[Nasopharyngeal colonization by Streptococcus pneumoniae in children with sickle cell disease receiving prophylactic penicillin].
OBJECTIVE
To determine the prevalence of nasopharyngeal pneumococcus colonization in children with sickle cell disease undergoing penicillin prophylaxis, to identify risk factors for colonization and to serotype and determine antibiotic resistance in pneumococci obtained from those children.


METHODS
Between April 9, 2002 and February 28, 2003, 188 nasopharyngeal swabs were obtained from 98 children with sickle cell disease in follow-up at the Hospital São Paulo-Universidade Federal de São Paulo. Pneumococci were isolated and identified by standard methods. The minimal inhibitory concentration for penicillin was determined by the E-test method. Isolates were serotyped with the use of type-specific antisera for 46 different serotypes (Neufeld-Quellung reaction).


RESULTS
The age of children ranged from 4 months to 17 years (median and standard deviation 6.8-/+4.7 years). Thirteen of the 98 children had nasopharyngeal pneumococcus colonization (13.3% prevalence). There was a significantly greater risk of colonization among children less than 2 years old (p = 0.02). Twenty-one percent of isolates had intermediate penicillin resistance. There were no isolates highly resistant to penicillin. All isolates were susceptible to erythromycin, ceftriaxone, or vancomycin. The most frequently identified serotypes were 18C and 23F.


CONCLUSIONS
Penicillin prophylaxis reduced pneumococcal nasopharyngeal colonization and did not increase the prevalence of penicillin-resistant pneumococci in children with sickle cell disease. Penicillin can be used not only for prophylaxis, but also in the acute management of febrile states with these children.
Fonseca
Patricia B Blum
PB
Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, SP. patricia_blum@uol.com.br
Braga
Josefina Aparecida P
JA
Machado
Antônia Maria de O
AM
Brandileone
Maria Cristina de C
MC
Farhat
Calil Kairalla
CK
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006450:Hemoglobin SC Disease / Q000150:complications / Q000382:microbiology*; D006801:Humans; D007223:Infant; D009305:Nasopharynx / Q000382:microbiology*; D010403:Penicillin Resistance; D010406:Penicillins / Q000627:therapeutic use*; D011008:Pneumococcal Infections / Q000517:prevention & control*; D012307:Risk Factors; D013296:Streptococcus pneumoniae / Q000187:drug effects / Q000302:isolation & purification*
D010406:Penicillins