title: Distribution, dynamics and antibiotic resistance patterns of Streptococcus pneumoniae serotypes causing acute otitis media in children in southern Israel during the 10 year-period before the introduction of the 7-valent pneumococcal conjugate vaccine.
abstract: OBJECTIVE
  To determine the dynamics of serotype prevalence, potential coverage by pneumococcal conjugate vaccines (PCV) and antibiotic resistance patterns of Streptococcus pneumoniae causing acute otitis media (AOM) in children in southern Israel before PCV7 introduction in the routine immunization program in Israel.
  
  
  METHODS
  All S. pneumoniae isolates from middle ear fluid from children with AOM during 1999-2008 were included. Prospectively collected demographic data on S. pneumoniae serotypes and antibiotic resistance patterns were analyzed.
  
  
  RESULTS
  A total of 14,911 tympanocenteses yielded 5281 (35%) S. pneumoniae. Proportion of S. pneumoniae-AOM did not vary significantly (overall 35%; 33% in 2007; 38% in 2002 and 2003). The most frequent serotypes were 19F, 14, 23F and 19A; in both Jewish and Bedouin children; serotypes 6A and 19A contributed 6% and 10%, respectively, of all S. pneumoniae isolates. Serotypes included in PCV7, PCV10 and PCV13 represented 60%, 64%, 85% in Jewish children vs. 49%, 55% and 74%, respectively, in Bedouin children (P < 0.001). Nonsusceptibility to TMP/SMX decreased significantly, in parallel with a significant increase in the nonsusceptibility to erythromycin, clindamycin and in multidrug resistant (MDR) isolates. No changes were recorded in the proportion of S. pneumoniae isolates with penicillin MIC ≥ 1.0 μg/ml. The proportion of penicillin- and erythromycin-nonsusceptible and of MDR serotype 6A and 19A isolates increased significantly in Bedouin children.
  
  
  CONCLUSIONS
  (1) No significant changes were recorded in the yearly proportions of serotypes 23F, 19F, 19A, 14 and 6A in both ethnic populations; (2) Potential coverage of the 3 PCVs was higher in Jewish children than in Bedouin children; (3) The relatively high coverage of macrolides- and multidrug-resistant S. pneumoniae by PCV13 and lack of increase in penicillin, erythromycin and multidrug nonsusceptibility among non-PCV13 isolates is encouraging.
authors.affiliation: Pediatric Infectious Disease Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Ido
authors.initials: I
authors.lastname: Somech
authors.forename: Ron
authors.initials: R
authors.lastname: Dagan
authors.forename: Noga
authors.initials: N
authors.lastname: Givon-Lavi
authors.forename: Nurith
authors.initials: N
authors.lastname: Porat
authors.forename: Simon
authors.initials: S
authors.lastname: Raiz
authors.forename: Alberto
authors.initials: A
authors.lastname: Leiberman
authors.forename: Mark
authors.initials: M
authors.lastname: Puterman
authors.forename: Nehama
authors.initials: N
authors.lastname: Peled
authors.forename: David
authors.initials: D
authors.lastname: Greenberg
authors.forename: Eugene
authors.initials: E
authors.lastname: Leibovitz
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D004432:Ear, Middle / Q000382:microbiology; D005006:Ethnicity; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D006801:Humans; D007557:Israel / Q000453:epidemiology; D018942:Macrolides / Q000494:pharmacology; D010033:Otitis Media / Q000453:epidemiology* / Q000382:microbiology*; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000382:microbiology*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification* / Q000187:drug effects* / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D018942:Macrolides; D022242:Pneumococcal Vaccines