title: Mechanisms by which antibiotics promote dissemination of resistant pneumococci in human populations.
abstract: Mechanisms by which antimicrobials contribute to dissemination of pneumococcal resistance are incompletely characterized. A serial cross-sectional study of nasopharyngeal pneumococcal carriage in healthy, home-living children <or=6 years of age was conducted in four rural communities-two in Utah (1998-2003) and two in Idaho (2002-2003). Prevalence odds ratios for carriage of resistant pneumococci (OR(res)) and of susceptible pneumococci (OR(sus)) were estimated. Dynamic transmission models were developed to facilitate a mechanistic interpretation of OR(res) and OR(sus) and to compare the population impact of distinct antimicrobial classes. A total of 5,667 cultures were obtained; 25% of the cultures were positive, and 29% of isolates exhibited reduced susceptibility to penicillin. The adjusted OR(res) for recent individual and sibling cephalosporin use was 2.2 (95% confidence interval: 1.4, 3.4) and 1.8 (95% confidence interval: 1.0, 3.3), respectively. Neither individual nor sibling penicillin use was associated with increased OR(res). Rather, recent use of penicillins was associated with decreased carriage of susceptible pneumococci (OR(sus) = 0.2, 95% confidence interval: 0.1, 0.3). In simulations, both types of effects promoted dissemination of resistant pneumococci at the population level. Findings show that oral cephalosporins enhance the risk of acquiring resistant pneumococci. Penicillins accelerate clearance of susceptible strains. The effect of penicillins in increasing resistance is shared equally by treated and untreated members of the population.
authors.affiliation: Division of Clinical Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT 84132, USA. matthew.samore@hsc.utah.edu
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Samore
authors.forename: Marc
authors.initials: M
authors.lastname: Lipsitch
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Alder
authors.forename: Bassam
authors.initials: B
authors.lastname: Haddadin
authors.forename: Greg
authors.initials: G
authors.lastname: Stoddard
authors.forename: Jacquelyn
authors.initials: J
authors.lastname: Williamson
authors.forename: Katherine
authors.initials: K
authors.lastname: Sebastian
authors.forename: Karen
authors.initials: K
authors.lastname: Carroll
authors.forename: Onder
authors.initials: O
authors.lastname: Ergonul
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Carmeli
authors.forename: Merle A
authors.initials: MA
authors.lastname: Sande
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D002353:Carrier State / Q000453:epidemiology / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D018562:Disease Transmission, Infectious / Q000706:statistics & numerical data; D024901:Drug Resistance, Multiple, Bacterial; D006801:Humans; D007061:Idaho; D009305:Nasopharynx / Q000382:microbiology; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission*; D013296:Streptococcus pneumoniae / Q000187:drug effects* / Q000302:isolation & purification; D011795:Surveys and Questionnaires; D014589:Utah
chemical_list: D000900:Anti-Bacterial Agents