title: The spread of multiply resistant Streptococcus pneumoniae at a day care center in Ohio.
abstract: Streptococcus pneumoniae, type 23F, resistant to penicillin (MIC, 2 micrograms/mL) and multiple other antimicrobic agents, was isolated from middle ear fluid of a child with otitis media attending a day care center in Ohio. To determine the extent of spread of this strain, nasopharyngeal culture surveys were done, and 52 carriers were identified among 250 children attending the index day care center. No carriers were found among 121 children at two other day care centers in the same urban area. Use of prophylactic doses of antibiotics (P < .001) and frequent use of antibiotics (P < 0.001) were risk factors for nasopharyngeal carriage. Carriers were more likely to have had frequent otitis media episodes (P < .02) and otitis media not responsive to antimicrobial therapy (P < .001). Strategies to limit the spread of highly resistant pneumococcal strains should include encouraging judicious use of antimicrobic agents and reevaluating indications for prophylactic use of antimicrobic agents.
authors.affiliation: Respiratory Diseases Branch, Centers for Disease Control, Atlanta, Georgia 30333.
authors.forename: M R
authors.initials: MR
authors.lastname: Reichler
authors.forename: A A
authors.initials: AA
authors.lastname: Allphin
authors.forename: R F
authors.initials: RF
authors.lastname: Breiman
authors.forename: J R
authors.initials: JR
authors.lastname: Schreiber
authors.forename: J E
authors.initials: JE
authors.lastname: Arnold
authors.forename: L K
authors.initials: LK
authors.lastname: McDougal
authors.forename: R R
authors.initials: RR
authors.lastname: Facklam
authors.forename: B
authors.initials: B
authors.lastname: Boxerbaum
authors.forename: D
authors.initials: D
authors.lastname: May
authors.forename: R O
authors.initials: RO
authors.lastname: Walton
mesh_terms: D000328:Adult; D000367:Age Factors; D002353:Carrier State / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D002648:Child; D002656:Child Day Care Centers; D002675:Child, Preschool; D004352:Drug Resistance, Microbial; D015643:Erythromycin Ethylsuccinate / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D009305:Nasopharynx / Q000382:microbiology; D009820:Ohio / Q000453:epidemiology; D010033:Otitis Media / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D010403:Penicillin Resistance; D011008:Pneumococcal Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D012293:Rifampin / Q000627:therapeutic use; D012307:Risk Factors; D013296:Streptococcus pneumoniae / Q000187:drug effects* / Q000302:isolation & purification
chemical_list: D015643:Erythromycin Ethylsuccinate; D012293:Rifampin