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Colonization of the nasopharynx by  Streptococcus pneumoniae  is a necessary precursor to pneumococcal diseases that result in morbidity and mortality worldwide. The nasopharynx is also host to other bacterial species, including the common pathogens  Staphylococcus aureus ,  Haemophilus influenzae , and  Moraxella catarrhalis . To better understand how these bacteria change in relation to pneumococcal colonization, we used species-specific quantitative PCR to examine bacterial densities in 52 subjects 7 days before, and 2, 7, and 14 days after controlled inoculation of healthy human adults with  S. pneumoniae  serotype 6B. Overall, 33 (63%) of subjects carried  S. pneumoniae  post-inoculation. The baseline presence and density of  S. aureus ,  H. influenzae , and  M. catarrhalis  were not statistically associated with likelihood of successful pneumococcal colonization at this study’s sample size, although a lower rate of pneumococcal colonization in the presence of  S. aureus  (7/14) was seen compared to that in the presence of  H. influenzae  (12/16). Among subjects colonized with pneumococci, the number also carrying either  H. influenzae  or  S. aureus  fell during the study and at 14 days post-inoculation, the proportion carrying  S. aureus  was significantly lower among those who were colonized with  S. pneumoniae  ( p  = 0.008) compared to non-colonized subjects. These data on bacterial associations are the first to be reported surrounding experimental human pneumococcal colonization and show that co-colonizing effects are likely subtle rather than absolute.

Impact of Experimental Human Pneumococcal Carriage on Nasopharyngeal Bacterial Densities in Healthy Adults