2000-2002年三家儿童医院分离的肺炎链球菌血清型分布及其对β内酰胺类抗生素敏感性的变化  

Serotype distribution and resistance to β-lactams of Streptococcus pneumoniae isolated from children in Beijing, Shanghai and Guangzhou, 2000-2002

作　　者：姚开虎[1] 陆权[2] 邓力[3] 俞桑洁[1] 张泓[4] 邓秋莲[5] 佟月娟[1] 高薇[1] 袁林[1] 沈叙庄[1] 杨永弘[1] 

机构地区：[1]首都医科大学附属北京儿童医院微生物免疫室,100045 [2]上海儿童医院呼吸科 [3]广州市儿童医院呼吸科 [4]上海儿童医院检验科 [5]广州市儿童医院检验科

出　　处：《中华儿科杂志》2006年第12期928-932,共5页Chinese Journal of Pediatrics

基　　金：国家自然科学基金资助项目(30070793)

摘　　要：目的了解当前我国儿童人群中肺炎链球菌血清型分布,及不同血清型菌株对β内酰胺类抗生素的敏感性变化,评估疫苗在预防肺炎链球菌感染及控制其耐药性流行中的价值。方法以2000-2002年于北京、上海和广州三家儿童医院门诊分离的625株肺炎链球菌为研究对象,应用简易棋盘式肺炎链球菌分型系统检测血清型,分析肺炎链球菌7价结合疫苗(4、6B、9V、14、18C、19F和23F)覆盖率;采用E-test最小抑菌浓度(MIC)法检测分离菌株对5种β内酰胺类抗生素的敏感性。结果最常见的血清型/群为19群,共121株(19·4%),其次是23群(15·4%)、6群(13·3%)、14型(6·6%)和15群(4·3%)。140株(22·4%)不能分型,还有117株(18·7%)属于其他28种少见的血清型/群。肺炎链球菌7价结合疫苗覆盖约360株,占57·6%;其中,血清型/群4、9和18分别有1、6和12株,共计占3·0%。常见血清型/群中,19群和23群与青霉素不敏感肺炎链球菌(PNSP)明显有关,其他血清型/群与PNSP无明显相关。结论常见的血清型为19群、23群、6群、14型和15群,19群和23群与PNSP明显相关。肺炎链球菌7价结合疫苗可覆盖多数分离株。Objective The present study was designed to investigate the situation of serotype distribution and β-lactam antibiotics resistance of Streptococcus pneumoniae （S, pneumoniae） isolated from Chinese children, and to further understand the significance of vaccine for preventing infection caused by the bactria and controlling the resistance to antibiotics. Methods Nasopharageal swab specimens were collected from randomly selected less than 5-year-old out-patients with upper respiratory infection in Beijing, Shanghai and Guangzhou, 2000 -2002. Capsular typing was performed by the Quellung reaction tested using a simplified chessboard system for typing of S. pneumoniae. The coverage rate of the 7-valent pneumococcal conjugate vaccine （4, 6B, 9V, 14, 18C, 19F and 23F） was calculated. Antibiotic susceptibility was determined by E-test MIC method for β-1actam antibiotics （ penicillin, amoxicillin/clavulanic acid, cefaclor, cefuroxime and ceftriaxone ） . Results Totally 625 pneumococcal strains were typed. Serogroup 19, including 121 strains, was the most frequent serogroup observed （ 19.4% ）. Other frequently observed serotypes/serogroups in decreasing order of frequency were serotype/serogroups 23 （ 15.4% ） , 6 （ 13.3% ） , 14 （6.6%） and 15 （4.3%）. Of all these isolates, about 57.6% （360/625） were in the 7-valent conjugate vaccine. Only 1, 6 and 12 strains were serotypes/serogroups 4, 9 and 18, respectively. The coverage rate for the 7-valent vaccine of penicillin nonsusceptible S. pneumoniae （PNSP） was higher than penicillin susceptible S. pneumoniae （PSSP） （73.2% and 46.1% ）. Serogroups 19 and 23 ,without other serotypes/serogroups,were significantly associated with PNSP （serogroup 19 accounted for 29. 1% of PNSP and 12. 2% of PSSP; serogroup 23 accounted for 23. 8% of PNSP to 9. 2% of PSSP）. Overall, 140 strains （22. 4% ） could not be typed by using the chessboard system, and 117 strains （ 18.7% ） were identified as other 28 kinds of serotype/serogroup. The

关 键 词：链球菌 肺炎 血清分型 β内酰胺抗药性 儿童 

分 类 号：R725.6[医药卫生—儿科]