Emergence of levofloxacin-non-susceptible Streptococcus pneumoniae and treatment for multidrug-resistant tuberculosis in children in South Africa: a cohort observational surveillance study

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dc.contributor.authorvon Gottberg A.
dc.contributor.authorKlugman K.P.
dc.contributor.authorCohen C.
dc.contributor.authorWolter N.
dc.contributor.authorde Gouveia L.
dc.contributor.authordu Plessis M.
dc.contributor.authorMpembe R.
dc.contributor.authorQuan V.
dc.contributor.authorWhitelaw A.
dc.contributor.authorHoffmann R.
dc.contributor.authorGovender N.
dc.contributor.authorMeiring S.
dc.contributor.authorSmith A.M.
dc.contributor.authorSchrag S.
dc.date.accessioned2011-05-15T15:58:08Z
dc.date.available2011-05-15T15:58:08Z
dc.date.issued2008
dc.description.abstractBackground: Use of fluoroquinolones to treat paediatric cases of multidrug-resistant tuberculosis could affect the emergence of resistance to this class of drugs. Our aim was to estimate the incidence of, and risk factors for, invasive pneumococcal disease caused by fluoroquinolone-resistant Streptococcus pneumoniae in children in South Africa. Methods: 21 521 cases of invasive pneumococcal disease were identified by active national surveillance between 2000 and 2006, with enhanced surveillance at 15 sentinel hospitals in seven provinces introduced in 2003. We screened 19 404 isolates (90% of cases) for ofloxacin resistance and measured levofloxacin minimum inhibitory concentrations (MICs) for all isolates that were ofloxacin resistant. Non-susceptibility to levofloxacin was defined as an MIC of 4 mg/L or more. Nasopharyngeal pneumococcal carriage was assessed in 65 children in two tuberculosis hospitals where invasive pneumococcal disease caused by levofloxacin-non-susceptible S pneumoniae had been detected. Findings: 12 cases of invasive pneumococcal disease were identified as being non-susceptible to levofloxacin, all in children aged under 15 years. All isolates were rifampicin resistant. Outcome was known for 11 of these patients; five (45%) died. Invasive disease caused by levofloxacin-non-susceptible S pneumoniae was associated with a history of tuberculosis treatment (eight [89%] of nine children with non-susceptible isolates had a history of treatment vs 396 [18%] of 2202 children with susceptible isolates; relative risk [RR] 35·78, 95% CI 4·49-285·30) and nosocomial invasive pneumococcal disease (eight [80%] of ten children with non-susceptible isolates had acquired infection nosocomially vs 109 [4%] of 2709 with susceptible isolates; RR 88·96, 19·10-414·29). 31 (89%) of 35 pneumococcal carriers had bacteria that were non-susceptible to levofloxacin. Interpretation: Our data suggest that the use of fluoroquinolones to treat multidrug-resistant tuberculosis in children has led to the emergence of invasive pneumococcal disease caused by levofloxacin-non-susceptible S pneumoniae and its nosocomial spread. Funding: National Institute for Communicable Diseases of the National Health Laboratory Service (South Africa), US Agency for International Development Antimicrobial Resistance Initiative, US Centers for Disease Control and Prevention. © 2008 Elsevier Ltd. All rights reserved.
dc.description.versionArticle
dc.identifier.citationThe Lancet
dc.identifier.citation371
dc.identifier.citation9618
dc.identifier.issn1406736
dc.identifier.other10.1016/S0140-6736(08)60350-5
dc.identifier.urihttp://hdl.handle.net/10019.1/10792
dc.subjectclindamycin
dc.subjectcotrimoxazole
dc.subjecterythromycin
dc.subjectlevofloxacin
dc.subjectmoxifloxacin
dc.subjectofloxacin
dc.subjectpenicillin G
dc.subjectquinolone derivative
dc.subjectrifampicin
dc.subjecttetracycline
dc.subjectadolescent
dc.subjectarticle
dc.subjectbacterium isolate
dc.subjectchild
dc.subjectcohort analysis
dc.subjectconfidence interval
dc.subjectdisease control
dc.subjectfemale
dc.subjecthistory
dc.subjecthospital
dc.subjecthospital infection
dc.subjecthuman
dc.subjectinfant
dc.subjectlaboratory
dc.subjectmajor clinical study
dc.subjectmale
dc.subjectminimum inhibitory concentration
dc.subjectmorbidity
dc.subjectmultidrug resistance
dc.subjectnasopharynx
dc.subjectnewborn
dc.subjectobservational study
dc.subjectoutcome assessment
dc.subjectpriority journal
dc.subjectpublic health
dc.subjectrisk factor
dc.subjectscreening
dc.subjectSouth Africa
dc.subjectStreptococcus pneumoniae
dc.subjecttuberculosis
dc.subjectUnited States
dc.subjectAdolescent
dc.subjectAnti-Bacterial Agents
dc.subjectAntitubercular Agents
dc.subjectChild
dc.subjectChild, Preschool
dc.subjectCross Infection
dc.subjectCross-Sectional Studies
dc.subjectDrug Resistance, Bacterial
dc.subjectFemale
dc.subjectHumans
dc.subjectInfant
dc.subjectMale
dc.subjectOfloxacin
dc.subjectPneumococcal Infections
dc.subjectPopulation Surveillance
dc.subjectRifampin
dc.subjectRisk Factors
dc.subjectSouth Africa
dc.subjectStatistics, Nonparametric
dc.subjectStreptococcus pneumoniae
dc.subjectTuberculosis, Multidrug-Resistant
dc.subjectWorld Health Organization
dc.titleEmergence of levofloxacin-non-susceptible Streptococcus pneumoniae and treatment for multidrug-resistant tuberculosis in children in South Africa: a cohort observational surveillance study
dc.typeArticle
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