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High rate of antibiotic resistance among pneumococci carried by healthy children in the eastern part of the Democratic Republic of the Congo

Journal article
Authors Archippe M. Birindwa
Matilda Emgård
Rickard Nordén
Ebba Samuelsson
Shadi Geravandi
Lucia Gonzales-Siles
B. Muhigirwa
T. Kashosi
E. Munguakonkwa
J. T. Manegabe
D. Cibicabene
L. Morisho
B. Mwambanyi
J. Mirindi
N. Kabeza
Magnus Lindh
Rune Andersson
Susann Skovbjerg
Published in Bmc Pediatrics
Volume 18
ISSN 1471-2431
Publication year 2018
Published at Institute of Biomedicine, Department of Infectious Medicine
Centre for antibiotic resistance research, CARe
Language en
Links dx.doi.org/10.1186/s12887-018-1332-...
Keywords Streptococcus pneumoniae, Antibiotic resistance, DR Congo, Nasopharyngeal carriage, Children, streptococcus-pneumoniae, conjugate vaccine, nasopharyngeal carriage, serotype distribution, high prevalence, risk-factors, susceptibility, disease, age, epidemiology, Pediatrics
Subject categories Infectious Medicine

Abstract

BackgroundPneumococcal conjugate vaccines have been introduced in the infant immunisation programmes in many countries to reduce the rate of fatal pneumococcal infections. In the Democratic Republic of the Congo (DR Congo) a 13-valent vaccine (PCV13) was introduced in 2013. Data on the burden of circulating pneumococci among children after this introduction are lacking. In this study, we aimed to determine the risk factors related to pneumococcal carriage in healthy Congolese children after the vaccine introduction and to assess the antibiotic resistance rates and serotype distribution among the isolated pneumococci.MethodsIn 2014 and 2015, 794 healthy children aged one to 60months attending health centres in the eastern part of DR Congo for immunisation or growth monitoring were included in the study. Data on socio-demographic and medical factors were collected by interviews with the children's caregivers. Nasopharyngeal swabs were obtained from all the children for bacterial culture, and isolated pneumococci were further tested for antimicrobial resistance using disc diffusion tests and, when indicated, minimal inhibitory concentration (MIC) determination, and for serotype/serogroup by molecular testing.ResultsThe pneumococcal detection rate was 21%, being higher among children who had not received PCV13 vaccination, lived in rural areas, had an enclosed kitchen, were malnourished or presented with fever (p value <0.05). The predominant serotypes were 19F, 11, 6A/B/C/D and 10A. More than 50% of the pneumococcal isolates belonged to a serotype/serogroup not included in PCV13.Eighty per cent of the isolates were not susceptible to benzylpenicillin and non-susceptibility to ampicillin and ceftriaxone was also high (42 and 37% respectively). Almost all the isolates (94%) were resistant to trimethoprim-sulphamethoxazole, while 43% of the strains were resistant to 3 antibiotics.ConclusionsOur study shows alarmingly high levels of reduced susceptibility to commonly used antibiotics in pneumococci carried by healthy Congolese children. This highlights the importance of local antibiotic resistance surveillance and indicates the needs for the more appropriate use of antibiotics in the area. The results further indicate that improved living conditions are needed to reduce the pneumococcal burden, in addition to PCV13 vaccination.

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