This article is more than 5 years old. Information may no longer be current.
Serotype 19A most common type of S. pneumoniae found in children with chronic sinusitis
Click Here to Manage Email Alerts
Among the various Streptococcus pneumoniae serotypes obtained from sinus cultures, 19A was the most prevalent in a population of children, according to study findings.
Between January 2007 and July 2008, researchers obtained sinus cultures that were growing S. pneumoniae from 24 patients (median age, 25.5 months) at Texas Children’s Hospital. Only cultures obtained via nasal endoscopy were included in the study. Cultures were evaluated for serotype, antimicrobial susceptibility and the frequency of coinfection with other organisms.
Of the 21 serotyped isolates, 20 were not included in the pneumococcal conjugate vaccine seven-valent, and the most common isolate was 19A (n=12). When testing for antimicrobial susceptibility, the researchers found that a greater number of serotype 19A isolates were penicillin-resistant (P<.001) or nonsusceptible to cefotaxime (P<.001) when compared with the non-19A isolates. Resistance to clindamycin, erythromycin or trimethoprim-sulfamethoxazole was observed more often among the 19A isolates. Also, at least one other pathogen was isolated from the sinus culture in 87% of cases, according to the researchers. The most common organisms included nontypeable Haemophilus influenzae, Moraxella catarrhalis and group A beta-hemolytic Streptococcus. Thirteen patients were coinfected with at least one beta-lactamase–producing organism.
After surgery, 23 patients were treated with antimicrobials, including cefpodoxime, amoxicillin, cefdinir, TMP-SMX and cefuroxime. Three patients had disease recurrence after the study period; two were treated with an additional endoscopic surgery. No patients with recurrent disease had systemic or intracranial complications, according to the researchers.
“Physicians treating children with chronic or recurrent sinusitis should consider sinus culture early to assist in the identification and treatment of these infections,” they wrote. – by Meredith Ripa
McNeil JC. Pediatr Infect Dis J. 2009;28:766-768.
The study by the Texas Children’s Hospital group is yet another call to action for judicious antibiotic use and the need for licensure of the new pneumococcal conjugate vaccine from Wyeth that will include serotype 19A among the 13 serotypes. Although the strains identified in this study were mostly antibiotic resistant, the investigators did not find the “superbug” serotype 19A pneumococcus identified in work by our group (Pichichero ME. JAMA. 2007;298:1772-1778). That pneumococcus was resistant to all 18 antibiotics FDA had approved for children in the treatment of acute otitis media. The study from Texas Children’s Hospital involved children with chronic sinusitis, and our study involved children with AOM. But since the pathogenesis of sinusitis and otitis is the same, the pathogens are the same and the immune response to control and prevent infections at the two upper respiratory sites are the same, it would follow that the pneumococcal types most likely would be the same, too. Practitioners need to be aware of the evolving changes in pathogens causing AOM and sinusitis in children and the antibiotic resistance of the strains of bacteria causing these infections so that our patients can receive optimal care.
– Michael Pichichero, MD
Infectious Diseases in Children Editorial Board