaccine (PCV13) era. Methods This was a prospective collection of 1201 isolates of S. pneumoniae from 2006 through 2016 in a primary care setting. Antibiotic susceptibility testing to 16 different antibiotics of 10 classes was performed. Participants were children aged 6–36 months. Nasopharyngeal swabs were obtained from patients during acute otitis media (AOM) visits and routine healthy visits. Middle ear fluid was obtained by tympanocentesis. Results After introduction of PCV13, antibiotic susceptibility of pneumococci, especially to penicillin, initially improved largely due to disappearance of serotype 19A, included in PCV13. However, beginning in 2013, antibiotic susceptibility among pneumococcal strains began decreasing due to new serotypes not included in PCV13. In addition to reduced susceptibility to penicillin, the most recent isolates show reduced susceptibility to third-generation cephalosporins, fluoroquinolones, and carbapenems, antibiotics commonly used to treat life-threatening, invasive pneumococcal diseases. Conclusions In recent years, pneumococcal nasopharyngeal and AOM isolates from children exhibit reduced susceptibility to penicillin, third-generation cephalosporin, fluoroquinolone, and carbapenem antibiotics. The new strains have a different profile of resistance compared to the pre-PCV13 era.

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Efficacy, safety and immunogenicity of a pneumococcal protein-based vaccine co-administered with 13-valent pneumococcal conjugate vaccine against acute otitis media in young children: A phase IIb randomized study

Vaccine ◽

10.1016/j.vaccine.2019.09.076 ◽

2019 ◽

Vol 37 (51) ◽

pp. 7482-7492 ◽

Cited By ~ 8

Author(s):

Laura L. Hammitt ◽

James C. Campbell ◽

Dorota Borys ◽

Robert C. Weatherholtz ◽

Raymond Reid ◽

...

Keyword(s):

Young Children ◽

Otitis Media ◽

Conjugate Vaccine ◽

Pneumococcal Conjugate Vaccine ◽

Randomized Study ◽

Acute Otitis Media

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Pneumococcal Conjugate Vaccine Does Not Influence Staphylococcus aureus Carriage in Young Children with Acute Otitis Media

Clinical Infectious Diseases ◽

10.1086/523734 ◽

2007 ◽

Vol 45 (12) ◽

pp. 1583-1587 ◽

Cited By ~ 25

Author(s):

R. Cohen ◽

C. Levy ◽

F. Thollot ◽

F. de La Rocque ◽

M. Koskas ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Young Children ◽

Otitis Media ◽

Conjugate Vaccine ◽

Pneumococcal Conjugate Vaccine ◽

Acute Otitis Media

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Faculty Opinions recommendation of Efficacy, safety and immunogenicity of a pneumococcal protein-based vaccine co-administered with 13-valent pneumococcal conjugate vaccine against acute otitis media in young children: A phase IIb randomized study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.736779516.793573976 ◽

2020 ◽

Author(s):

Charles Feldman

Keyword(s):

Young Children ◽

Otitis Media ◽

Conjugate Vaccine ◽

Pneumococcal Conjugate Vaccine ◽

Randomized Study ◽

Acute Otitis Media

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Impact of Culturing All Uncomplicated Urinary Tract Infections on the Estimated Prevalence Of Resistance in the Primary Care Setting

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.839 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S349-S349

Author(s):

Gregory B Tallman ◽

Miriam R Elman ◽

Adriane N Irwin ◽

Brie N Noble ◽

Peter K Atkins ◽

...

Keyword(s):

Primary Care ◽

Urinary Tract ◽

Usual Care ◽

Antibiotic Susceptibility ◽

Care Setting ◽

Primary Care Setting ◽

Cross Sectional ◽

Primary Care Clinics ◽

Tract Infections ◽

Care Period

Abstract Background Urine cultures to confirm a urinary tract infection (UTI) are not consistently collected in the primary care setting; thus estimates of the prevalence of resistance in uropathogens may be biased. As part of an ongoing study, microbiologic cultures were collected for all patients presenting with uncomplicated UTI at primary care clinics over a six-month period to assess the potential misclassification in frequency of resistance. Methods Data from an electronic health record repository were used to identify clinic encounters for women with a diagnosis code for unspecified UTI or cystitis from six primary care clinics between October 1, 2015 and February 28, 2017 in this cross-sectional study. Prior to August 22, 2016, urine microbiology cultures were collected at the discretion of the provider (usual care period), and from August 22, 2016 to February 28, 2017 urinary microbiology cultures were collected from all patients suspected of having uncomplicated UTI (full culturing period). Urinary microbiology culture and pharmacy data occurring within three days of the encounter were collected. Antibiotic susceptibility data was summarized for isolated Enterobacteriaceae. Frequency of susceptibility to trimethoprim-sulfamethoxazole (TMP-SMX), nitrofurantoin, and fluoroquinolones were compared between usual care vs. the full culturing periods using a chi-square test. Results We identified 131 urine microbiology cultures in the usual care period and 104 in the full culturing period with 61.1% and 55.8%, respectively, being positive cultures. Enterobacteriaceae were isolated from 85.0% of positive cultures in the usual care period and 86.2% in the full culturing period. Between the usual and full culturing periods, antibiotic susceptibility in the Enterobacteriaceae did not differ statistically for TMP-SMX (85.1% vs.. 88.0%; P = 0.65), nitrofurantoin (98.5% vs. 94.0%; P = 0.19), and fluoroquinolones (89.6% vs. 90.0%; P = 0.94). Conclusion Full culturing did not significantly change estimates of the prevalence of antibiotic resistance among Enterobacteriaceae isolated from urine samples. Current urine culturing practices provide adequate susceptibility information to inform empiric prescribing for women with uncomplicated UTIs. Disclosures J. C. McGregor, Merck & Co.: Grant Investigator, Research grant

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