title: Patterns of antibiotic-resistant Streptococcus pneumoniae in children in a day-care setting.
abstract: BACKGROUND
  Streptococcus pneumoniae is one of the primary causes of illness and death among young children, and evidence suggests that the prevalence of antibiotic-resistant S pneumoniae is increasing. The purpose of this study was to investigate the prevalence of antibiotic-resistant S pneumoniae in a sample of children in day-care facilities in a region that includes both rural and urban communities.
  
  
  METHODS
  Nasopharyngeal cultures were obtained from 104 children in eight day-care centers located in rural and urban central Kentucky in April and May, 1997. Thirty-five of the children produced isolates positive for S pneumoniae. Each isolate was tested for susceptibility to penicillin, trimethoprim-sulfamethoxazole, erythromycin, tetracycline, vancomycin, and cefotaxime.
  
  
  RESULTS
  Of the children with S pneumoniae isolates, 54% had isolates that were resistant to penicillin and 40% that were resistant to trimethoprim-sulfamethoxazole. Twenty-one (60%) of the isolates had resistance to at least one of the six tested antimicrobials, with 15 (43%) having resistance to more than one of the antimicrobials. The mean age of children with isolates resistant to penicillin was significantly less (2.7 + 1.6) than those with penicillin-susceptible isolates (3.7 + 1.1, P = .02). There was no relation between resistance and rural or urban day-care location.
  
  
  CONCLUSIONS
  A substantial proportion of S pneumoniae isolates in young children are resistant to antibiotics. Limiting the effect of S pneumoniae drug resistance may require a reexamination of outpatient treatment strategies for childhood respiratory tract infections.
authors.affiliation: Department of Family Practice, University of Kentucky, Lexington 40536-0284, USA.
authors.forename: A G
authors.initials: AG
authors.lastname: Mainous
authors.forename: M E
authors.initials: ME
authors.lastname: Evans
authors.forename: W J
authors.initials: WJ
authors.lastname: Hueston
authors.forename: W B
authors.initials: WB
authors.lastname: Titlow
authors.forename: L J
authors.initials: LJ
authors.lastname: McCown
mesh_terms: D002648:Child; D002656:Child Day Care Centers; D002675:Child, Preschool; D004352:Drug Resistance, Microbial; D005260:Female; D006801:Humans; D007223:Infant; D007629:Kentucky; D008297:Male; D009305:Nasopharynx / Q000382:microbiology; D010403:Penicillin Resistance; D013296:Streptococcus pneumoniae / Q000187:drug effects*