Streptococcus pneumoniae SEROTYPE PREVALENCE, ANTIBIOTIC SUSCEPTIBILITY AND ASSOCIATED RISK FACTORS AMONG CHILDREN ATTENDING GERTRUDES CHILDREN’S HOSPITAL IN NAIROBI CITY COUNTY-KENYA
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Date
2020-06
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Abstract
Pneumococcal disease remains the biggest killer of children living in Kenya. This
is true despite inclusion of the 10-valent pneumococcal conjugate vaccine in the
Kenya Expanded Program on Immunization. Serotype replacement, emergence of
antibiotic resistance, inaccurate laboratory diagnosis due to optochin resistant
bacterial types and a range of environmental and host related risk factors have
been touted to be the cause of these statistics elsewhere. This study sought to
establish prevalence of Streptococcus pneumoniae serotypes, antibiotic
susceptibility patterns and associated risk factors among PCV-10 vaccinated and
unvaccinated children attending Gertrude’s Childrens Hospital. A total of 206
children were recruited for this study. Nasopharyngeal swabs were the main
specimen used. Culturing and isolation of the bacteria was done on blood agar
with gentamicin and plain blood agar plates respectively. Optochin and bile
solubility (where necessary) tests were done as confirmatory assays for the
bacteria. Pneumococci serotyping was done using the Gold Standard Quellung
Reaction test while the disk diffusion method was used to asses antibiotic
susceptibility profiles. Out of the 206 subjects sampled, 20.39% (n=42) were
found to be carriers of the bacteria. About 52% (n=22) of the carriers had received
the recommended dose of PCV-10, while 48% (n=20) had not. Almost all (n=41;
19.90% of subjects) isolates contained non-vaccine type serotypes, while n=1 of
the isolates (0.49% of subjects) were both optochin resistant and untypeable.
Serotypes 28F, 6A, 11A, 3 and 7C were prevalent in both vaccinated and
unvaccinated children, whereas serotypes 23A, 17F, 35F, 48, 13 and 35B, and
23B, 20, 19B, 21, untypeable, 15B and 39 were found among unvaccinated and
vaccinated cohorts, respectively. Thirty nine (92.86%) of pneumococci isolates
were susceptible to erythromycin, 39 (92.86%) were susceptible to vancomycin, 8
(19.86%) were susceptible to oxacillin; 40 (95.24%) were susceptible to
clindamycin, 24 (57.86%) were susceptible to ceftriaxone while 18 (42.86%)
were non-susceptible. The risk of nasopharyngeal carriage decreased
insignificantly when the subject was female (odds ratio [OR]: 0.766, 95% CI:
0.388, 1.511, p-value=0.442). Children between the age of 25-36 months (OR:
1.147 (95% I: 483, 2.722) and 37-48 months (OR: 1, 95% CI: 0.286, 3.501) had
an insignificant elevated risk of nasopharyngeal carriage of the bacteria. Children
whose mothers were non-cigarrate smokers exhibited low odds of carriage (OR:
0.764 (95% CI: 0.077, 7.537; p=0.818). Serotype replacement, resistance to
penicillins and exposure to smoke were correlated with incresaed risk of
nasopharyngeal carriage. Continuous and broader epidemiological surveys should
be carried out in the entire country to accurately determine the degree of serotype
replacement and; people should be sensitised on judicious use and/or consumption
of antibiotics. Optochin test should be introduced as a routine assay in diagnosis
of Streptococcus pneumoniae in hospitals.