title: Changes in the nasal carriage of drug-resistant Streptococcus pneumoniae in urban and rural Vietnamese schoolchildren.
abstract: Studying the antimicrobial drug resistance of nasopharyngeal or nasal carriage isolates of Streptococcus pneumoniae in children is likely to have predictive potential for invasive isolates. Streptococcus pneumoniae nasal carriage was studied in 1422 Vietnamese children. Forty-six percent of 536 isolates showed reduced susceptibility to penicillin and 7% showed intermediate susceptibility to ceftriaxone; and 50% of 518 isolates showed resistance to erythromycin. All isolates were sensitive to levofloxacin and gatifloxacin. Urban and suburban children were significantly more likely to carry drug-resistant isolates than rural children. Rates of non-susceptibility to penicillin and erythromycin increased significantly in the rural province Khanh Hoa in 2003/2004 compared with rates obtained in 1997. An emerging clone of penicillin non-susceptible S. pneumoniae of serogroup 15 was identified, which was widely distributed in addition to the pandemic clones Spain(23F)-1 and Taiwan(19F)-14. Although resistance to fluoroquinolones was not observed, 6 (18%) of 34 isolates had a Lys137Asn mutation in the parC gene. This study shows that drug resistance is increasing in carriage isolates of S. pneumoniae in rural areas in Vietnam owing to spread of pandemic and emerging resistant clones.
authors.affiliation: Oxford University Clinical Research Unit at the Hospital for Tropical Diseases, 190 Ben Ham Tu, District 5, Ho Chi Minh City, Vietnam. schultsz@gmail.com
authors.forename: Constance
authors.initials: C
authors.lastname: Schultsz
authors.forename: Le Minh
authors.initials: le M
authors.lastname: Vien
authors.forename: James I
authors.initials: JI
authors.lastname: Campbell
authors.forename: Nguyen Van Vinh
authors.initials: NV
authors.lastname: Chau
authors.forename: To Song
authors.initials: TS
authors.lastname: Diep
authors.forename: Nguyen Van Minh
authors.initials: NV
authors.lastname: Hoang
authors.forename: Tran Thi Thu
authors.initials: TT
authors.lastname: Nga
authors.forename: Paul
authors.initials: P
authors.lastname: Savelkoul
authors.forename: Kasia
authors.initials: K
authors.lastname: Stepnieuwska
authors.forename: Christopher
authors.initials: C
authors.lastname: Parry
authors.forename: Tran Tinh
authors.initials: TT
authors.lastname: Hien
authors.forename: Jeremy J
authors.initials: JJ
authors.lastname: Farrar
mesh_terms: D002353:Carrier State / Q000382:microbiology*; D002648:Child; D024881:Drug Resistance, Bacterial; D006801:Humans; D008826:Microbial Sensitivity Tests; D009154:Mutation; D009296:Nasal Cavity / Q000382:microbiology*; D010406:Penicillins / Q000494:pharmacology; D011110:Polymorphism, Genetic; D012423:Rural Health / Q000706:statistics & numerical data; D013290:Streptococcal Infections / Q000382:microbiology*; D013296:Streptococcus pneumoniae / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D014504:Urban Health / Q000706:statistics & numerical data; D014744:Vietnam
chemical_list: D010406:Penicillins