Invasive disease due to multiply resistant Streptococcus pneumoniae in a Houston, Tex, day-care center
A. M. Rauch, M. O'Ryan, R. Van and L. K. Pickering
Department of Pediatrics, University of Texas Medical School, Houston 77030.
Two toddlers who attended the same day-care center were hospitalized hours
apart with sepsis and meningitis due to a multiply resistant Streptococcus
pneumoniae. We determined the prevalence of multiply resistant S pneumoniae
respiratory carriage and disease in infants, toddlers, and staff in the
day-care center and in household contacts. The nasopharynges of 82 (96%) of
85 day-care center children, 26 (90%) of 29 day-care center staff, and 28
(90%) of 31 family members were cultured. Streptococcus pneumoniae grew
from 29 (35%) of the 82 cultured day-care center children. Ten (34%) of the
S pneumoniae isolates were resistant to sulfamethoxazole-trimethoprim,
oxacillin, and tetracycline and were relatively resistant to penicillin
(minimum inhibitory concentration, 0.5 mg/L). All were serotype 14 and had
the same antibiotic resistance pattern. Treatment of 97% of the day-care
center children and staff with rifampin (10 mg/kg twice daily for 2 days)
resulted in 70% reduction in positive nasopharyngeal cultures for S
pneumoniae. No additional disease due to multiply resistant S pneumoniae
was identified in the day-care center during a 9-month follow-up period.
This report documents that an outbreak of multiply resistant invasive S
pneumoniae occurred in a day-care center setting; that nasopharyngeal
colonization of exposed children was common; and that rifampin treatment of
2 days only partially eradicated the organism from colonized individuals.
