Original report| Volume 3, ISSUE 4, P211-215, June 1999

Download started.


Nasopharyngeal carriage of multidrug-resistant Streptococcus pneumoniae in institutionalized HIV infected and HIV-negative children in Northeastern Romania

      This paper is only available as a PDF. To read, Please Download here.


      Objectives: The study compared nasopharyngeal carriage of resistant pneumoniae in human immunodeficiency virus (HIV)-seropositive and -seronegative children.
      Methods: Nasopharyngeal colonization with Streptococcus pneumoniae was investigated during May 1996 in 162 HIV-negative infants and children (age range, 1–38 mo) and 40 HIV-infected children (age range, 39–106 mo) living in an orphanage in Iasi, northeastern Romania. The HIV-infected children lived separated from the other children and were cared for by a different staff. Streptococcus pneumoniae was isolated from 12 of 40 (30%) HIV-infected and from 81 of 160 (50%) HIV-negative children. Antimicrobial susceptibility to penicillin and ceftriaxone was determined by E-test, and to another five antibiotics by disk diffusion. Serotyping was performed by the Quellung method on 81 of 93 (87%) isolates.
      Results: Serotypes 6A, 613, 19A, and 23F together represented 98% of all isolates. Ninety-nine percent of S. pneumoniae isolates were resistant to penicillin, and 74% were highly resistant to penicillin (minimum inhibitory concentration [MIC] > 1 μg/mL); MIC50 and MIC90 to penicillin of the isolates were 2 μg/mL and 8 μg/mL, respectively. Eighty-nine of ninety-one isolates were susceptible to ceftriaxone; 99%, 87%, 87%, 48%, and 21 % of the isolates were resistant to trimethoprim-sulphamethoxazole, erythromycin, clindamycin, tetracycline, and chloramphenicol, respectively. Eighty-two (89%) isolates were multidrug resistant (resistant to ≥3 antibiotic classes); 37 of 92 (40%) isolates were resistant to 5 or more antibiotic classes, and 16 of these 37 (43%) belonged to serotype 19A. All serotype 19 isolates were highly resistant to penicillin.
      Conclusions: No significant differences were observed in the resistance rates of S. pneumoniae in HIV-infected children compared to HIV-negative children. Multidrug-resistant pneumococci were highly prevalent in this Romanian orphanage in both HIV-negative and older HIV-infected children. The observed high prevalence of multidrug-resistant pneumococci (coupled with high penicillin resistance) with a limited number of circulating serotypes emphasizes the need to further evaluate the conjugate vaccines in children at risk for invasive pneumococcal infection.



        • Appelbaum P.C.
        Antimicrobial resistance in Streptococcus pneumoniae: an overview.
        Clin Infect Dis. 1992; 15: 77-83
        • Appelbaum P.C.
        Epidemiology and in vitro susceptibility of drug-resistant Streptococcus pneumoniae.
        Pediatr Infect Dis J. 1996; 15: 932-939
        • Musher D.M.
        Infections caused by Streptococcus pneumoniae: clinical spectrum, pathogenesis, immunity, and treatment.
        Clin Infect Dis. 1992; 14: 801-809
        • Caputo G.M.
        • Appelbaum P.C.
        • Liu H.H.
        Infections due to penicillin-resistant pneumococci: clinical, epidemiologic, and microbiologic features.
        Arch Intern Med. 1993; 153: 1301-1310
        • Kaplan S.L.
        The emergence of resistant pneumococcus as a pathogen in childhood upper respiratory infections.
        Semin Respir Infect. 1996; 10: 31-36
        • Friedland I.R.
        • McCracken G.H.
        Management of infections caused by antibiotic-resistant Streptococcus pneumoniae.
        N Engl J Med. 1994; 331: 377-382
        • Dagan R.
        • Melamed R.
        • Mualem M.
        • Piglansky L.
        • Yagupsky P.
        Nasopharyngeal colonization in southern Israel with antibiotic-resistant pneumococci during the first 2 years of life: relation to serotypes likely to be included in pneumococcal conjugate vaccines.
        J Infect Dis. 1996; 174: 1352-1355
        • Yagupsky P.
        • Porat N.
        • Prajgrod F.
        • et al.
        Acquisition, carriage, and transmission of pneumococci with reduced antibiotic susceptibility in young children attending a day-care facility in southern Israel.
        J Infect Dis. 1998; 177: 1003-1012
        • Reichler M.R.
        • Allphin A.A.
        • Breiman R.E.
        • et al.
        The spread of multiply resistant Streptococcus pneumoniae at a day care center in Ohio.
        J Infect Dis. 1992; 166: 1346-1353
        • Boken D.J.
        • Chartrand S.A.
        • Goering R.V.
        • Kruger R.
        • Harrison C.J.
        Colonization with penicillin-resistant Streptococcus pneumoniae in a child-care center.
        Pediatr Infect Dis J. 1995; 14: 879-884
        • Duchin J.S.
        • Breiman R.E.
        • Diamond A.
        • et al.
        High prevalence of multidrug-resistant Streptococcus pneumoniae among children in a rural Kentucky community.
        Pediatr Infect Dis J. 1995; 14: 745-750
        • Mastro T.D.
        • Nomani N.K.
        • Ishaq Z.
        • et al.
        Use of nasopharyngeal isolates of Streptococcus pneumoniae and Haemophilus influenzae from children in Pakistan for surveillance for antimicrobial resistance.
        Pediatr Infect Dis J. 1993; 12: 824-830
        • Lehmann D.
        • Gratten M.
        • Montgomery J.
        Susceptibility of pneumococcal carriage isolates to penicillin provides a conservative estimate of susceptibility of invasive pneumococci.
        Pediatr Infect Dis J. 1997; 16: 297-305
        • Baquero F.
        • Martinez-Beltran J.
        • Loza E.
        A review of antibiotic resistance patterns of Streptococcus pneumoniae in Europe.
        J Antimicrob Chemother. 1991; 28: 31-38
        • Marton A.
        Pneumococcal antimicrobial resistance: the problem in Hungary.
        Clin Infect Dis. 1992; 15: 106-111
        • Hryniewicz W.
        Bacterial resistance in eastern Europe: selected problems.
        Scand J Infect Dis Suppl. 1994; 93: 33-39
        • Stetchanova L.
        Clinical isolates and nasopharyngeal carriage of antibiotic-resistant Streptococcus pneumoniae in Hospital for Infectious Diseases, Sofia, Bulgaria, 1991–1993.
        Microb Drug Resist. 1995; 1: 79-84
        • Syrogiannoupoulos G.A.
        • Grives I.N.
        • Beratis N.G.
        • et al.
        Resistance patterns of Streptococcus pneumoniae from carriers attending day-care centers in southwestern Greece.
        Clin Infect Dis. 1997; 25: 188-194
        • National Committee for Clinical Laboratory Standards
        3rd Ed. Performance standards for antimicrobial susceptibility testing: sixth informed supplement. Vol. 15. National Committee for Clinical Laboratory Standards, Villanova, PA1995 (No. 14. Document M100S6)
        • Austrian R.
        The Quellung reaction, a neglected microbiologic technique.
        Mt Sinai J Med. 1976; 43: 669-705
        • Vata A.
        • Turcu T.
        • Mihut V.
        • et al.
        Penicillin-resistant Streptococcus pneumoniae.
        Arch Roum Pathol Exp Microbiol. 1977; 36: 277-283
        • Mihalcu F.
        • Stanescu C.
        • Mermezan E.
        • et al.
        Surveillance of Streptococcus pneumoniae infection during 1974–1981.
        Arch Roum Pathol Exp Microbiol. 1983; 42: 65-74
        • Millar M.
        • Grover M.
        • Osbourne F.
        • Antoniou A.
        Control of antibiotic-resistant Streptococcus pneumoniae in Romania.
        Lancet. 1991; 338: 323-324
        • Vereanu A.
        • Mihalcu F.
        • Ungureanu V.
        • Buzatu S.
        Sensitivity to penicillin of S. pneumoniae strains isolated from various pathological conditions.
        Roum Arch Microbiol Immunol. 1992; 51: 171-182
        • Appelbaum P.C.
        • Gladkova C.
        • Hryniewicz W.
        • et al.
        Carriage of antibiotic-resistant Streptococcus pneumoniae by children in Eastern and Central Europe: a multicenter study with use of standardized methods.
        Clin Infect Dis. 1996; 23: 712-717
        • Jacobs M.R.
        • Dagan R.
        • Appelbaum P.C.
        • Burch D.J.
        Prevalence of antimicrobial-resistant pathogens in middle ear fluid: multinational study of 917 children with acute otitis media.
        Antimicrob Agents Chemother. 1998; 42: 589-595
        • Johnson D.E.
        • Miller L.C.
        • Iverson S.
        • et al.
        The health of children adopted from Romania.
        JAMA. 1992; 268: 3446-3451
        • Hersh B.S.
        • Popovici F.
        • Apetrei R.C.
        • et al.
        Acquired immunodeficiency syndrome in Romania.
        Lancet. 1991; 338: 645-649
        • Patrascu I.V.
        • Dumitrescu O.
        The epidemic of human immunodeficiency virus infection in Romanian children.
        AIDS Res Hum Retroviruses. 1993; 9: 99-104
        • Leibovitz E.
        • Cooper D.
        • Giurgiutiu D.
        • et al.
        Varicella-zoster virus infection in Romanian children infected with the human immunodeficiency virus.
        Pediatrics. 1993; 92: 838-842
        • Brannan D.K.
        • Greenfeld R.A.
        • Owen W.L.
        • et al.
        Protozoal colonization of the intestinal tract in institutionalized Romanian children.
        Clin Infect Dis. 1996; 22: 456-461
        • Nigro G.
        • Luzi G.
        • Krzysztofiak A.
        • et al.
        Detection of IgM antibodies to human herpesvirus 6 in Romanian children with nonprogressive human immunodeficiency virus disease.
        Pediatr Infect Dis J. 1995; 14: 891-894
        • Janoff E.N.
        • O'Brien J.
        • Thompson P.
        • et al.
        Streptococcus pneumoniae colonization, bacteremia, and immune response among persons with human immunodeficiency virus infection.
        J Infect Dis. 1993; 167: 49-56
        • Gesner M.
        • Desiderio D.
        • Kim M.
        • et al.
        Streptococcus pneumoniae in human immunodeficiency virus type 1-infected children.
        Pediatr Infect Dis J. 1994; 13: 697-703
        • Rusen I.D.
        • Fraser-Roberts L.
        • Slanley L.
        • et al.
        Nasopharyngeal pneumococcal colonization among Kenyan children: antibiotic resistance, strain types, and associations with human immunodeficiency virus type 1 infection.
        Pediatr Infect Dis J. 1997; 16: 656-662
        • Rodriguez-Barradas M.C.
        • Tharapel R.A.
        • Groover J.E.
        • et al.
        Colonization by Streptococcus pneumoniae among human immunodeficiency virus-infected adults: prevalence of antibiotic resistance, impact of immunization, and characterization by polymerase chain reaction with BOX primers of isolates from persistent S. pneumoniae carriers.
        J Infect Dis. 1997; 175: 590-597
        • Dagan R.
        • Melamed R.
        • Muallem M.
        • et al.
        Reduction of nasopharyngeal carriage of pneumococci during the second year of life by a heptavalent conjugate pneumococcal vaccine.
        J Infect Dis. 1996; 174: 1271-1278
        • Dagan R.
        • Melamed R.
        • Zamir O.
        • Leroy O.
        Safety and immunogenicity of tetravalent pneumococcal vaccines containing 6B, 14, 19E and 23F polysaccharides conjugated to either tetanus toxoid or diphtheria toxoid in young infants, and their boosterability by native polysaccharide antigens.
        Pediatr Infect Dis J. 1997; 16: 1053-1059
        • Dagan R.
        • Muallem M.
        • Melamed R.
        • Leroy O.
        • Yagupsky E.
        Reduction of pneumococcal nasopharyngeal carriage in early infancy after immunization with tetravalent pneumococcal vaccines conjugated to either tetanus toxoid or diphtheria toxoid.
        Pediatr Infect Dis J. 1997; 16: 1060-1064