Patients With Sickle Cell Disease
Background: Prevention of pneumococcal sepsis in children with sickle cell disease (SCD) is threatened by the emergence of penicillin-nonsusceptible pneumococci.
Methods: In this study, nasopharyngeal colonization with Streptococcus pneumoniae and penicillin susceptibility were compared in children with SCD and a control group. Nasopharyngeal cultures were obtained from 130 children with SCD and 123 control children. Penicillin susceptibility was determined by Epsilometer test. Compliance with penicillin prophylaxis in SCD patients was determined by parent interviews and review of patients' medical and pharmacy records.
Results: Streptococcus pneumoniae was isolated from 8 (6%) of 130 SCD patients, and 21 (17%) of 123 control patients. Of the 29 S pneumoniae isolates, 6 (21%) were nonsusceptible to penicillin; 4 of 8 (50%) were from the SCD group and 2 of 21 (10%) from the control group.
Conclusions: Penicillin prophylaxis decreased the rate of S pneumoniae colonization in SCD patients; however, it also increased the risk of selective colonization with penicillin-nonsusceptible S pneumoniae.
Children with SCD are at greatly increased risk of invasive pneumococcal disease, including bacteremia, pneumonia, and meningitis. Daily oral penicillin prophylaxis and early immunization with pneumococcal vaccine have markedly reduced this risk. These gains are now threatened by the emergence of penicillin-nonsusceptible strains of S pneumoniae. Penicillin-nonsusceptible S pneumoniae isolates are being recovered with increasing frequency from patients with both systemic infections and infections of the upper respiratory tract. Resistance rates vary geographically, and there is a growing need to monitor their prevalence in various localities. Several studies have shown that nasopharyngeal colonization with multiply resistant pneumococci is enhanced by frequent use of antibiotics. Furthermore, nasopharyngeal colonization with S pneumoniae has been shown to be a risk factor for invasive pneumococcal disease. The purpose of the present study was to compare nasopharyngeal colonization with S pneumoniae in SCD children with that in an age-matched control group in our area.
Background: Prevention of pneumococcal sepsis in children with sickle cell disease (SCD) is threatened by the emergence of penicillin-nonsusceptible pneumococci.
Methods: In this study, nasopharyngeal colonization with Streptococcus pneumoniae and penicillin susceptibility were compared in children with SCD and a control group. Nasopharyngeal cultures were obtained from 130 children with SCD and 123 control children. Penicillin susceptibility was determined by Epsilometer test. Compliance with penicillin prophylaxis in SCD patients was determined by parent interviews and review of patients' medical and pharmacy records.
Results: Streptococcus pneumoniae was isolated from 8 (6%) of 130 SCD patients, and 21 (17%) of 123 control patients. Of the 29 S pneumoniae isolates, 6 (21%) were nonsusceptible to penicillin; 4 of 8 (50%) were from the SCD group and 2 of 21 (10%) from the control group.
Conclusions: Penicillin prophylaxis decreased the rate of S pneumoniae colonization in SCD patients; however, it also increased the risk of selective colonization with penicillin-nonsusceptible S pneumoniae.
Children with SCD are at greatly increased risk of invasive pneumococcal disease, including bacteremia, pneumonia, and meningitis. Daily oral penicillin prophylaxis and early immunization with pneumococcal vaccine have markedly reduced this risk. These gains are now threatened by the emergence of penicillin-nonsusceptible strains of S pneumoniae. Penicillin-nonsusceptible S pneumoniae isolates are being recovered with increasing frequency from patients with both systemic infections and infections of the upper respiratory tract. Resistance rates vary geographically, and there is a growing need to monitor their prevalence in various localities. Several studies have shown that nasopharyngeal colonization with multiply resistant pneumococci is enhanced by frequent use of antibiotics. Furthermore, nasopharyngeal colonization with S pneumoniae has been shown to be a risk factor for invasive pneumococcal disease. The purpose of the present study was to compare nasopharyngeal colonization with S pneumoniae in SCD children with that in an age-matched control group in our area.