title: Carriage of gram-negative bacilli in young Brazilian children with community-acquired pneumonia.
abstract: BACKGROUND
  Gram-negative bacilli are not infrequently encountered as etiologic organisms of pneumonia in children in warm-climate countries.
  
  
  OBJECTIVE
  To investigate the nasopharyngeal carriage rate and antimicrobial susceptibility patterns of gram-negative bacilli colonizing children with community-acquired pneumonia in Fortaleza, Brazil.
  
  
  METHODS
  A single nasopharyngeal specimen was collected from children 2 months to 5 years of age presenting at one of the three children's hospitals in Fortaleza and fulfilling the World Health Organization criteria for pneumonia. Randomly recruited healthy children from public daycare centers and immunization clinics served as controls.
  
  
  RESULTS
  The study included 912 children, 482 (53%) with pneumonia and 430 (47%) controls. Aerobic gram-negative bacilli were seen in 79 (16%) of the 482 children with pneumonia and 51 (12%) of the 430 healthy controls. Nonfermentative gram-negative bacilli were seen in 85 (18%) of children with pneumonia and 54 (13%) of healthy controls. Neither gender, nutritional status, season, previous hospital admission nor antibiotic use was associated with carriage with gram-negative bacilli. However, pneumonia was associated with increased carriage, whereas concomitant colonization with Streptococcus pneumoniae or Haemophilus influenzae was associated with decreased carriage with gram-negative bacilli. Only 36% of all Escherichia species and 76% of all Klebsiella isolates were susceptible to cotrimoxazole; 90% of all Acinetobacter species were susceptible to gentamicin.
  
  
  CONCLUSIONS
  Nasopharyngeal carriage with gram-negative bacilli, in particular with Acinetobacter species, is common and associated with a clinical diagnosis of community-acquired pneumonia in children in Fortaleza, Brazil.
authors.affiliation: Department of Pediatrics, St. Lucas Andreas Hospital, Amsterdam, The Netherlands. m.j.wolf@amc.uva.nl
authors.forename: B
authors.initials: B
authors.lastname: Wolf
authors.forename: L C
authors.initials: LC
authors.lastname: Rey
authors.forename: L B
authors.initials: LB
authors.lastname: Moreira
authors.forename: D
authors.initials: D
authors.lastname: Milatovic
authors.forename: A
authors.initials: A
authors.lastname: Fleer
authors.forename: J
authors.initials: J
authors.lastname: Verhoef
authors.forename: J J
authors.initials: JJ
authors.lastname: Roord
mesh_terms: D001938:Brazil; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification*; D006801:Humans; D007223:Infant; D008297:Male; D009305:Nasopharynx / Q000382:microbiology*; D018410:Pneumonia, Bacterial / Q000188:drug therapy / Q000382:microbiology*; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
chemical_list: D015662:Trimethoprim, Sulfamethoxazole Drug Combination