title: Trends in drug resistance, serotypes, and molecular types of Streptococcus pneumoniae colonizing preschool-age children attending day care centers in Lisbon, Portugal: a summary of 4 years of annual surveillance.
abstract: Of the nasopharyngeal cultures recovered from 942 day care center (DCC) attendees in Lisbon, Portugal, 591 (62%) yielded Streptococcus pneumoniae during a surveillance performed in February and March of 1999. Forty percent of the isolates were resistant to one or more antimicrobial agents. In particular, 2% were penicillin resistant and 20% had intermediate penicillin resistance. Multidrug resistance to macrolides, lincosamides, and tetracycline was the most frequent antibiotype (17% of all isolates). Serotyping and molecular typing by pulsed-field gel electrophoresis were performed for 202 out of 237 drug-resistant pneumococci (DRPn). The most frequent serotypes were 6B (26%), 14 (22%), 19F (16%), 23F (10%), and nontypeable (12%). The majority (67%) of the DRPn strains were representatives of nine international clones included in the Pneumococcal Molecular Epidemiology Network; eight of them had been detected in previous studies. Fourteen novel clones were identified, corresponding to 26% of the DRPn strains. The remaining 7% of the strains were local clones detected in our previous studies. Comparison with studies conducted since 1996 in Portuguese DCCs identified several trends: (i) the rate of DRPn frequency has fluctuated between 40 and 50%; (ii) the serotypes most frequently recovered have remained the same; (iii) nontypeable strains appear to be increasing in frequency; and (iv) a clone of serotype 33F emerged in 1999. Together, our observations highlight that the nasopharynxes of children in DCCs are a melting pot of successful DRPn clones that are important to study and monitor if we aim to gain a better understanding on the epidemiology of this pathogen.
authors.affiliation: The Rockefeller University, 1230 York Ave., New York, NY 10021, USA.
authors.forename: S
authors.initials: S
authors.lastname: Nunes
authors.forename: R
authors.initials: R
authors.lastname: Sá-Leão
authors.forename: J
authors.initials: J
authors.lastname: Carriço
authors.forename: C R
authors.initials: CR
authors.lastname: Alves
authors.forename: R
authors.initials: R
authors.lastname: Mato
authors.forename: A Brito
authors.initials: AB
authors.lastname: Avô
authors.forename: J
authors.initials: J
authors.lastname: Saldanha
authors.forename: J S
authors.initials: JS
authors.lastname: Almeida
authors.forename: I Santos
authors.initials: IS
authors.lastname: Sanches
authors.forename: H
authors.initials: H
authors.lastname: de Lencastre
mesh_terms: D015373:Bacterial Typing Techniques; D002648:Child; D002656:Child Day Care Centers; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009305:Nasopharynx / Q000382:microbiology*; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification / Q000187:drug effects* / Q000235:genetics