肺炎链球菌耐药性和血清型分布及隐匿性耐药克隆株的研究  

Resistance, serotypes and “hidden resistant clones” of Streptococcu pneumoniae among children in Beijing

作　　者：俞桑洁[1] 王槿芳[1] 李洁 李艳 王雪莲[1] Whitney CG Levine OS Dowell SF 杨永弘[1] 

机构地区：[1]北京市儿科研究所微生物免疫室,100045 [2]美国疾病控制中心

出　　处：《中华儿科杂志》2000年第7期424-427,共4页Chinese Journal of Pediatrics

摘　　要：目的　了解儿童肺炎链球菌携带者耐药菌株的流行情况 ,比较携带者菌株血清型与肺炎链球菌结合疫苗血清型的符合率 ,寻找单个患儿同时携带敏感和耐药菌株的可能性。方法　 (1)对1997年 11月～ 12月在北京儿童医院普通门诊登记的 3个月～ 5岁儿童进行问卷调查 ;(2 )采集鼻咽拭子和尿标本 ,培养、分离和鉴定肺炎链球菌 ,并测定尿标本中的抗生素活性 ;(3)根据NCCLS方法使用微量稀释法测定肺炎链球菌对青霉素、头孢呋新、头孢噻肟、复方新诺明、红霉素和氯霉素的敏感性 ;(4 )从最初发现的青霉素、红霉素敏感株中寻找“隐匿性耐药克隆株”。结果　 (1) 5 0 2例受试儿童中 ,分离出 190株肺炎链球菌 ,携带率为 37.8% (190 / 5 0 2 ) ,对青霉素的敏感率为 91.1% ;(2 )只有33 .9%的菌株血清型与建议使用的肺炎链球菌结合疫苗血清型相符 ;(3) 4 2例含青霉素和红霉素敏感菌株鼻咽拭子中发现 6株 (14% )“隐匿性耐药克隆株”。结论　在携带者中 ,肺炎链球菌对 β 内酰胺类耐药还不常见 ,但对红霉素和复方新诺明耐药却非常严重 ;建议使用的结合疫苗血清型不能覆盖大部分携带菌株 ;耐药菌株的小部分隐匿在敏感菌株中 。Objective Streptococcus pneumoniae (Sp) has long been one of the most important bacterial pathogen causing pneumonia, meningitis, otitis media, sinusitis, and septicemia. During the recent 2 decades, the resistance of Sp to penicillin has been rapidly increasing in many parts of the world. The authors designed the present study to determine the prevalence of drug resistance among streptococcus pneumoniae carried by children in China, to determine the prevalence of vaccine serotypes among carriage strains and to look for carriage of both susceptible and resistant Sp clones in individual patients. Methods The subjects enrolled 502 patients with upper respiratory infections who were 3 months to 5 years of age attending a general outpatient clinic at Beijing Children′s Hospital from Nov. to Dec.1997. A standardized questionnaire addressing age, symptoms of upper respiratory infections, recent antimicrobial use, breastfeeding, day care attendance, household size, smoke exposure, and parental education was completed for all the cases. Nasopharyngeal specimens and urine were collected for culture and antimicrobial activity, respectively. Sp was identified by optochin sensitivity and bile solubility. Sp serotyping was performed by using quelling reaction. Sensitivity to penicillin, cefuroxime, co trimoxazole, erythromycin, and chloramphenicol was determined using broth microdilution according to NCCLS methods. Urine sensitivity for antimicrobial activity was tested by pan susceptible Micrococcus luteus method. Forty two swabs were checked for “hidden clones” by selective plates containing penicillin or erythromycin compared to isolates found on gentamycin using antimicrobial susceptibility, serotype, and pulsed field gel electrophoresis (PFGE). Results Nasopharyngeal carriage of Sp among less than 5 years old children was 37.8% of the 502 subjects with upper respiratory infections. Beta lactam non susceptible strains remain uncommon (only 8%～9%) in this population. Resistance to erythromycin and co

关 键 词：肺炎链球菌 儿童抗药性 克隆 抗生素 

分 类 号：R378[医药卫生—病原生物学]