title: Colonization with penicillin-nonsusceptible Streptococcus pneumoniae in urban and rural child-care centers.
abstract: OBJECTIVE
  To determine the prevalence of penicillin-nonsusceptible Streptococcus pneumoniae (NS-SP) at 12 child-care centers (CCC) in urban and rural Nebraska and to evaluate the genetic diversity of pneumococcal strains present in the CCC environment.
  
  
  METHODS
  Nasopharyngeal cultures for S. pneumoniae were obtained from children 2 to 24 months old. Capsular serotyping, pulsed field gel electrophoresis (PFGE) and microbroth dilution MICs were performed for all S. pneumoniae. Antibiotic exposure was also evaluated as a potential risk factor for colonization with NS-SP.
  
  
  RESULTS
  Nasopharyngeal colonization with S. pneumoniae was present in 121 (56%) of 215 children. The MICs of penicillin were 0.12 to 1.0 microgram/ml for 57 (47%) and > 1.0 microgram/ml for 10 (8%) isolates. Clindamycin MICs of > 0.5 microgram/ml were found in 6 isolates (5%). MICs of ceftriaxone were 0.5 microgram/ml in 28% of S. pneumoniae and 1.0 microgram/ml in 7%. PFGE and capsular serotyping demonstrated multiple strains that were penicillin-nonsusceptible in both the urban and rural CCC. PFGE and capsular serotype defined shared strains within each CCC, but some PFGE "types" could be found in multiple serotypes. Antibiotic exposure during the 2 months before nasopharyngeal culture was not a statistically significant risk factor for nasopharyngeal colonization with NS-SP.
  
  
  CONCLUSIONS
  NS-SP are highly prevalent in urban and rural Nebraska. PFGE similarities between serotypes may reflect "serotype switching" but may also reflect genetic similarity between S. pneumoniae strains.
authors.affiliation: Department of Pediatrics, Creighton University, Omaha, NE, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Boken
authors.forename: S A
authors.initials: SA
authors.lastname: Chartrand
authors.forename: E S
authors.initials: ES
authors.lastname: Moland
authors.forename: R V
authors.initials: RV
authors.lastname: Goering
mesh_terms: D002353:Carrier State / Q000453:epidemiology / Q000382:microbiology*; D002656:Child Day Care Centers; D006801:Humans; D007223:Infant; D008826:Microbial Sensitivity Tests; D017720:Molecular Epidemiology; D009305:Nasopharynx / Q000382:microbiology; D009329:Nebraska / Q000453:epidemiology; D010403:Penicillin Resistance; D011008:Pneumococcal Infections / Q000453:epidemiology / Q000382:microbiology*; D015995:Prevalence; D012424:Rural Population; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000187:drug effects / Q000302:isolation & purification; D014505:Urban Population