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

Summary Background 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... Full description

Journal Title: The Lancet (British edition) 2008, Vol.371 (9618), p.1108-1113
Main Author: von Gottberg, Anne, FCPath [SA] Micro
Other Authors: Klugman, Keith P, Prof , Cohen, Cheryl, FCPath [SA] Micro , Wolter, Nicole, PhD , de Gouveia, Linda, MT , du Plessis, Mignon, PhD , Mpembe, Ruth, MT , Quan, Vanessa, MBBCh , Whitelaw, Andrew, FCPath [SA] Micro , Hoffmann, Rena, MMed , Govender, Nelesh, FCPath [SA] Micro , Meiring, Susan, MBChB , Smith, Anthony M, PhD , Schrag, Stephanie, DPhil
Format: Electronic Article Electronic Article
Language: English
Subjects:
Quelle: Alma/SFX Local Collection
Publisher: England: Elsevier Ltd
ID: ISSN: 0140-6736
Link: https://www.ncbi.nlm.nih.gov/pubmed/18359074
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title: Emergence of levofloxacin-non-susceptible Streptococcus pneumoniae and treatment for multidrug-resistant tuberculosis in children in South Africa: a cohort observational surveillance study
format: Article
creator:
  • von Gottberg, Anne, FCPath [SA] Micro
  • Klugman, Keith P, Prof
  • Cohen, Cheryl, FCPath [SA] Micro
  • Wolter, Nicole, PhD
  • de Gouveia, Linda, MT
  • du Plessis, Mignon, PhD
  • Mpembe, Ruth, MT
  • Quan, Vanessa, MBBCh
  • Whitelaw, Andrew, FCPath [SA] Micro
  • Hoffmann, Rena, MMed
  • Govender, Nelesh, FCPath [SA] Micro
  • Meiring, Susan, MBChB
  • Smith, Anthony M, PhD
  • Schrag, Stephanie, DPhil
subjects:
  • Abridged Index Medicus
  • Adolescent
  • Anti-Bacterial Agents - therapeutic use
  • Antitubercular Agents - therapeutic use
  • Child
  • Child, Preschool
  • Children
  • Cross Infection
  • Cross-Sectional Studies
  • Diseases
  • Drug resistance in microorganisms
  • Drug Resistance, Bacterial - drug effects
  • Drug therapy
  • Evaluation
  • Female
  • Humans
  • Infant
  • Internal Medicine
  • Levofloxacin
  • Male
  • Ofloxacin - therapeutic use
  • Physiological aspects
  • Pneumococcal Infections - drug therapy
  • Pneumococcal Infections - epidemiology
  • Population Surveillance
  • Quinolone antibacterial agents
  • Quinolones
  • Research
  • Rifampin - therapeutic use
  • Risk Factors
  • South Africa - epidemiology
  • Statistics, Nonparametric
  • Streptococcus pneumoniae
  • Streptococcus pneumoniae - drug effects
  • Streptococcus pneumoniae - pathogenicity
  • Tuberculosis
  • Tuberculosis, Multidrug-Resistant - drug therapy
  • World Health Organization
ispartof: The Lancet (British edition), 2008, Vol.371 (9618), p.1108-1113
description: Summary Background 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.
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0140-6736
fulltext: fulltext
issn:
  • 0140-6736
  • 1474-547X
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titleEmergence 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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creatorvon Gottberg, Anne, FCPath [SA] Micro ; Klugman, Keith P, Prof ; Cohen, Cheryl, FCPath [SA] Micro ; Wolter, Nicole, PhD ; de Gouveia, Linda, MT ; du Plessis, Mignon, PhD ; Mpembe, Ruth, MT ; Quan, Vanessa, MBBCh ; Whitelaw, Andrew, FCPath [SA] Micro ; Hoffmann, Rena, MMed ; Govender, Nelesh, FCPath [SA] Micro ; Meiring, Susan, MBChB ; Smith, Anthony M, PhD ; Schrag, Stephanie, DPhil
creatorcontribvon Gottberg, Anne, FCPath [SA] Micro ; Klugman, Keith P, Prof ; Cohen, Cheryl, FCPath [SA] Micro ; Wolter, Nicole, PhD ; de Gouveia, Linda, MT ; du Plessis, Mignon, PhD ; Mpembe, Ruth, MT ; Quan, Vanessa, MBBCh ; Whitelaw, Andrew, FCPath [SA] Micro ; Hoffmann, Rena, MMed ; Govender, Nelesh, FCPath [SA] Micro ; Meiring, Susan, MBChB ; Smith, Anthony M, PhD ; Schrag, Stephanie, DPhil ; for the Group for Enteric, Respiratory and Meningeal Disease Surveillance in South Africa (GERMS-SA) ; Group for Enteric, Respiratory and Meningeal Disease Surveillance in South Africa (GERMS-SA)
descriptionSummary Background 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.
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languageeng
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subjectAbridged Index Medicus ; Adolescent ; Anti-Bacterial Agents - therapeutic use ; Antitubercular Agents - therapeutic use ; Child ; Child, Preschool ; Children ; Cross Infection ; Cross-Sectional Studies ; Diseases ; Drug resistance in microorganisms ; Drug Resistance, Bacterial - drug effects ; Drug therapy ; Evaluation ; Female ; Humans ; Infant ; Internal Medicine ; Levofloxacin ; Male ; Ofloxacin - therapeutic use ; Physiological aspects ; Pneumococcal Infections - drug therapy ; Pneumococcal Infections - epidemiology ; Population Surveillance ; Quinolone antibacterial agents ; Quinolones ; Research ; Rifampin - therapeutic use ; Risk Factors ; South Africa - epidemiology ; Statistics, Nonparametric ; Streptococcus pneumoniae ; Streptococcus pneumoniae - drug effects ; Streptococcus pneumoniae - pathogenicity ; Tuberculosis ; Tuberculosis, Multidrug-Resistant - drug therapy ; World Health Organization
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2Cohen, Cheryl, FCPath [SA] Micro
3Wolter, Nicole, PhD
4de Gouveia, Linda, MT
5du Plessis, Mignon, PhD
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7Quan, Vanessa, MBBCh
8Whitelaw, Andrew, FCPath [SA] Micro
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10Govender, Nelesh, FCPath [SA] Micro
11Meiring, Susan, MBChB
12Smith, Anthony M, PhD
13Schrag, Stephanie, DPhil
14for the Group for Enteric, Respiratory and Meningeal Disease Surveillance in South Africa (GERMS-SA)
15Group for Enteric, Respiratory and Meningeal Disease Surveillance in South Africa (GERMS-SA)
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0Emergence 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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descriptionSummary Background 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.
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1Adolescent
2Anti-Bacterial Agents - therapeutic use
3Antitubercular Agents - therapeutic use
4Child
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6Children
7Cross Infection
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9Diseases
10Drug resistance in microorganisms
11Drug Resistance, Bacterial - drug effects
12Drug therapy
13Evaluation
14Female
15Humans
16Infant
17Internal Medicine
18Levofloxacin
19Male
20Ofloxacin - therapeutic use
21Physiological aspects
22Pneumococcal Infections - drug therapy
23Pneumococcal Infections - epidemiology
24Population Surveillance
25Quinolone antibacterial agents
26Quinolones
27Research
28Rifampin - therapeutic use
29Risk Factors
30South Africa - epidemiology
31Statistics, Nonparametric
32Streptococcus pneumoniae
33Streptococcus pneumoniae - drug effects
34Streptococcus pneumoniae - pathogenicity
35Tuberculosis
36Tuberculosis, Multidrug-Resistant - drug therapy
37World Health Organization
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titleEmergence of levofloxacin-non-susceptible Streptococcus pneumoniae and treatment for multidrug-resistant tuberculosis in children in South Africa: a cohort observational surveillance study
authorvon Gottberg, Anne, FCPath [SA] Micro ; Klugman, Keith P, Prof ; Cohen, Cheryl, FCPath [SA] Micro ; Wolter, Nicole, PhD ; de Gouveia, Linda, MT ; du Plessis, Mignon, PhD ; Mpembe, Ruth, MT ; Quan, Vanessa, MBBCh ; Whitelaw, Andrew, FCPath [SA] Micro ; Hoffmann, Rena, MMed ; Govender, Nelesh, FCPath [SA] Micro ; Meiring, Susan, MBChB ; Smith, Anthony M, PhD ; Schrag, Stephanie, DPhil
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abstractSummary Background 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.
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