title: Nasopharyngeal carriage of respiratory pathogens in children undergoing pressure equalization tube placement in the era of pneumococcal protein conjugate vaccine use.
abstract: OBJECTIVE
  To define carriage of bacterial respiratory pathogens in children undergoing pressure equalization tube placement.
  
  
  METHODS
  Nasopharyngeal cultures were performed during tube placement. Antibiotic susceptibilities and serotypes of pneumococci were determined.
  
  
  RESULTS
  Sixty-nine Streptococcus pneumoniae, 72 Haemophilus influenzae (41% beta-lactamase positive), and 39 Moraxella catarrhalis (all beta-lactamase positive) were isolated from 201 children. Overall, 42% of pneumococci were nonsusceptible to penicillin, and 34.8% were resistant to macrolides. In relation to the pneumococcal conjugate vaccine, 17.4% were vaccine, 31.9% vaccine-related, and 50.7% nonvaccine serotypes.
  
  
  CONCLUSIONS
  Twenty-five percent of children colonized with pneumococci carried antibiotic resistant nonvaccine serotypes rarely detected before the introduction of pneumococcal conjugate vaccine, including serotype 19A isolates (7%) resistant to all oral agents tested and type 35B isolates (12%) nonsusceptible to penicillin and cefuroxime.
  
  
  CONCLUSIONS
  Pneumococcal colonization suggests replacement of vaccine serotypes with vaccine related and nonvaccine serotypes, many of which are resistant to common oral antimicrobials.
authors.affiliation: Department of Pathology, Case Western Reserve University, University Hospitals of Cleveland, Cleveland, Ohio 44106, USA. mrj6@po.cwru.edu
authors.forename: Michael R
authors.initials: MR
authors.lastname: Jacobs
authors.forename: Caryn E
authors.initials: CE
authors.lastname: Good
authors.forename: Tom
authors.initials: T
authors.lastname: Sellner
authors.forename: Saralee
authors.initials: S
authors.lastname: Bajaksouzian
authors.forename: Anne
authors.initials: A
authors.lastname: Windau
authors.forename: Jack B
authors.initials: JB
authors.lastname: Anon
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D002444:Cefuroxime / Q000494:pharmacology; D018550:Cephalosporin Resistance; D002648:Child; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D005260:Female; D006193:Haemophilus influenzae / Q000302:isolation & purification*; D006801:Humans; D007223:Infant; D018942:Macrolides / Q000494:pharmacology; D008297:Male; D008876:Middle Ear Ventilation; D001936:Moraxella catarrhalis / Q000302:isolation & purification*; D009305:Nasopharynx / Q000382:microbiology*; D010033:Otitis Media / Q000601:surgery; D010034:Otitis Media with Effusion / Q000601:surgery; D010403:Penicillin Resistance; D022242:Pneumococcal Vaccines; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification / Q000302:isolation & purification*; D018074:Vaccines, Conjugate
chemical_list: D000900:Anti-Bacterial Agents; D018942:Macrolides; D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate; D002444:Cefuroxime