title: Risk factors for carriage of drug-resistant Streptococcus pneumoniae among children in Memphis, Tennessee.
abstract: OBJECTIVE
  To determine risk factors for carriage of drug-resistant Streptococcus pneumoniae to understand better the factors promoting spread of these isolates.
  
  
  METHODS
  We obtained medical and demographic information and nasopharyngeal swab specimens from 216 children less than 6 years old with upper respiratory tract infections, seeking medical care at five Memphis, Tenn, study sites. We evaluated risk factors for carriage of penicillin-nonsusceptible S. pneumoniae (NSSP) among 100 children with S. pneumoniae isolates. Patterns of antimicrobial prescription were recorded for enrolled children.
  
  
  RESULTS
  Independent risk factors for carriage of NSSP included an increased number of antimicrobial treatment courses during the previous 3 months and white race. Day care attendance approached statistical significance (p = 0.07). Most children with upper respiratory tract infection received a prescription for antimicrobial drugs. These prescriptions were more common for white children than for black children.
  
  
  CONCLUSIONS
  Increased use of antimicrobial drugs enhances the risk of carriage of NSSP. This may contribute to the higher risk among white children of NSSP infection; however, after control for antimicrobial use, white children were still at an increased risk of infection with NSSP, possibly through greater exposure to resistant strains.
authors.affiliation: Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
authors.forename: K E
authors.initials: KE
authors.lastname: Arnold
authors.forename: R J
authors.initials: RJ
authors.lastname: Leggiadro
authors.forename: R F
authors.initials: RF
authors.lastname: Breiman
authors.forename: H B
authors.initials: HB
authors.lastname: Lipman
authors.forename: B
authors.initials: B
authors.lastname: Schwartz
authors.forename: M A
authors.initials: MA
authors.lastname: Appleton
authors.forename: K O
authors.initials: KO
authors.lastname: Cleveland
authors.forename: H C
authors.initials: HC
authors.lastname: Szeto
authors.forename: B C
authors.initials: BC
authors.lastname: Hill
authors.forename: F C
authors.initials: FC
authors.lastname: Tenover
authors.forename: J A
authors.initials: JA
authors.lastname: Elliott
authors.forename: R R
authors.initials: RR
authors.lastname: Facklam
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002353:Carrier State / Q000188:drug therapy* / Q000382:microbiology; D002675:Child, Preschool; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008826:Microbial Sensitivity Tests; D009305:Nasopharynx / Q000382:microbiology; D010403:Penicillin Resistance; D011008:Pneumococcal Infections / Q000188:drug therapy* / Q000382:microbiology; D012141:Respiratory Tract Infections / Q000188:drug therapy* / Q000382:microbiology; D012307:Risk Factors; D013296:Streptococcus pneumoniae / Q000187:drug effects*; D013714:Tennessee / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents