CORRESPONDENCE Mustafa Bakir á Aysegul Yagci á Cengiz Akbenlioglu Arzu Ilki á Nurver Ulger á Guner Soyletir Epidemiology of Streptococcus pneumoniae pharyngeal carriage among healthy Turkish infants and children Received: 11 September 2001 / Accepted: 5 November 2001 / Published online: 16 January 2002 Ó Springer-Verlag 2002 Sir: Since there is little information on the epidemiol- ogy of pharyngeal carriage and infection due to Streptococcus pneumoniae in Turkish children [3], suspected cases of bacterial pneumonia and meningitis are treated empirically; blood cultures are not rou- tinely collected and have little value in areas where antibiotic use before seeking medical care is common. Conjugated pneumococcal vaccine coverage has not been evaluated with large scale studies in Turkey. Between 12 January and 25 April 2000, pharyngeal swab specimens were collected from 1382 healthy infants and children in 24 randomly selected centres, including 6 well-child clinics WCCs, 438 samples), 11 day-care centres DCCs, 440 samples), and 7 elemen- tary schools ESs, 504 samples). S. pneumoniae was identi®ed by standard methods and serogrouped/sero- typed using Pneumotest kits Statens Serum Institute, Denmark). All isolates were screened for penicillin susceptibility using 1 lg oxacillin disks and penicillin minimal inhibitory concentrations MIC) were detected by the penicillin E test. Penicillin-resistant isolates were tested for other antibiotics. Median age  SD) of participants at WCCs was 6.0 months 10 days±24 months); at DCCs, 5 years 2±6 years); and at ESs, 8 years 7±10 years). S. pneumoniae carriage was detected in 118 8.5%) of subjects. Of 118 S. pneumoniae iso- lates, 34 28.8%) were resistant to penicillin. Carriage rate for penicillin-resistant Pneumococcus PRSP) was 1.1% in WCCs, 3.6% in DCCs, and 2.6% in ESs. A total of 91 77%) of 118 pneumococcal isolates were typable with the available antisera. Serogroups 6 24%), 23 21%), 19 19%) and 9 11%), comprised 75% of typable pneumococcal isolates. Of 34 PRSP isolates, 32 94%) were typable. Serogroups 6 28%), 23 28%), 19 17%), and 9 12%) comprised 85% of all typable PRSP isolates. Serotypes 1, 4, 5, and se- rogroup 18 were not found at all. The 7, 9, and 11- valent conjugate pneumococcal vaccines covered 59%, 59%, and 65% of all S. pneumoniae isolates and 82%, 82%, and 88% of PRSP isolates, respectively. MIC of PRSP isolates were between 0.05 and 1.0 lg/ml. None of the isolates had a MIC>2.0 lg/ml. Cross-resistance to trimethoprim-sulfamethoxazole, tetracycline, ery- thromycin, chloramphenicol, and cipro¯oxacin was detected in 85%, 62%, 18%, 18%, and 3% of PRSP isolates, respectively. All PRSP isolates were suscepti- ble to ceftriaxone and rifampicin. However, 23 68%) of the PRSP isolates were resistant to two or more dierent classes of antibiotics in addition to penicillin. Of multi-resistant isolates, 87% were covered by the heptavalent vaccine. The carriage rate of Pneumococcus was low in our study, similar to that found in Italy [2] and Russia [1]. The rate of penicillin resistance was not as high as in other European countries. An adequate level of sero- group coverage of currently licensed conjugated pneu- mococcal vaccines for the most frequent circulating and multiple-resistant pneumococcal isolates may be expected in Turkish children. References 1. Appelbaum PC, Gladkova C, Hryniewicz W, Kojouharov B, Kotulova D, Mihalcu F, Schindler J, Setchanova L, Semina N, Trupl J, Tyski S, Urbaskova P, Jakobs MR 1996) Carriage of antibiotic-resistant Streptococcus pneumoniae Eur J Pediatr 2002) 161: 165±166 DOI 10.1007/s00431-001-0886-4 M. Bakir &) á C. Akbenlioglu Division of Paediatric Infectious Diseases, Department of Paediatrics, Marmara University School of Medicine, Istanbul A. Yagci á A. Ilki á N. Ulger á G. Soyletir Department of Clinical Microbiology, Marmara University School of Medicine, Istanbul Present address: M. Bakir Merkez Mah, Begonya Sok, Emre Sitesi B Blok D.14, Kucukyali 81570, Istanbul, Turkey, Tel.: +90-532-5081418 Fax: +90-216-4897916 e-mail: bakirm@superonline.com