RISK-FACTORS FOR NASOPHARYNGEAL CARRIAGE OF RESISTANT STREPTOCOCCUS-PNEUMONIAE AND DETECTION OF A MULTIPLY RESISTANT CLONE AMONG CHILDREN LIVING IN THE YUKON-KUSKOKWIM DELTA REGION OF ALASKA

Background. Children <2 years old living in the Yukon-Kuskokwim Delta (YKD) region of Alaska have one of the highest pneumococcal bacteremia rates of in the world. Methods, To determine the prevalence of and ri sk factors for infection with intermediate or resistant Streptococcus pneumoniae in the YKD, we cultured nasopharyngeal secretions of health y children less than or equal to 5 years old, reviewed their hospital records and administered questionnaires to accompanying parents. Resul ts. Of 185 children evaluated we obtained 95 pneumococcal isolates; dr ug susceptibility patterns and serotyping results were available for 9 2. Of these, 33 (36%) were intermediate or resistant to at least one d rug class tested; 27 isolates were intermediate (minimum inhibitory co ncentration 0.1 to 1.0 mg/l) and none were resistant to penicillin. Co mpared with other isolates, capsular serotype 6B isolates were more li kely to be intermediate or resistant to at least one drug (relative ri sk, 5.3; P < 0.001) and to more than one drug (relative risk, 17.0; P < 0.001), The majority of 6B isolates had identical pneumococcal surfa ce protein A patterns. Carriage of intermediate or resistant pneumococ cus was associated with age <2 years (relative risk, 3.0; P < 0.001) b ut not with antibiotic use or other evaluated risk factors. Conclusion s. Young age but not antibiotic use was associated with carriage of in termediate or resistant S. pneumoniae in the YKD region of Alaska. Muc h of the intermediate or resistant pneumococcus in the YKD may have re sulted from the proliferation of a single capsular serotype 6B clone.