DOI: https://doi.org/10.22141/2312-413x.6.4.2018.142472

Problems of treatment and prevention of pneumococcus infection in children

L.I. Chernyshova, A.M. Gilfanova, A.V. Bondarenko, V.V. Yanovskaya, T.G. Glushkevich, S.A. Yakimovich

Abstract


Background. Streptococcus pneumoniae is one of the main causes of invasive and non-invasive diseases of different locations in all age groups around the world. Pneumococcus is the No. 1 killer of children under 5 years of age: 40 % in the mortality structure, 500,000 deaths per year. The global rise in resistance to antibiotics creates problems for empirical treatment of infection. Vaccination against pneumococcus is the most effective mean for controlling infection. Choice of vaccine “must be based on available local or regional estimates of the distribution of pneumococcal serotypes in different age groups” (World Health Organization). The purpose of the study was to determine the serotype composition of pneumococcus in children with carriage and purulent meningitis, their correspondence to vaccination strains and sensitivity to antibiotics. Materials and methods. Nine hundred healthy children aged 6 months to 5 years were monitored. Nasopharyngeal swabs were taken for the study by specially trained nurses. The identification of pneumococci was carried out by a classical culture method and real-time polymerase chain reaction (PCR). The sensitivity to 13 antibiotics was determined by the disco-diffuse method and the serial dilution method. Pneumococci serotyping was carried out using multiplex PCR. The carriage of 15 serotypes of pneumococcus was checked, 13 of them are the part of pneumococcal conjugate vaccine (PCV13). Results. When culture method was used, pneumococci were isolated from the nasopharynx in 21.3 % of children under 5 years of age. When using PCR — in 53.8 % of children. Such antibiotics as co-trimoxazole, erythromycin and azithromycin crossed the barrier of resistance in 25 % of pneumococci, in which it is not practical to use the drug. 28.3 % of pneumococci detected in nasopharyngeal carriage in children under 5 years of age have developed partial resistance to amoxicillin/clavulanate, which is still the first-line antibiotic for the treatment of community-acquired pneumonia. No isolates of pneumococcus with high resistance to third-generation cephalosporins were isolated from healthy carriers. Multidrug-resistant pneumococci with serotypes 14, 6A/B, 19F and HT strains together account for 52.2 % in carriage in children and 69.1 % — in meningitis. The serotypes included in PCV13 coincide in 65.53 % of cases with the serotypes detected in nasopharyngeal carriage, and in 87.5 % with purulent meningitis in children. Conclusions. The main source of pneumococci is pharyngeal carriage, which occurs in healthy children in the first five years of life. The causative agents of pneumococcal meningitis are the same serotypes of pneumococci that colonize the nasopharynx of children. Selection of resistant strains of pneumococcus occurs mainly in children with nasopharyngeal carriage. The results of determining the coincidence of vaccinating serotypes of PCV13 and pneumococcal serotypes in carriage and purulent meningitis make it possible to predict that the introduction of universal vaccination against pneumococcal infection will reduce the carriage of pneumococci by almost 66 % and protect more than 87 % of children from pneumococcal meningitis

Keywords


children; serotypes of pneumococci; antibiotic resistance; vaccination

References


Berezniakov IG. New possibilities of therapeutic use of levofloxacin. Zdorov’ja Ukrai'ny. 2010;(233):42-43. (in Russian).

Feshchenko YuІ, Dziublyk OYa, Pertseva TO, Mostovoy YuM, Bratus OV, Dziublyk YaO. Survey of antibiotic resistance of S. pneumoniae and H. influenzae strains, isolated from thepatients with respiratory tract infections during 2010-2012 years in Ukraine. Visnyk morfologii'. 2014;(20):395-401. (in Ukrainian).

Kozlov RS, Sivaya OV, Kretchikova OI, Ivanchik NV. Antimicrobial Resistance of Streptococcus pneumoniae in Russia over the 1999-2009: Results of Multicenter Prospective Study PEHASus. Clinical Microbiology and Antimicrobial Chemotherapy. 2010;12(4):329-341. (in Russian).

Kozlov RS. Pnevmokokki: uroki proshlogo - vzgliad v budushchee [Pneumococcus: lessons from the past - a look into the future]. Smolensk: MakMAKh, 2010. 128 p. (in Russian).

Lezhenko GA, Pashkovа EE. Substantiation of tactics of antibacterial therapy in children with acute obstructive bronchitis of bacterial origin. Sovremennaya Pediatriya. 2015;(68):63-66. (in Ukrainian).

Marchenko VF, Makhaneva LG, Tindikevich VL. Frequency of microorganisms allocation from different biological materials and comparative analysis of its antibiograms. Sovremennaya Pediatriya. 2010;(29):52-56. (in Russian).

Chernyshova LI, Bondarenko AV, Vynnyk NP,et al. Do we need Hib-vaccination for children in Ukraine? Zdorovʹe rebenka. 2010;(23):120-123. (in Ukrainian).

Chernyshova LI. Pneumococcal disease is a feasible problem. Zdorovʹe rebenka. 2013;(46):107-110. (in Ukrainian).

International Vaccine Access Center (IVAC), Johns Hopkins Bloomberg School of Public Health. VIMS Report: Global Vaccine Introduction: a report on current global access to new childhood vaccines. Available from: https://www.dropbox.com/s/45a4rlx6c505ywd/IVAC_VIMS_Report%202015Jan_public.pdf?dl=0. Accessed: January 2015.

European Centre for Disease Prevention and Control. Annual Epidemiological Report on Communicable Diseases in Europe 2010. Stockholm: ECDC; 2010. 192 p.

O'Brien KL, Wolfson LJ, Watt JP, et al. Burden of disease caused by Streptococcus pneumoniae in children younger than 5 years: global estimates. Lancet. 2009 Sep 12;374(9693):893-902. doi: 10.1016/S0140-6736(09)61204-6.

Huang WL, Wu TM, Yu CK, Cheng YL, Lien C. Pneumococcal osteomyelitis: report of one case. Pediatr Neonatol. 2008;49(6):248-253. doi: 10.1016/S1875-9572(09)60020-6.

WHO Publication. Pneumococcal vaccines WHO position paper - 2012 - recommendations. Vaccine. 2012 Jul 6;30(32):4717-8. doi: 10.1016/j.vaccine.2012.04.093.

Tomic V, Dowzicky MJ. Regional and global antimicrobial susceptibility among isolates of Streptococcus pneumoniae and Haemophilus influenzae collected as part of the Tigecycline Evaluation and Surveillance Trial (T.E.S.T.) from 2009 to 2012 and comparison with previous years of T.E.S.T. (2004-2008). Ann Clin Microbiol Antimicrob. 2014 Nov 7;13:52. doi: 10.1186/s12941-014-0052-2.




Copyright (c) 2018 ACTUAL INFECTOLOGY

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

 

© Publishing House Zaslavsky, 1997-2018

 

   Seo анализ сайта