title: Carriage of multidrug-resistant Streptococcus pneumoniae and impact of chemoprophylaxis during an outbreak of meningitis at a day care center.
abstract: 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.
authors.affiliation: Tennessee Department of Health, Communicable and Environmental Disease Services, Nashville, TN 37247-5281, USA. acraig@mail.state.tn.us
authors.forename: A S
authors.initials: AS
authors.lastname: Craig
authors.forename: P C
authors.initials: PC
authors.lastname: Erwin
authors.forename: W
authors.initials: W
authors.lastname: Schaffner
authors.forename: J A
authors.initials: JA
authors.lastname: Elliott
authors.forename: W L
authors.initials: WL
authors.lastname: Moore
authors.forename: X T
authors.initials: XT
authors.lastname: Ussery
authors.forename: L
authors.initials: L
authors.lastname: Patterson
authors.forename: A D
authors.initials: AD
authors.lastname: Dake
authors.forename: S G
authors.initials: SG
authors.lastname: Hannah
authors.forename: J C
authors.initials: JC
authors.lastname: Butler
mesh_terms: 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*
chemical_list: D001428:Bacterial Vaccines; D022242:Pneumococcal Vaccines