title: Invasive disease due to multiply resistant Streptococcus pneumoniae in a Houston, Tex, day-care center.
abstract: Two toddlers who attended the same day-care center were hospitalized hours apart with sepsis and meningitis due to a multiply resistant Streptococcus pneumoniae. We determined the prevalence of multiply resistant S pneumoniae respiratory carriage and disease in infants, toddlers, and staff in the day-care center and in household contacts. The nasopharynges of 82 (96%) of 85 day-care center children, 26 (90%) of 29 day-care center staff, and 28 (90%) of 31 family members were cultured. Streptococcus pneumoniae grew from 29 (35%) of the 82 cultured day-care center children. Ten (34%) of the S pneumoniae isolates were resistant to sulfamethoxazole-trimethoprim, oxacillin, and tetracycline and were relatively resistant to penicillin (minimum inhibitory concentration, 0.5 mg/L). All were serotype 14 and had the same antibiotic resistance pattern. Treatment of 97% of the day-care center children and staff with rifampin (10 mg/kg twice daily for 2 days) resulted in 70% reduction in positive nasopharyngeal cultures for S pneumoniae. No additional disease due to multiply resistant S pneumoniae was identified in the day-care center during a 9-month follow-up period. This report documents that an outbreak of multiply resistant invasive S pneumoniae occurred in a day-care center setting; that nasopharyngeal colonization of exposed children was common; and that rifampin treatment of 2 days only partially eradicated the organism from colonized individuals.
authors.affiliation: Department of Pediatrics, University of Texas Medical School, Houston 77030.
authors.forename: A M
authors.initials: AM
authors.lastname: Rauch
authors.forename: M
authors.initials: M
authors.lastname: O'Ryan
authors.forename: R
authors.initials: R
authors.lastname: Van
authors.forename: L K
authors.initials: LK
authors.lastname: Pickering
mesh_terms: D000284:Administration, Oral; D002353:Carrier State / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D002656:Child Day Care Centers; D004196:Disease Outbreaks; D004352:Drug Resistance, Microbial; D006801:Humans; D007223:Infant; D008586:Meningitis, Pneumococcal / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D009305:Nasopharynx / Q000382:microbiology; D015995:Prevalence; D012293:Rifampin / Q000008:administration & dosage / Q000627:therapeutic use; D018805:Sepsis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D013290:Streptococcal Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D013781:Texas
chemical_list: D012293:Rifampin