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

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.