Carriage of multidrug-resistant Streptococcus pneumoniae and impact of chemoprophylaxis during an outbreak of meningitis at a day care center

Clin Infect Dis. 1999 Nov;29(5):1257-64. doi: 10.1086/313451.

Abstract

Three cases of meningitis due to multidrug-resistant serotype 14 Streptococcus pneumoniae occurred at a day care center (DCC) over 5 days. Cultures of nasopharyngeal samples were done at the index DCC, 2 comparison DCCs, and a pediatrics practice. Isolates were serotyped and subtyped by pulsed-field gel electrophoresis (PFGE) with SmaI. Pneumococcal carriage rates ranged from 44%-65% at the 3 DCCs and 29% in the pediatrics practice. Carriage of multidrug-resistant serotype 14 S. pneumoniae was noted in 13%-19% of children at the 3 DCCs. An outbreak strain was identified by PFGE at the index DCC and 1 other DCC; a closely related strain was found in the third DCC. Carriage of the outbreak strain was associated with being age 0-24 months, antibiotic use, upper respiratory tract infections, and otitis media. DCC contacts of the ill children were offered chemoprophylaxis with rifampin and clindamycin, which produced a profound but transient decrease in carriage. No additional cases occurred.

MeSH terms

  • Bacterial Vaccines / immunology
  • Carrier State / drug therapy*
  • Child
  • Child Day Care Centers*
  • Child, Preschool
  • Disease Outbreaks*
  • Drug Resistance, Microbial
  • Drug Resistance, Multiple
  • Female
  • Humans
  • Infant
  • Male
  • Meningitis, Pneumococcal / epidemiology
  • Meningitis, Pneumococcal / prevention & control*
  • Nasopharynx / microbiology
  • Patient Compliance
  • Pneumococcal Vaccines
  • Streptococcus pneumoniae / drug effects*

Substances

  • Bacterial Vaccines
  • Pneumococcal Vaccines