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CARRIAGE OF PENICILLIN- AND ERYTHROMYCIN-RESISTANT ORAL STREPTOCOCCI IN CHILDREN WITH ACUTE RESPIRATORY INFECTIONS


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Abstract

Oral streptococci, primarily from Viridans group streptococci, composing oropharyngeal commensal microbiota, are not pathogenic for immunocompetent individuals, although they may cause a severe invasive infection in patients at risk. Moreover, oral streptococci compose a reservoir for resistance determinants against many antimicrobial groups. Hereby, we both analyzed the prevalence of resistant oral streptococci and examined risk factors for their carriage in the children population. The study included children of various age presented at our emergency pediatric department symptoms of acute respiratory infection, who had no received antibiotic treatment for the current infection. Oropharyngeal swabs were plated on Petri dishes, and the colonization rate was calculated as a number of colonies-forming units (CFU) grown on streptococcus selective medium (SSS) without antibiotics, with penicillin (Pen, 1 mg/l) or erythromycin (Ery, 2 mg/l). The proportion of Pen- and Ery-resistant streptococci was calculated as a ratio of CFU value on the antibiotic-containing medium to CFU value on the SSS without any addition. The risk of carriage of resistant streptococci was assessed using odds ratio (OR). In total, in 290 children of a median age of 5.6 (3.4-7.8) years, oropharyngeal swabs were taken. A growth of streptococci on SSS without antibiotics was observed in all 290 specimens. On SSS+Pen and SSS+Ery, a growth was detected in 232 (79.8%) and 268 (92.3%) specimens, respectively. In 224 (77.2%) specimens, both Pen- and Ery-resistant streptococci were present; in 14 (4.8%) no growth on antibiotic-containing plates was found. A median proportion (P25; P75) of Pen- and Ery-resistant streptococci was of 5.8% (0.9%; 16.7%) and 17.5% (6%; 49%), respectively. The colonization rate of Pen-resistant streptococci had a strong reverse correlation with the age (r=-0.222; p<0.001). The risk of carrying Pen-resistant streptococci was higher in children younger of 2 years of age (OR=6; 95%, CI: 0.8-46; p=0.088). Moreover, the use of cephalosporins within the previous year predisposed for Pen-resistant bacteria (OR=8/3; 95% CI: 1.1-62; p=0.015). The prevalence of beta-lactam- and macrolide-resistant oral streptococci in children population is high, especially in younger children. The uptake of a cephalosporin antibiotic with the previous year was a major predisposing factor for the Pen-resistant streptococci carriage


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