From The Toronto Sun:

'It is unsettling'
New superbug strain at Sick Kids resists drugs
By By Helen Branswell, THE CANADIAN PRESS

TORONTO A child is being treated in Torontos Hospital for Sick Children for a case of meningitis caused by a worrisome multi-drug resistant strain of the Streptococcus pneumoniae bacteria, a hospital official confirmed Wednesday.

The head of infectious diseases for the hospital said doctors elsewhere in Ontario should consider the possibility of a multi-drug resistant strain when faced with cases of pneumococcal disease in children.

The most important thing ... is that it identifies and confirms the need for there to be a heightened state of alertness as this relates to surveillance to determine the full extent of this ... and whether or not this truly represents a sporadic event or is this part of any evolving trend, Dr. Upton Allen said in an interview.

One needs to consider that children presenting particularly those presenting with severe disease such as meningitis could have a 19A strain or in fact other strains that might be resistant to antibiotics.

In children, Streptococcus pneumoniae also known as pneumococcus often causes ear infections, though it can also cause pneumonia, bloodstream infections and meningitis, an infection of the fluid in spinal cord and around the brain.

The unidentified childs illness was caused by a variant of the 19A strain of Streptococcus pneumoniae that is resistant to the antibiotic ceftriaxon, a treatment staple for bacterial meningitis in children. The child is still not out of the woods.

The child is still quite ill, Allen said. We still have a far way to go as far as treatment. When it became apparent the initial treatment regime wasnt working, a number of other antibiotics were tried without success, he said. Eventually doctors turned to levofloxicin, a powerful antibiotic not typically used in meningitis in children. That drug was effective against the bacteria.

It is unsettling, Allen admitted about seeing such a case.

We often, in the treatment of meningitis in children, are faced with situations where we have medications that were absolutely sure will work against all cases.

And here was one that basically was acquired in the community, came into hospital and the initial antibiotics werent exactly right on as far as being totally perfect, simply because this was a very resistant strain. An unusual occurrence.

Multi-drug resistant variants of 19A have recently been reported to be causing pneumococcal disease in parts of the Northeastern United States.

Infectious disease experts at the University of Rochester, N.Y., reported at a major medical conference earlier in the fall that they had seen a number of cases of ear infections in children caused by a 19A variant that was resistant to all antibiotics approved for treatment of ear infections in the United States.

The 19A subtype is not covered by the pneumococcal vaccine commonly given to children, Wyeth Pharmaceuticals Prevnar. The vaccine covers the seven strains of the bacteria that were responsible for the most pneumococcal illness before the vaccine was introduced.

A new version which will cover the 13 top strains including 19A is currently in clinical trials in a number of countries, including Canada.

Since the introduction of Prevnar, infectious disease experts have been watching closely to see if other severe strains of the disease become more commonplace as the vaccine reduces levels of the former top seven strains.

Some have theorized that the emergence of a multi-drug resistant variant of 19A may be linked to that phenonomen, known as replacement disease. But others insist its too soon to say.

Dr. David Scheifele, a vaccine expert at B.C. Childrens Hospital, said study in Canada has shown that about five per cent of pneumococcal bacteria are resistant to ceftriaxon.

And Dr. Allison McGeer, an infectious diseases expert at Torontos Mount Sinai Hospital, said there have been earlier findings of multi-drug resistant variants of 19A.

Weve had invasive disease, caused by resistant 19A strains, McGeer said. Weve not had a meningitis with it.