[Distribution of serotypes and antibiotic susceptibility patterns of Streptococcus pneumoniae strains isolated from children in Misiones, Argentina].
BACKGROUND
The aim of this study was to assess the local resistance patterns and serotypes of Streptococcus pneumoniae implicated in invasive infections in children in Hospital Provincial de Pediatría in Misiones, Argentina.


METHODS
A total of 101 strains isolated from sterile sites between June 1998 and June 2001 were studied. Strains were identified according to standard methods. Resistance patterns were determined by disk diffusion and a macrodilution method according to NCCLS guidelines. Capsular typing was based on the Quellung technique.


RESULTS
Among the total, 62% of pneumonia cases, 70% of pneumonia with pleural effusion and meningitis, and 78% of sepsis occurred in children younger than 2 years old (74% of the total). Twelve serotypes were detected among 71 strains analyzed. Types 14 (37.1%), 5 (21.4%), 1 (10%), 6A/6B (7.1%), 9N and 19A (5.7%) and 9V (4.3%), were the most frequent. Penicillin (PEN) resistance was detected in 39% of isolates: 17.5% had intermediate levels and 21.5% high levels of resistance. None of the strains had PEN MICs of > 4 microg/ml. PEN resistance was limited to 5 serotypes, with 84% corresponding to type 14. Among the 71 strains, in 50 CTX MICs were < or = 0.5 microg/ml, in 18 the MIC was 1 mg/ml and in 3 the MIC was 2 microg/ml. None of the strains had CTX MICs of > 2 microg/ml. Twenty-two percent of strains were resistant to tetracycline, 48% to trimethoprim-sulfamethoxazole (TMS), 11% to chloramphenicol (CLO) and 6.8% to erythromycin. None of the isolates were resistant to vancomycin, ofloxacin or rifampin. The most common combined resistance patterns were PEN-TMS (20%), PEN-CTX-TMS (7%, 3 strains with a CTX MIC of 2 .g/ml) and PEN-TMS-CLO (5%).


CONCLUSIONS
The local drug resistance patterns and serotype distribution defined in this study allow appropriate empirical therapy to be established in our area and provide information that can be used assess vaccination strategies as a preventive tool for the control of invasive pneumococcal infections.
Grenon
Sandra
S
Servicio de Microbiología, Hospital Provincial de Pediatría de Misiones, Facultad de Ciencias Exactas Químicas y Naturales, Universidad Nacional de Misiones, Posadas, Argentina.
von Specht
Martha
M
Corso
Alejandra
A
Pace
Julio
J
Regueira
Mabel
M
D001118:Argentina / Q000453:epidemiology; D015373:Bacterial Typing Techniques; D002648:Child; D002675:Child, Preschool; D004351:Drug Resistance; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008586:Meningitis, Pneumococcal / Q000453:epidemiology / Q000382:microbiology; D011008:Pneumococcal Infections / Q000453:epidemiology / Q000382:microbiology; D011018:Pneumonia, Pneumococcal / Q000453:epidemiology / Q000382:microbiology; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology / Q000382:microbiology; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification* / Q000187:drug effects / Q000302:isolation & purification