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Characteristic peculiarities of antibiotic sensitivity of pneumococcus, isolated in children with pneumonia
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Shamansurova Elmira Amannulayevna, Tashkent Pediatric Medical Institute, Department of ambulatory Medicine, chief, DM Makhkamova Gulnoza Turakhodjayeva, Senior scientific assistant, applicant of the Department of ambulatory Medicine of the Tashkent Pediatric Medical Institute
E-mail: mbshakur@mail.ru
Characteristic peculiarities of antibiotic sensitivity of pneumococcus, isolated in children with pneumonia
Abstract: The basis of this article was the data of checking of 52 children with pneumonia in the age from 2 months to 9 years. We determined the pattern of clinical strains of the agents collected in Tashkent. Among the revealed isolates the prevailing one was pneumococcus taking 15.4%. The results of the study showed that, there is weak antibiotic sensitivity to amoxicillin/clavulanate, azithromycin and metronidazole, and in some cases it is absent. High sensitivity of pneumococcus is preserved to injection cephalosporins, but cephalosporins are not recommended for wide application in extra hospital pneumonia in children. For maintaining of antibiotic sensitivity of the agents it is rational to apply them in extra hospital pneumonia.
Keywords: pneumonia, children, Streptococcus pneumoniae, sensitivity to antibiotics.
Topicality. Streptococcus pneumoniae is one of the leading Pneumococcus (S. Pneumoniae) is one of the most often
agents of infections of respiratory ways [2; 8]. The main prob- bacterial agents of respiratory infections, and it causes severe
lem of the therapy of pneumococcal infections is appearance and spread of penicillin resistant pneumococcus in several countries, and strains resistant to macrolide antibiotics [1; 3]. In relation to this, it is necessary to have local epidemiological data about the resistance of pneumococcus to various antibacterial agents.
The study of S.pneumoniae sensitivity has certain difficulties, such as common recommendations require application of special nutritious media, unavailable for the majority of laboratories [5]. It was one of the main reasons of the absence of wide-range studies of pneumococcal sensitivity to antibiotics in our country.
Pneumococcal pneumonia is one of the most often forms of acute inflammation of lungs among extra hospital pneumonia. The problem of diagnostics and therapy of pneumococcal pneumonia is still one of the most topical issues in the modern health care. In spite of constant perfection of diagnostic methods and availability of modern very effective antibacterial agents, pneumococcal pneumonia still occupies a leading p [lace in the structure of morbidity and lethality from infectious diseases in developed countries [1; 6].
pneumonia in children of young age [3]. In USA every year more than 40 thousand people die of pneumococcal infection [8]. The important problem, linked with pneumococcal infections, is growth of antibiotic resistance of the agents isolated in the patients with invasive infections [2; 4].
It should be noted that, resistance of S. pneumoniae significantly differs in various countries. The most problematic regions are Hong Kong, SAR, countries of the Western Europe, South-East Asia and North America, where the resistance to penicillin and/or erythromycin reaches 40-80% [5; 7].
Thus, study of S. Pneumoniae sensitivity to antibacterial agents at the modern stage is topical problem in pediatrics.
Objective of this study is definition of S. Pneumoniae sensitivity to antibacterial agents used in present time for children with pneumonia in clinic.
Materials and methods. The study was performed in 52 children with pneumonia, who came to clinic of TashPMI and Urban clinical children's hospital № 1 in Tashkent. The age of the children varied from 2 months to 9 years old. Status of the children was considered to be severe (9children) and average severity (43 children).
Section 7. Medical science
Bacteriologic planting of nasopharyngeal mucous was performed by the following method: material from nasal cavity was taken with the help of dry sterile cotton wad inserted deep inside nasal cavity.
Cultural diagnostics of pneumococcus was performed in compliance with common scheme of material study in bacterial infections of respiratory ways. In the planting on nutritious media and further incubation for 24 hour in 37 °C on dense nutritious media pneumococcus formed soft, small, transparent colonies. Cups were checked visually.
On blood agar Streptococcus pneumonia were present in the form of small, flat, transparent colonies surrounded with green zone of alfa-hemolysis. Tinctorial properties of pneumococcus were studied using microscopy with Gram staining. For the differentiation of Str. pneumoniae from Str. Viridans we performed test for bile lysis of pneumococcus.
The estimation of sensitivity of Streptococcus pneumonia isolated colonies to antibacterial agents was performed by means of disc-diffusion method, based on the suppression of growth of the studied culture in case of diffusion from carrier of antibacterial agent to dense nutritious media. The isolated strains of microorganisms were classified according to the degree of sensitivity to high sensitive, sensitive, moderate resistant or resistant ones.
Results of the study. Totally within the period from January till May 2015 we isolated 8 strains of S. pneumoniae in 52 patients (15.4%).
We determined sensitivity of the isolated strains of pneu-mococcus to antibiotics applied in clinics of Tashkent city. Results of the studies showed that, antibiotic sensitivity to amoxicillin/clavulanate tended to decrease — 3 (37.5%) out of 8 achieved samples had weak or no sensitivity to that antibiotic.
87.5% of the patients had weak sensitivity to azithromycin, and no sensitivity to metronidazole.
It should be noted that, high sensitivity of pneumococcus
to injection cephalosporins is preserved, but cephalosporins are not recommended for wide application in extra hospital pneumonia in children. For maintenance of antibiotic sensitivity of the agents it is rational to limit their application in cases of extra hospital pneumonia.
Thus, pneumococcus is still the most often agent of bacterial respiratory infections in children. Important method of epidemiologic control of pneumococcal infections is the study of the spectrum of the agents circulating in certain territory. In this work we determined the pattern of clinical strains of the agents collected in Tashkent city in 2015. Among the detected isolates the prevailing one was pneumococcus, taking 15.4%.
Our study revealed an uneasy tendency of increase of pneumococcus resistance to macrolides and metronidazole. That result coincides with global tendency of fast growing prevalence of resistant pneumococcus, and resistance to mac-rolides increased from 5% to 25% [2].
Thus, our results once again demonstrate the necessity of constant monitoring of the prevalence of antibiotic resistant strains of pneumococcus and study of its sensitivity for perfection of empiric antibacterial therapy.
In conclusion, the performed study presents important information about the prevalence of pneumococcus in clinical samples in cases of pneumonia in children. These data can be used as starting point for the monitoring of antibiotic resistance of S. pneumoniae in our country.
Conclusions:
1. For the provision of adequate empiric antibacterial therapy of pneumonia it is rational to perform local monitoring of S. pneumonia resistance to antibiotics.
2. For the improvement of etiologic diagnostics in children it is recommended to use molecular detection methods and identification of pathogens together with cultural methods.
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