Carriage of multidrug-resistant Streptococcus pneumoniae and impact of chemoprophylaxis during an outbreak of meningitis at a day care center.
Three cases of meningitis due to multidrug-resistant serotype 14 Streptococcus pneumoniae occurred at a day care center (DCC) over 5 days. Cultures of nasopharyngeal samples were done at the index DCC, 2 comparison DCCs, and a pediatrics practice. Isolates were serotyped and subtyped by pulsed-field gel electrophoresis (PFGE) with SmaI. Pneumococcal carriage rates ranged from 44%-65% at the 3 DCCs and 29% in the pediatrics practice. Carriage of multidrug-resistant serotype 14 S. pneumoniae was noted in 13%-19% of children at the 3 DCCs. An outbreak strain was identified by PFGE at the index DCC and 1 other DCC; a closely related strain was found in the third DCC. Carriage of the outbreak strain was associated with being age 0-24 months, antibiotic use, upper respiratory tract infections, and otitis media. DCC contacts of the ill children were offered chemoprophylaxis with rifampin and clindamycin, which produced a profound but transient decrease in carriage. No additional cases occurred.
Craig
A S
AS
Tennessee Department of Health, Communicable and Environmental Disease Services, Nashville, TN 37247-5281, USA. acraig@mail.state.tn.us
Erwin
P C
PC
Schaffner
W
W
Elliott
J A
JA
Moore
W L
WL
Ussery
X T
XT
Patterson
L
L
Dake
A D
AD
Hannah
S G
SG
Butler
J C
JC
D001428:Bacterial Vaccines / Q000276:immunology; D002353:Carrier State / Q000188:drug therapy*; D002648:Child; D002656:Child Day Care Centers; D002675:Child, Preschool; D004196:Disease Outbreaks; D004352:Drug Resistance, Microbial; D018432:Drug Resistance, Multiple; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008586:Meningitis, Pneumococcal / Q000453:epidemiology / Q000517:prevention & control*; D009305:Nasopharynx / Q000382:microbiology; D010349:Patient Compliance; D022242:Pneumococcal Vaccines; D013296:Streptococcus pneumoniae / Q000187:drug effects*
D001428:Bacterial Vaccines; D022242:Pneumococcal Vaccines