Nasopharyngeal Carriage of Respiratory Pathogens in Children Undergoing Pressure Equalization Tube Placement in the Era of Pneumococcal Protein Conjugate Vaccine Use

OBJECTIVE: To define carriage of bacterial respiratory pathogens in children undergoing pressure equalization tube placement. STUDY DESIGN: Nasopharyngeal cultures were performed during tube placement. Antibiotic susceptibilities and serotypes of pneumococci were determined. RESULTS: Sixty-nine Streptococcus pneumoniae, 72 Haemophilus influenzae (41% beta-lactamase positive), and 39 Moraxella catarrhalis (all beta-lactamase positive) were isolated from 201 children. Overall, 42% of pneumococci were nonsusceptible to penicillin, and 34.8% were resistant to macrolides. In relation to the pneumococcal conjugate vaccine, 17.4% were vaccine, 31.9% vaccine-related, and 50.7% nonvaccine serotypes. CONCLUSION: Twenty-five percent of children colonized with pneumococci carried antibiotic resistant nonvaccine serotypes rarely detected before the introduction of pneumococcal conjugate vaccine, including serotype 19A isolates (7%) resistant to all oral agents tested and type 35B isolates (12%) nonsusceptible to penicillin and cefuroxime. SIGNIFICANCE: Pneumococcal colonization suggests replacement of vaccine serotypes with vaccine related and nonvaccine serotypes, many of which are resistant to common oral antimicrobials.