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


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


children; serotypes of pneumococci; antibiotic resistance; vaccination


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