Risk factors for nasopharyngeal carriage of drug-resistant Streptococcus pneumoniae: data from a nation-wide surveillance study in Greece.
BACKGROUND
A nation-wide surveillance study was conducted in Greece in order to provide a representative depiction of pneumococcal carriage in the pre-vaccination era and to evaluate potential risk factors for carriage of resistant strains in healthy preschool children attending daycare centers.


METHODS
A study group was organized with the responsibility to collect nasopharyngeal samples from children. Questionnaires provided demographic data, data on antibiotic consumption, family and household data, and medical history data. Pneumococcal isolates were tested for their susceptibility to various antimicrobial agents and resistant strains were serotyped.


RESULTS
Between February and May 2004, from a total population of 2536 healthy children, a yield of 746 pneumococci was isolated (carriage rate 29.41%). Resistance rates differed among geographic regions. Recent antibiotic use in the last month was strongly associated with the isolation of resistant pneumococci to a single or multiple antibiotics. Serotypes 19F, 14, 9V, 23F and 6B formed 70.6% of the total number of resistant strains serotyped.


CONCLUSIONS
Recent antibiotic use is a significant risk factor for the colonization of otherwise healthy children's nasopharynx by resistant strains of S pneumoniae. The heptavalent pneumococcal conjugate vaccine could provide coverage for a significant proportion of resistant strains in the Greek community. A combined strategy of vaccination and prudent antibiotic use could provide a means for combating pneumococcal resistance.
Katsarolis
Ioannis
I
4th Dept of Internal Medicine, Athens Medical School, ATTIKON University General Hospital, Athens, Greece. ikatsarolis@yahoo.com
Poulakou
Garyphallia
G
Analitis
Antonios
A
Matthaiopoulou
Irini
I
Roilides
Emmanuel
E
Antachopoulos
Charalampos
C
Kafetzis
Dimitrios A
DA
Daikos
Georgios L
GL
Vorou
Regina
R
Koubaniou
Christina
C
Pneumatikos
Ioannis
I
Samonis
Georgios
G
Syriopoulou
Vasiliki
V
Giamarellou
Helen
H
Kanellakopoulou
Kyriaki
K
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002353:Carrier State / Q000453:epidemiology*; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D005260:Female; D006115:Greece / Q000453:epidemiology; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D009305:Nasopharynx / Q000382:microbiology*; D011008:Pneumococcal Infections / Q000453:epidemiology*; D011159:Population Surveillance; D012307:Risk Factors
D000900:Anti-Bacterial Agents