title: Interaction of the heptavalent pneumococcal conjugate vaccine and the use of individual antibiotics among children on nasopharyngeal colonization with erythromycin-resistant Streptococcus pneumoniae.
abstract: The purpose of this study was to assess the complex interaction of the heptavalent pneumococcal conjugate vaccine (PCV7) and individual classes of antimicrobial agents on the nasopharyngeal carriage of erythromycin-resistant pneumococci within the day-care center population. Between February 2005 and May 2007, nasopharyngeal cultures for Streptococcus pneumoniae were obtained from 1,829 day-care center attendees in Central Greece. Thirty-one percent of the pneumococci were erythromycin-resistant; 85.2% of these isolates were also penicillin-nonsusceptible. PCV7 immunization was associated with decreased carriage of erythromycin-resistant PCV7 serotypes but not with an overall decrease in erythromycin-resistant S. pneumoniae colonization. The largest decline in the carriage of erythromycin-resistant pneumococci, particularly of PCV7 serotypes, was observed among vaccinated attendees who had not been exposed to antimicrobials within the preceding 3 months. Exposure to macrolides, 90% clarithromycin, significantly correlated with erythromycin resistance (adjusted odds ratio [AOR] = 2.08, 95% confidence interval [CI] = 1.38-3.12). There was a trend toward an association between the use of oral cephalosporins, other than cefprozil and cefaclor, and colonization with erythromycin-resistant pneumococci (AOR = 1.91, 95% CI = 0.92-3.96). Penicillins had a nonsignificant correlation with the carriage of erythromycin-resistant pneumococci (AOR = 1.17, 95% CI = 0.80-1.71). Despite the widespread PCV7 immunization, the antibiotic pressure, particularly of macrolides, continues to cause dissemination of erythromycin-resistant, commonly multidrug-resistant, pneumococci within the day-care center population.
authors: Department of Pediatrics, University of Thessaly, School of Medicine, General University Hospital, Biopolis, Larissa, Greece.
authors: Ioanna N
authors: IN
authors: Grivea
authors: Alexandra G
authors: AG
authors: Tsantouli
authors: Denise C
authors: DC
authors: Chryssanthopoulou
authors: George A
authors: GA
authors: Syrogiannopoulos
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002353:Carrier State / Q000382:microbiology*; D002648:Child; D002656:Child Day Care Centers; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D004363:Drug Utilization / Q000706:statistics & numerical data*; D004917:Erythromycin / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D006115:Greece; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D006801:Humans; D007223:Infant; D008297:Male; D022242:Pneumococcal Vaccines / Q000276:immunology*; D013290:Streptococcal Infections / Q000382:microbiology; D013296:Streptococcus pneumoniae / Q000187:drug effects* / Q000276:immunology / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D022242:Pneumococcal Vaccines; D004917:Erythromycin