COMMUNITY-ACQUIRED PNEUMONIA PNEUMOCOCCAL ETIOLOGY AND MICROBIOLOGICAL ASPECTS OF NASOPHARYNGEAL CARRIAGE IN CHILDREN IN THE REPUBLIC OF TATARSTAN

Prevalence estimate of pneumococcus carrier in preschool age children (medically fragile children with respiratory diseases and practically healthy organized children) have been carried out; microbiological features of clinical isolates S. pneumoniae have been studied. 511 S. pneumoniae strains isolated from medically fragile children with respiratory diseases aged between 6 months to 7 years during the period 2009–2016 and 47 isolates isolated from 200 practically healthy children attending preschool institutions of Kazan (2016) have been included in the research. Among 343 strains, 76 isolates were isolated during the period of 2009–2011; 82 strains — in 2012–2013; 87 strains — in 2014; 98 strains — in 2015; 168 strains — in 2016. Analysis of microbiocenosis of nasopharynx in medically fragile children showed that S. pneumoniae was sowed in 32.9% cases. In 58.4% of children it was as a monoculture (degree of colonization is 10⁴–10⁶  CFU/ml). S. pneumoniae contaminated nasopharynx in bacterial associations with other respiratory pathogens (S. aureus, Moraxella spp., Haemophilus spp.) in 41.6% of children. The analysis of microbiocenosis character of nasopharynx in children aged between 2.5–7 years attending preschool institutions in Kazan (n = 200) have showed that contamination S. pneumoniae (23.5%) was observed in 47 children. Pneumococcus have been isolated in monoculture in 82.9% of children; the contamination degree made 10³–10⁶ CFU/ml. According to serotyping data, nasopharynx of often and long-term ill children living in Kazan is colonized by serotypes of pneumococcus which are covered with 13 valence conjugated serum. The obtained data on the dynamics of strain S. pneumoniae antibiotic sensitivity among medically fragile children with respiratory diseases in Kazan during 2009–2015 showed high activity of β-lactams antibiotics (from 96 to 90.8% sensitive isolates) and clyndamicin (94.7–91.8% sensitive straines). Macrolides (azytromicin, clarytromicin) and phtorchinolons (ciprof loxacin) are less active in regard to isolates S. рneumoniae. S. pneumoniae with multiple antibiotic resistance were detected in children nasopharynx: 3.8–9.95 in medically fragile children and 8.5% in organized children-bactericides. Identification of the carrier level S. pneumoniae and monitoring the dynamics on antibiotic resistance and serotyping composition of nasopharyngeal pneumococcus will optimize prevention and treatment of infections S. pneumoniae in preschool children.