Nasopharyngeal carriage of respiratory pathogens in children undergoing pressure equalization tube placement in the era of pneumococcal protein conjugate vaccine use

Abstract

Objective: To define carriage of bacterial respiratory pathogens in children undergoing pressure equalization tube placement.

Study design: Nasopharyngeal cultures were performed during tube placement. Antibiotic susceptibilities and serotypes of pneumococci were determined.

Results: Sixty-nine Streptococcus pneumoniae, 72 Haemophilus influenzae (41% beta-lactamase positive), and 39 Moraxella catarrhalis (all beta-lactamase positive) were isolated from 201 children. Overall, 42% of pneumococci were nonsusceptible to penicillin, and 34.8% were resistant to macrolides. In relation to the pneumococcal conjugate vaccine, 17.4% were vaccine, 31.9% vaccine-related, and 50.7% nonvaccine serotypes.

Conclusion: Twenty-five percent of children colonized with pneumococci carried antibiotic resistant nonvaccine serotypes rarely detected before the introduction of pneumococcal conjugate vaccine, including serotype 19A isolates (7%) resistant to all oral agents tested and type 35B isolates (12%) nonsusceptible to penicillin and cefuroxime.

Significance: Pneumococcal colonization suggests replacement of vaccine serotypes with vaccine related and nonvaccine serotypes, many of which are resistant to common oral antimicrobials.