Antimicrobial susceptibility and serotype distribution of Streptococcus pneumoniae causing meningitis in Egypt, 1998-2003.
OBJECTIVE
To determine the antimicrobial susceptibility and serotype distribution of 205 isolates of Streptococcus pneumoniae, collected from the CSF of meningitis patients identified between 1998-2003, during sentinel meningitis surveillance in Egypt.


METHODS
Antimicrobial susceptibility was evaluated against six antibiotics using disc diffusion and Etest methods. Serotyping was performed by latex agglutination and the Quellung test.


RESULTS
Forty-nine percent of all isolates were found to be non-susceptible to penicillin (46% intermediate, MIC range 0.12-1.0 mg/L; 3% resistant, MIC = 2.0 mg/L), and 6% of the isolates were non-susceptible to ceftriaxone (5% intermediate, MIC = 1.0 mg/L; 1.3% resistant, MIC >/= 2 mg/L). Resistance rates for tetracycline and trimethoprim/sulfamethoxazole were high (52 and 59.7%, respectively), but those for erythromycin and chloramphenicol were lower (11 and 9%, respectively). Five serotypes (6B, 1, 19A, 23F and 6A) accounted for 37% of the total isolates. Ten isolates (5%) were non-typeable. Overall, 29 and 42% of serotypes were represented in the 7- and 11-valent conjugate vaccines, respectively. However, vaccine coverage for children <2 years was 38 and 56% for the 7- and 11-valent, respectively.


CONCLUSIONS
Resistance to penicillin may be increasing among S. pneumoniae strains causing meningitis in Egypt, and a moderate proportion of these strains are not covered by current pneumococcal conjugate vaccines. In addition to intensifying education efforts about judicious use of antibiotics, laboratory-based surveillance for other forms of invasive pneumococcal disease, especially pneumonia, is needed before decisions can be made regarding the most effective vaccines for control of this disease in Egypt.
Wasfy
Momtaz O
MO
U.S. Naval Medical Research Unit No. 3, Cairo, Egypt. wasfym@namru3.med.navy.mil
Pimentel
Guillermo
G
Abdel-Maksoud
Mohammed
M
Russell
Kevin L
KL
Barrozo
Christopher P
CP
Klena
John D
JD
Earhart
Kenneth
K
Hajjeh
Rana
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D006801:Humans; D007223:Infant; D008586:Meningitis, Pneumococcal / Q000382:microbiology* / Q000517:prevention & control; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D022242:Pneumococcal Vaccines / Q000276:immunology; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification / Q000187:drug effects*; D013997:Time Factors
D022242:Pneumococcal Vaccines