title: Susceptibility of pneumococcal carriage isolates to penicillin provides a conservative estimate of susceptibility of invasive pneumococci.
abstract: OBJECTIVE
  Because of its practical importance for public health monitoring in developing countries, we aimed to determine whether susceptibility to penicillin of pneumococci isolated from the upper respiratory tract (URT) is representative of the susceptibility of pneumococci causing pneumonia in children.
  
  
  METHODS
  The serogroup distribution and minimum inhibitory concentration of penicillin for 56 and 90 isolates from blood and cerebrospinal fluid, respectively, were compared with those of 833 pneumococcal carriage isolates from Papua New Guinean children. These included 154 and 98 strains from bacteremic and nonbacteremic hospitalized patients with pneumonia, respectively, 350 from outpatients with respiratory infections and 176 and 55, respectively, from children in a community-based study who were healthy or sick with pneumonia.
  
  
  RESULTS
  Proportions of pneumococci intermediately resistant to penicillin were comparable in the URT and blood (60%) in 1985 through 1987 when serogroup distributions in the two sites were similar. However, penicillin resistance was higher in the URT (75%) than blood (44%) in 1980 through 1984 when the less frequently carried, less resistant serogroups (1 to 5, 7 to 12, 45 and 46) accounted for a high proportion of bacteremic strains.
  
  
  CONCLUSIONS
  URT isolates from any group of sick or healthy children could provide a conservative estimate of antimicrobial susceptibility of invasive strains and is a practical way of monitoring susceptibility as well as evaluating the continued effectiveness of standard antibiotic therapy. If there was cause for concern, it would then be necessary to examine invasive isolates.
authors.affiliation: Papua New Guinea Institute of Medical Research, Goroka. dlehmann@gka.imr.ac.pg
authors.forename: D
authors.initials: D
authors.lastname: Lehmann
authors.forename: M
authors.initials: M
authors.lastname: Gratten
authors.forename: J
authors.initials: J
authors.lastname: Montgomery
mesh_terms: D002353:Carrier State; D002648:Child; D004198:Disease Susceptibility; D006801:Humans; D008826:Microbial Sensitivity Tests; D010219:Papua New Guinea; D010403:Penicillin Resistance; D010406:Penicillins / Q000494:pharmacology*; D011008:Pneumococcal Infections / Q000188:drug therapy* / Q000382:microbiology; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification / Q000187:drug effects*
chemical_list: D010406:Penicillins