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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

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 c...

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Autores principales: Birindwa, Archippe M., Emgård, Matilda, Nordén, Rickard, Samuelsson, Ebba, Geravandi, Shadi, Gonzales-Siles, Lucia, Muhigirwa, Balthazar, Kashosi, Théophile, Munguakonkwa, Eric, Manegabe, Jeanière T., Cibicabene, Didace, Morisho, Lambert, Mwambanyi, Benjamin, Mirindi, Jacques, Kabeza, Nadine, Lindh, Magnus, Andersson, Rune, Skovbjerg, Susann
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6241069/
https://www.ncbi.nlm.nih.gov/pubmed/30453916
http://dx.doi.org/10.1186/s12887-018-1332-3
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author Birindwa, Archippe M.
Emgård, Matilda
Nordén, Rickard
Samuelsson, Ebba
Geravandi, Shadi
Gonzales-Siles, Lucia
Muhigirwa, Balthazar
Kashosi, Théophile
Munguakonkwa, Eric
Manegabe, Jeanière T.
Cibicabene, Didace
Morisho, Lambert
Mwambanyi, Benjamin
Mirindi, Jacques
Kabeza, Nadine
Lindh, Magnus
Andersson, Rune
Skovbjerg, Susann
author_facet Birindwa, Archippe M.
Emgård, Matilda
Nordén, Rickard
Samuelsson, Ebba
Geravandi, Shadi
Gonzales-Siles, Lucia
Muhigirwa, Balthazar
Kashosi, Théophile
Munguakonkwa, Eric
Manegabe, Jeanière T.
Cibicabene, Didace
Morisho, Lambert
Mwambanyi, Benjamin
Mirindi, Jacques
Kabeza, Nadine
Lindh, Magnus
Andersson, Rune
Skovbjerg, Susann
author_sort Birindwa, Archippe M.
collection PubMed
description 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12887-018-1332-3) contains supplementary material, which is available to authorized users.
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spelling pubmed-62410692018-11-23 High rate of antibiotic resistance among pneumococci carried by healthy children in the eastern part of the Democratic Republic of the Congo Birindwa, Archippe M. Emgård, Matilda Nordén, Rickard Samuelsson, Ebba Geravandi, Shadi Gonzales-Siles, Lucia Muhigirwa, Balthazar Kashosi, Théophile Munguakonkwa, Eric Manegabe, Jeanière T. Cibicabene, Didace Morisho, Lambert Mwambanyi, Benjamin Mirindi, Jacques Kabeza, Nadine Lindh, Magnus Andersson, Rune Skovbjerg, Susann BMC Pediatr Research Article 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12887-018-1332-3) contains supplementary material, which is available to authorized users. BioMed Central 2018-11-19 /pmc/articles/PMC6241069/ /pubmed/30453916 http://dx.doi.org/10.1186/s12887-018-1332-3 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Birindwa, Archippe M.
Emgård, Matilda
Nordén, Rickard
Samuelsson, Ebba
Geravandi, Shadi
Gonzales-Siles, Lucia
Muhigirwa, Balthazar
Kashosi, Théophile
Munguakonkwa, Eric
Manegabe, Jeanière T.
Cibicabene, Didace
Morisho, Lambert
Mwambanyi, Benjamin
Mirindi, Jacques
Kabeza, Nadine
Lindh, Magnus
Andersson, Rune
Skovbjerg, Susann
High rate of antibiotic resistance among pneumococci carried by healthy children in the eastern part of the Democratic Republic of the Congo
title High rate of antibiotic resistance among pneumococci carried by healthy children in the eastern part of the Democratic Republic of the Congo
title_full High rate of antibiotic resistance among pneumococci carried by healthy children in the eastern part of the Democratic Republic of the Congo
title_fullStr High rate of antibiotic resistance among pneumococci carried by healthy children in the eastern part of the Democratic Republic of the Congo
title_full_unstemmed High rate of antibiotic resistance among pneumococci carried by healthy children in the eastern part of the Democratic Republic of the Congo
title_short High rate of antibiotic resistance among pneumococci carried by healthy children in the eastern part of the Democratic Republic of the Congo
title_sort high rate of antibiotic resistance among pneumococci carried by healthy children in the eastern part of the democratic republic of the congo
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6241069/
https://www.ncbi.nlm.nih.gov/pubmed/30453916
http://dx.doi.org/10.1186/s12887-018-1332-3
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