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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.
BMC Pediatr. 2018 11 19; 18(1):361.BPed

Abstract

BACKGROUND

Pneumococcal 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.

METHODS

In 2014 and 2015, 794 healthy children aged one to 60 months 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.

RESULTS

The 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.

CONCLUSIONS

Our 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.

Authors+Show Affiliations

Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden. birindwaarchippe@gmail.com. Panzi Hospital, Bukavu, Democratic Republic of the Congo. birindwaarchippe@gmail.com. Université Evangélique en Afrique, Bukavu, Democratic Republic of the Congo. birindwaarchippe@gmail.com. Hôpital Général de Référence de Panzi, BP: 266, Bukavu, DR, Congo. birindwaarchippe@gmail.com.Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden.Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden.Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden.Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden.Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden.Panzi Hospital, Bukavu, Democratic Republic of the Congo.Université Evangélique en Afrique, Bukavu, Democratic Republic of the Congo.Panzi Hospital, Bukavu, Democratic Republic of the Congo.Panzi Hospital, Bukavu, Democratic Republic of the Congo.Panzi Hospital, Bukavu, Democratic Republic of the Congo.Panzi Hospital, Bukavu, Democratic Republic of the Congo.Panzi Hospital, Bukavu, Democratic Republic of the Congo.Panzi Hospital, Bukavu, Democratic Republic of the Congo.Panzi Hospital, Bukavu, Democratic Republic of the Congo.Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden.Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden. CARe - Center for Antibiotic Resistance Research, Gothenburg University, Gothenburg, Sweden.Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30453916

Citation

Birindwa, Archippe M., et al. "High Rate of Antibiotic Resistance Among Pneumococci Carried By Healthy Children in the Eastern Part of the Democratic Republic of the Congo." BMC Pediatrics, vol. 18, no. 1, 2018, p. 361.
Birindwa AM, Emgård M, Nordén R, et al. High rate of antibiotic resistance among pneumococci carried by healthy children in the eastern part of the Democratic Republic of the Congo. BMC Pediatr. 2018;18(1):361.
Birindwa, A. M., Emgård, M., Nordén, R., Samuelsson, E., Geravandi, S., Gonzales-Siles, L., Muhigirwa, B., Kashosi, T., Munguakonkwa, E., Manegabe, J. T., Cibicabene, D., Morisho, L., Mwambanyi, B., Mirindi, J., Kabeza, N., Lindh, M., Andersson, R., & Skovbjerg, S. (2018). High rate of antibiotic resistance among pneumococci carried by healthy children in the eastern part of the Democratic Republic of the Congo. BMC Pediatrics, 18(1), 361. https://doi.org/10.1186/s12887-018-1332-3
Birindwa AM, et al. High Rate of Antibiotic Resistance Among Pneumococci Carried By Healthy Children in the Eastern Part of the Democratic Republic of the Congo. BMC Pediatr. 2018 11 19;18(1):361. PubMed PMID: 30453916.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - High rate of antibiotic resistance among pneumococci carried by healthy children in the eastern part of the Democratic Republic of the Congo. AU - Birindwa,Archippe M, AU - Emgård,Matilda, AU - Nordén,Rickard, AU - Samuelsson,Ebba, AU - Geravandi,Shadi, AU - Gonzales-Siles,Lucia, AU - Muhigirwa,Balthazar, AU - Kashosi,Théophile, AU - Munguakonkwa,Eric, AU - Manegabe,Jeanière T, AU - Cibicabene,Didace, AU - Morisho,Lambert, AU - Mwambanyi,Benjamin, AU - Mirindi,Jacques, AU - Kabeza,Nadine, AU - Lindh,Magnus, AU - Andersson,Rune, AU - Skovbjerg,Susann, Y1 - 2018/11/19/ PY - 2018/04/30/received PY - 2018/10/31/accepted PY - 2018/11/21/entrez PY - 2018/11/21/pubmed PY - 2019/10/9/medline KW - Antibiotic resistance KW - Children KW - DR Congo KW - Nasopharyngeal carriage KW - PCV13 KW - Streptococcus pneumoniae SP - 361 EP - 361 JF - BMC pediatrics JO - BMC Pediatr VL - 18 IS - 1 N2 - BACKGROUND: Pneumococcal 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. METHODS: In 2014 and 2015, 794 healthy children aged one to 60 months 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. RESULTS: The 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. CONCLUSIONS: Our 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. SN - 1471-2431 UR - https://www.unboundmedicine.com/medline/citation/30453916/High_rate_of_antibiotic_resistance_among_pneumococci_carried_by_healthy_children_in_the_eastern_part_of_the_Democratic_Republic_of_the_Congo_ L2 - https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-018-1332-3 DB - PRIME DP - Unbound Medicine ER -