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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Emergence of levofloxacin-non-susceptible Streptococcus pneumoniae and treatment for multidrug-resistant tuberculosis in children in South Africa: a cohort observational surveillance study
The Lancet, Volume 371, No. 9618, Year 2008
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Description
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. © 2008 Elsevier Ltd. All rights reserved.
Authors & Co-Authors
von Gottberg, Anne M.
South Africa, Johannesburg
National Institute for Communicable Diseases
South Africa, Johannesburg
School of Pathology
South Africa, Tygerberg
South African Medical Research Council
Klugman, K. P.
South Africa, Johannesburg
National Institute for Communicable Diseases
South Africa, Johannesburg
School of Pathology
South Africa, Tygerberg
South African Medical Research Council
United States, Atlanta
Rollins School of Public Health
Cohen, Cheryl D.
South Africa, Johannesburg
National Institute for Communicable Diseases
South Africa, Johannesburg
Wits School of Public Health
Wolter, Nicole
South Africa, Johannesburg
National Institute for Communicable Diseases
South Africa, Johannesburg
School of Pathology
South Africa, Tygerberg
South African Medical Research Council
de Gouveia, Linda D.
South Africa, Johannesburg
National Institute for Communicable Diseases
South Africa, Tygerberg
South African Medical Research Council
Du Plessis, Mignon D.
South Africa, Johannesburg
National Institute for Communicable Diseases
South Africa, Johannesburg
School of Pathology
South Africa, Tygerberg
South African Medical Research Council
Mpembe, Ruth S.
South Africa, Johannesburg
National Institute for Communicable Diseases
South Africa, Tygerberg
South African Medical Research Council
Quan, Vanessa Cecilia
South Africa, Johannesburg
National Institute for Communicable Diseases
Whitelaw, Andrew C.
South Africa, Johannesburg
National Health Laboratory Service
South Africa, Cape Town
University of Cape Town
Hoffmann, Rena
South Africa, Johannesburg
National Health Laboratory Service
South Africa, Stellenbosch
Stellenbosch University
Govender, Nelesh P.
South Africa, Johannesburg
National Institute for Communicable Diseases
South Africa, Johannesburg
School of Pathology
Meiring, Susan T.
South Africa, Johannesburg
National Institute for Communicable Diseases
Smith, Anthony Marius
South Africa, Johannesburg
National Institute for Communicable Diseases
South Africa, Johannesburg
School of Pathology
Schrag, Stephanie J.
United States, Atlanta
National Center for Immunization and Respiratory Diseases
Statistics
Citations: 58
Authors: 14
Affiliations: 9
Identifiers
Doi:
10.1016/S0140-6736(08)60350-5
ISSN:
01406736
Research Areas
Maternal And Child Health
Study Design
Cohort Study
Study Locations
South Africa