NASOPHARYNGEAL CARRIAGE OF PENICILLIN-RESISTANT STREPTOCOCCUS-PNEUMONIAE IN CHILDREN WITH SICKLE-CELL DISEASE

Objective. We studied the prevalence of nasopharyngeal (NP) carriage, antimicrobial susceptibilities, and serotypes of Streptococcus pneumon iae (SP) in children with sickle cell disease (SCD) in the Mid-South. In addition, we examined risk factors for NP carriage of penicillin-re sistant SP (PRSP). Study Design. Between July 1994 and December 1995, we obtained NP cultures from 312 children with SCD followed at the Mid -South Sickle Cell Center, 208 (67%) of whom were receiving penicillin prophylaxis. Results. Among the 312 patients, colonization with SP oc curred in 42 (13%), 30 (71%) of whom were receiving penicillin prophyl axis. Twenty-three of the 42 SP isolates (55%) were resistant to penic illin; 5 of the 23 (22%) were highly resistant. PRSP organisms were al so resistant to cefotaxime (43%), trimethoprim-sulfamethoxazole (57%), and erythromycin (22%). Serotypes 6A, 6B, 14, 19A, and 23F accounted for 19 (90%) of 21 resistant strains. Children who were treated with a ntibiotics during the preceding month were more likely to carry PRSP t han children who were not treated. Conclusions. There is a high preval ence of NP carriage of PRSP in children with SCD in the Mid-South, whi ch raises concerns regarding the continued effectiveness of penicillin prophylaxis in these children. Further studies on the antimicrobial s usceptibilities of resistant organisms and the relationship between NP carriage of SP and invasive disease are needed before developing new recommendations for prophylaxis and treatment.