title: High carriage rate of high-level penicillin-resistant Streptococcus pneumoniae in a Taiwan kindergarten associated with a case of pneumococcal meningitis.
abstract: BACKGROUND
  The Taiwan19F-14 Streptococcus pneumoniae clone and its variants are being found with increasing frequency in the Asia-Pacific region. A 5-year old child with S. pneumoniae meningitis caused by a high-level penicillin resistant strain (MIC = 4 microg/ml) was admitted to a hospital in southern Taiwan. We carried out a study to determine the potential source of this strain.
  
  
  METHODS
  Nasopharyngeal cultures were obtained from all children attending the same kindergarten as the index case. To determine their relatedness all isolates were compared by serotype, antimicrobial susceptibility profile and pulsed field gel electrophoresis (PFGE).
  
  
  RESULTS
  A high proportion of the children including the index case (32/78, 41.0%) carried S. pneumoniae in their nasopharynx (NP). The most common serotype was 19F (13/32, 40.6%). The PFGE types of the 19F serotype isolates obtained from the patient's blood, CSF and NP were identical and were related to 11 other serotype 19F NP isolates including 10 that were indistinguishable from the Taiwan19F-14 clone. All 14 isolates had similar high-level penicillin and multi-drug resistance. The serotypes of the other 19 NP isolates included 6A (2), 6B (10), 23F (5), 9V (1) and 3 (1). The overall rate of penicillin resistance in these S. pneumoniae from these children was 87.5% (28/32), with an MIC50 of 2 and MIC90 of 4 ug/ml. In addition, multi-drug resistant-isolates (isolates resistant to 3 different classes of antimicrobials) accounted for 87.5% (28/32) of all isolates.
  
  
  CONCLUSIONS
  The high carriage rate of high-level penicillin- and multi-drug- resistant S. pneumoniae in a kindergarten associated with a case of pneumococcal meningitis emphasizes the need for restraint in antibiotic use and consideration of childhood immunization with conjugate pneumococcal vaccine to prevent the further spread of resistant S. pneumoniae in Taiwan.
authors.affiliation: Division of Clinical Research, National Health Research Institutes, Zhunan, Taiwan. lauderdale@nhri.org.tw
authors.forename: Tsai-Ling
authors.initials: TL
authors.lastname: Lauderdale
authors.forename: Wei Yang
authors.initials: WY
authors.lastname: Lee
authors.forename: Ming Fang
authors.initials: MF
authors.lastname: Cheng
authors.forename: I Fei
authors.initials: IF
authors.lastname: Huang
authors.forename: Yu Chen
authors.initials: YC
authors.lastname: Lin
authors.forename: Kai Sheng
authors.initials: KS
authors.lastname: Hseih
authors.forename: I-Wen
authors.initials: IW
authors.lastname: Huang
authors.forename: Christine C
authors.initials: CC
authors.lastname: Chiou
mesh_terms: D002353:Carrier State / Q000382:microbiology*; D002675:Child, Preschool; D006801:Humans; D008586:Meningitis, Pneumococcal / Q000382:microbiology*; D008826:Microbial Sensitivity Tests; D009305:Nasopharynx / Q000382:microbiology; D010403:Penicillin Resistance; D010802:Phylogeny; D012574:Schools; D013296:Streptococcus pneumoniae / Q000187:drug effects* / Q000235:genetics; D013624:Taiwan