Patterns of antibiotic-resistant Streptococcus pneumonia in children in a day-care setting

BACKGROUND. Streptococcus pneumoniae is one of the primary causes of illness and death among young children, and evidence suggests that the prevalence of antibiotic-resistant S pneumoniae is increasing, The purpose of this study was to investigate the prevalence of antibiotic-resistant S pneumoniae in a sample of children in day-care facilities in a region that includes both rural and urban communities. METHODS. Nasopharyngeal cultures were obtained from 104 children in eight day-care centers located in rural and urban central Kentucky in April and May, 1997. Thirty-five of the children produced isolates positive for S pneumoniae, Each isolate was tested for susceptibility to penicillin, trimethoprim-sulfamethoxazole, erythromycin, tetracycline, vancomycin, and cefotaxime. RESULTS. Of the children with S pneumoniae isolates, 54% had isolates that were resistant to penicillin and 40% that were resistant to trimethoprim-sulfamethoxazole. Twenty-one (60%) of the isolates had resistance to at feast one of the six tested antimicrobials, with 15 (43%) having resistance to more than one of the antimicrobials. The mean age of children with isolates resistant to penicillin was significantly less (2.7 + 1.6) than those with penicillin-susceptible isolates (3.7 + 1.1, P = .02). There was no relation between resistance and rural or urban day-care location. CONCLUSIONS. A substantial proportion of S pneumoniae isolates in young children are resistant to antibiotics. Limiting the effect of S pneumoniae drug resistance may require a reexamination of outpatient treatment strategies for childhood respiratory tract infections.