肺炎链球菌耐药性及分子流行病学调查

目的研究临沂地区肺炎链球菌呼吸道感染分离株的耐药性及其传播情况.方法 对肺炎链球菌分离株进行药物敏感试验和血清学分型,并结合BOX-PCR、青霉素结合蛋白基因指纹等分子生物学方法分析菌株间亲缘关系.结果 124株肺炎链球菌中红霉素不敏感菌株33株,占26.6%,其中ermB基因介导的红霉素耐药菌株21株,占63.6%,mefE基因介导的红霉素耐药菌株12株,占36.4%.青霉素敏感株(PSSP)111株,敏感率89.5%,青霉素低度耐药株(PISP)10株,发现青霉素耐药株(PRSP)3株,PSSP组中除对红霉素、克林霉素、复方磺胺甲噁唑敏感度较低外,对阿莫西林/克拉维酸,第二、三代头孢菌素,氧氟沙星,万古霉素亦敏感;而PISP组出现了对第二代头孢菌素耐药菌株,3株PRSP除对万古霉素敏感外,对其他抗菌药物均耐药.124株肺炎链球菌血清型主要为23F、3、19F、14、9V、6A、6B等;BOX-PCR谱型共35种,其中青霉素不敏感株(PNSP)有6种谱型.结论 上述肺炎链球菌呼吸道感染分离株对红霉素耐药的肺炎链球菌,其耐药机制以ermB基因介导为主,ermB基因介导的耐药水平高于mefE基因介导的耐药水平;对青霉素耐药率较低,耐二代头孢菌素肺炎链球菌对万古霉素敏感.存在青霉素耐药菌株克隆传播和耐药基因水平传播.     

广东省深圳社区获得性肺炎患儿肺炎链球菌的血清群/型的分布及其耐药性

目的通过了解广东省深圳地区社区获得性肺炎患儿肺炎链球菌的血清群/型的分布,几种疫苗的覆盖情况及其对8种抗菌药物的耐药性,评估几种疫苗在本地区预防肺炎链球菌的价值,以及为临床合理应用抗生素提供参考。方法选择2006年2月—2007年2月广东省深圳地区社区获得性肺炎患儿分离的肺炎链球菌,进行血清分型,E试验法检测该菌对8种抗菌药物的耐药情况。结果 1011例患儿中分离出肺炎链球菌90株,分离率为8.9%。血清型分布以19F最常见（62.2%,56/90）,其次为23F（15.6%,14/90）、6B（10.0%,9/90）、4（6.7%,6/90）,7价疫苗覆盖率为94.4%。而9、10和11价疫苗所包含的血清型均未分离到。13价疫苗的覆盖率（97.8%）较7价疫苗无明显升高（χ2=1.34,P〉0.05）。7价疫苗所含血清型的肺炎链球菌株中,青霉素耐药率为14.1%,所有分离的肺炎链球菌青霉素的耐药率为13.3%,对万古霉素100%敏感,氧氟沙星耐药率为0,阿莫西林的耐药率为2.2%。未出现耐亚胺培南菌株,但11.1%的菌株处于中介。对红霉素的耐药率高达98.9%,头孢呋辛的耐药率也达到64.4%,头孢曲松的耐药率为4.4%。结论广东省深圳地区社区获得性肺炎患儿肺炎链球菌的血清群/型的分布,以19F、23F、6B、4常见,7价疫苗覆盖率为94.4%。对万古霉素、左氧氟沙星、阿莫西林、亚胺培南敏感性高,青霉素、红霉素和头孢呋辛敏感率低。     

327例患儿肺炎链球菌感染分布及耐药性分析

目的分析该院0~14岁儿童患者肺炎链球菌感染分布及耐药性特征。方法使用基质辅助激光解析飞行时间质谱仪(MALDI-TOF MS)鉴定细菌,使用ATB STREP 5进行药敏试验,青霉素G最低抑菌浓度(MIC)采用E试验法检测。结果共分离肺炎链球菌327株,其中287株(87.8%)来自痰液,25株(7.6%)来自耳分泌物,10株(2.9%)来自鼻窦穿刺液,3株(0.9%)来自血液。菌株分离的季节以春季最多(28.4%),冬季最少(22.0%),但四季分离率差异无统计学意义(P0.05)。肺炎链球菌非脑膜炎株对青霉素G的敏感、中介和耐药率分别97.9%、0.6%、1.5%。该菌对红霉素、克林霉素、复方磺胺甲噁唑、四环素耐药率较高,已出现少量左氧氟沙星耐药株,未检出万古霉素和奎奴普丁/达福普汀耐药株。青霉素G耐药、青霉素肺炎链球菌(PRSP)、青霉素中介肺炎链球菌(PISP)对阿莫西林、头孢噻肟的耐药率显著高于青霉素G敏感的肺炎链球菌(PSSP),差异有统计学意义(P0.01)。共分离出多重耐药肺炎链球菌227株(69.4%),以红霉素、四环素、复方磺胺甲噁唑和克林霉素耐药为主(46.2%)。结论儿童患者感染肺炎链球菌的耐药性监测不容忽视,该菌对青霉素G的耐药性较低,青霉素G仍是治疗肺炎链球菌感染价廉而有效的药物。     

荆州地区肺炎链球菌流行特点的回顾性研究

目的:了解荆州地区肺炎链球菌患儿分离株的流行特点,为临床经验治疗提供依据。方法:2015年1月至2016年12月荆州市中心医院儿科(除外新生儿科)送检痰培养标本3 415例,共检出肺炎链球菌菌株342例,其中男200例(58.48%),女142例(41.52%)。分析肺炎链球菌的临床分布资料及对各种抗菌素的耐药情况。结果:肺炎链球菌女性患儿的检出率和男性患儿差别不大;肺炎链球菌主要感染5岁以下患儿,季节以冬春季节为主;尚未检出耐万古霉素和利奈唑胺的肺炎链球菌;肺炎链球菌对左氧氟沙星、莫西沙星、厄他培南、氯霉素、氧氟沙星、泰利霉素的敏感性较高;对复方新诺明、四环素、红霉素、青霉素的耐药率较高;美罗培南中介;阿莫西林、头孢噻肟、头孢曲松仍有较高的敏感性。结论:在荆州地区,阿莫西林、头孢噻肟、头孢曲松仍可作本地区肺炎链球菌感染的非脑膜炎的临床一线用药,对于高耐药菌株和重症感染时可以使用万古霉素和利奈唑胺。     

52株肺炎链球菌耐药性分析

目的调查分析临床标本分离到肺炎链球菌对青霉素等17种抗生素的体外抗菌活性,为临床治疗肺炎链球菌感染提供参考.方法对我院从2003年1月至2005年7月临床标本分离到的52株肺炎链球菌,用美国DADE-BEHRING公司的MICro STREP Plus链球菌药敏测定板检测肺炎链球菌对17种不同抗菌药物的MIC值.结果52株肺炎链球菌对红霉素、四环素的耐药率最高达71.2%,5株对青霉素耐药(9.6%),18株对青霉素低度耐药(34.6%),29株对青霉素敏感(55.8%),对阿奇霉素、克林霉素的耐药率为63.5%,对万古霉素、阿莫西林/棒酸、加替沙星的耐药率为0.00%.青霉素不敏感菌株对红霉素、阿奇霉素、克林霉素、氯霉素、头孢克洛、头孢呋辛的耐药率显著高于敏感株.结论肺炎链球菌对大环内酯类和四环素耐药率高,对青霉素以低度耐药为主,喹喏酮类药物和阿莫西林/棒酸刘肺炎链球菌抗菌活性较高,可作为首选药物.     

69株肺炎链球菌的体外抗菌药物活性研究

目的探讨医院内肺炎链球菌分离株对青霉素等抗菌药物的体外活性,为临床治疗肺炎链球菌感染及研究细菌耐药性提供参考。方法研究我院2002年11月～2004年2月从临床标本分离的69株肺炎链球菌,用法国BIOMERIEUX公司的ATBSTREP5测定其对11种抗菌药物的活性。结果检出青霉素敏感(MIC≤0.063mg/L)株占58%,低耐青霉素(MIC0.125～1mg/L)株占36%,高耐青霉素(MIC≥2mg/L)肺炎链球菌株占6%。肺炎链球菌对红霉素、复方新诺明、四环素耐药率在60%以上,对万古霉素、阿莫西林耐药率为0.0%。结论肺炎链球菌对青霉素的耐药性以低度耐药为主,对红霉素、四环素、复方磺胺类耐药性高。     

69株肺炎链球菌的体外抗菌药物活性研究

目的探讨医院内肺炎链球菌分离株对青霉素等抗菌药物的体外活性,为临床治疗肺炎链球菌感染及研究细菌耐药性提供参考.方法研究我院2002年11月～2004年2月从临床标本分离的69株肺炎链球菌,用法国BIOMERIEUX公司的ATBSTREP5测定其对11种抗菌药物的活性.结果检出青霉素敏感(MIC≤0.063mg/L)株占58%,低耐青霉素(MIC 0.125～1mg/L)株占36%,高耐青霉素(MIC≥2mg/L)肺炎链球菌株占6%.肺炎链球菌对红霉素、复方新诺明、四环素耐药率在60%以上,对万古霉素、阿莫西林耐药率为0.0%.结论肺炎链球菌对青霉素的耐药性以低度耐药为主,对红霉素、四环素、复方磺胺类耐药性高.     

儿童肺炎链球菌脑膜炎20例临床特征及分离株耐药性分析

目的探讨儿童肺炎链球菌脑膜炎临床特点及分离菌株耐药情况。方法回顾性分析复旦大学附属儿科医院2013年1月1日-2017年12月31日20例肺炎链球菌脑膜炎患者的临床资料。结果 20例患者男12例,女8例,年龄≤1岁10例,1～3岁1例,3～5岁5例,5岁4例。临床特点:≤1岁组患儿抽搐的发生率高于1岁组(P0.05);≤3岁组患儿并发症的发生率高于3岁组(P0.05)。实验室检查:≤3岁组患儿的C反应蛋白、降钙素原高于3岁组(P0.05)。治疗方案:3例应用头孢曲松,7例头孢曲松联合万古霉素,8例万古霉素联合美罗培南,1例头孢曲松联合青霉素,1例万古霉素。预后:治愈或好转14例(70.0%)。耐药情况:分离的细菌对万古霉素、利奈唑胺、左氧氟沙星均100%敏感,对红霉素、克林霉素耐药率高达90.0%,对甲氧苄啶-磺胺甲唑、青霉素的耐药率分别为65.0%、75.0%。结论肺炎链球菌脑膜炎临床表现因年龄而异,婴幼儿多表现为发热、抽搐、呕吐,其外周血的炎性指标及并发症发生率更高。治疗宜首选第三代头孢菌素,或第三代头孢菌素联合万古霉素。     

小儿社区获得性肺炎中肺炎链球菌感染在不同年龄组中的分布及耐药性分析

目的 分析小儿社区获得性肺炎中肺炎链球菌感染在不同年龄组中的分布及耐药性，为肺炎链球菌感染的小儿社区获得性肺炎的治疗提供依据。方法 选择2017—2021年抚州市妇幼保健院新生儿及儿科收治的肺炎链球菌感染的小儿社区获得性肺炎住院患儿作为观察对象，对其临床资料以及药敏结果进行分析，比较不同年龄段小儿社区获得性肺炎中肺炎链球菌感染的分布及耐药性。结果 共收集肺炎链球菌感染的小儿社区获得性肺炎患儿211例，其中男139例(65.9%),女72例(占34.1%);4个年龄组中婴儿期占比最高，为64.45%,其次为幼儿期和学龄前期，分别为17.54%、14.70%,新生儿期占比最低，为3.32%。各年龄段检测分离的肺炎链球菌均对青霉素、左氧氟沙星、万古霉素、利奈唑胺敏感(耐药率为0%),对阿莫西林/克拉维酸、头孢曲松、美罗培南有较强敏感性(耐药率<10%),对复方新诺明、头孢呋辛和四环素耐药率较高(耐药率>60%),对红霉素、克林霉素耐药率极高(耐药率>90%)。结论 本院小儿社区获得性肺炎中肺炎链球菌感染在婴儿期占比较高，肺炎链球菌耐药情况在各年龄段无明显差异，儿科医生在治疗过程中应依据药敏试验结果选择合适的抗菌药物，增加针对性用药，减少经验性或预防性抗生素使用情况，以减少本地区耐药菌株出现。     

长沙地区肺炎患儿肺炎链球菌耐药性分析

目的了解2007～2008年长沙地区肺炎患儿肺炎链球菌(SP)感染情况及耐药性变迁,以有效指导临床合理利用抗生素。方法回顾性分析2007～2008年在湖南省儿童医院就诊的10 035例肺炎患儿痰液或肺泡灌洗液中分离的肺炎链球菌的耐药性。结果 10035例呼吸道感染儿童痰中分离出肺炎链球菌481株,对常用抗生素耐药率分别为:青霉素52.8%、阿莫西林25.6%、阿莫西林/棒酸0.4%、红霉素63.2%、头孢曲松29.5%、头孢噻肟30.1%、头孢吡肟0%、利奈唑烷0.6%、亚胺培南22.7%、万古霉素0%。2008年SP分离株对青霉素、阿莫西林、亚胺培南、头孢噻肟、红霉素耐药率高于2007年。结论本地区儿童呼吸道感染SP耐药形势严峻,耐药率有逐年上升趋势,临床上应根据药敏结果合理应用抗生素,制定好防治SP的对策。     

Two cases of bacterial meningitis due to meropenem-resistant Streptococcus pneumoniae: A threat of serotype 35B,ST 558 lineage

Although the pneumococcal conjugate vaccine (PCV) has decreased the incidence of invasive pneumococcal disease (IPD) in children, cases of IPD caused by non-PCV serotypes have been increasing. Here, we report two cases of bacterial meningitis caused by meropenem-resistant Streptococcus pneumoniae; in both the cases, 13-valent PCV (PCV13) had been administered. The isolated S. pneumoniae strains were non-PCV13 serotype 35B and resistant to penicillin G, cefotaxime, and meropenem. In addition, multilocus sequence typing (MLST) revealed the sequence type (ST) to be 558. In case 1, a 6-month-old girl recovered without sequelae after antibiotic therapy comprising cefotaxime and vancomycin, whereas in case 2, a 9-month-old boy was treated with an empirical treatment comprising ceftriaxone and vancomycin administration. However, maintaining the blood concentration of vancomycin within the effective range was difficult, due to which the antibiotics were changed to panipenem/betamipron. During the treatment, he presented with seizures, which were effectively controlled with antiepileptic drugs. The rate of incidence of penicillin-susceptible IPD has been substantially increasing after the introduction of PCV. However, an upsurge in IPD cases due to multidrug-resistant (MDR) serotype 35B has been reported in countries where PCV13 was introduced before introducing in Japan. Moreover, an increase in the proportion of MDR serotype 35B and decrease in the susceptibility to broad-spectrum antimicrobials, including meropenem, have been reported. Hence, the number of meningitis cases caused by MDR serotype 35B/ST558 may increase in the future.     

儿童肺炎克雷伯菌血流感染53例临床特征及病原菌耐药性分析

目的分析53例儿童肺炎克雷伯菌血流感染患者的临床特征及病原菌的药敏试验结果,为临床合理用药及预防医院感染提供参考依据。方法回顾性收集2016年1月-2020年3月临床症状符合血流感染标准,且血培养为肺炎克雷伯菌的患儿临床资料及病原菌药敏结果。结果53例发生肺炎克雷伯菌血流感染的患儿主要来自重症监护室,16例(30.2%)患有先天性心脏病,6例(11.3%)患有血液肿瘤疾病;实验室检查中,39例(73.6%)外周血白细胞升高,47例(88.7%)C反应蛋白升高,37例(69.8%)降钙素原升高。药敏试验结果表明所有分离菌株对氨苄西林耐药,对氨基糖苷类抗生素耐药率低,有25株(47.2%)为耐碳青霉烯类肺炎克雷伯菌,表现为对头孢菌素类、碳青霉烯类抗生素耐药。结论肺炎克雷伯菌血流感染患儿常伴有严重的基础疾病,病程发展迅速,病情重。耐碳青霉烯类肺炎克雷伯菌的大量出现,临床应根据患儿临床特征及药敏结果谨慎用药,合理治疗。     

Penicillin-resistant Streptococcus pneumoniae infections: current trends in epidemiology and antibiotic chemotherapy

The world-wide emergence of penicillin-resistant Streptococcus pneumoniae has led to dilemmas in the management of pneumococcal infections. Furthermore, most penicillin-resistant pneumococci are simultaneously resistant to a wide variety of other antibiotics, including cephalosporins, macrolides and tetracyclines. Epidemiological surveys in Japan demonstrated that 30-50% of clinical isolates were penicillin-insusceptible(MIC: > or = 0.125 microgram/ml). At present time most penicillin-resistant pneumococcal pneumonia cases are well treated with penicillin or cephalosporin, but significant numbers of treatment failures were reported in meningitis patients. Data from healthy mice model of pneumonia clearly showed that carbapenems and vancomycin are more active than cefotaxime or penicillin in high dose. Careful and continuous surveys for trends in antibiotic resistance and clinical impacts of antibiotic-resistant pneumococci are warranted.     

2018年河南省儿童医院细菌耐药性监测

目的了解2018年河南省儿童医院临床分离菌的分布及细菌耐药情况。方法收集2018年1-12月临床分离的非重复菌株,采用质谱仪进行鉴定,自动化仪器法和纸片法进行抗菌药物敏感性试验,按2018年CLSI推荐的药敏试验方法及折点标准进行药敏试验和判读药敏结果。结果共分离临床非重复菌株8825株,其中革兰阳性菌占32.5%(2867/8825),革兰阴性菌占67.5%(5958/8825)。分离最多的前5位细菌为:嗜血杆菌属、肺炎链球菌、大肠埃希菌、肺炎克雷伯菌和金黄色葡萄球菌。检出6株青霉素不敏感肺炎链球菌,2株非脑膜炎株和4株脑膜炎株。葡萄球菌中MRSA和MRCNS分别占各自菌种的36.6%和77.5%,未发现对万古霉素和利奈唑胺不敏感菌株。屎肠球菌对大部分抗菌药物的耐药率高于粪肠球菌,未发现对利奈唑胺和万古霉素不敏感的肠球菌。流感嗜血杆菌和副流感嗜血杆菌的β内酰胺酶阳性率分别为58.0%和60.3%。大肠埃希菌和肺炎克雷伯菌中产ESBL的检出率分别为66.6%和72.0%,产ESBL菌株对多数抗菌药物的耐药率高于非产ESBL菌株。肺炎克雷伯菌对美罗培南和亚胺培南的耐药率为43.1%和43.2%;大肠埃希菌对美罗培南和亚胺培南的耐药率为4.5%和4.2%。铜绿假单胞菌对美罗培南和亚胺培南耐药率为21.2%和19.6%;鲍曼不动杆菌对美罗培南和亚胺培南的耐药率均为54.0%。结论多重耐药菌株在儿童中的感染形势严峻,威胁着儿科临床的抗感染治疗,应加强细菌耐药监测和合理使用抗菌药物。     

Time-kill studies of antimicrobial combinations including cefotaxime, ceftriaxone, vancomycin and meropenem against cephalosporin-resistant Streptococcus pneumoniae

BACKGROUND: Resistance of Streptococcus pneumoniae to penicillin is now widespread and rapidly increasing all over the world. This has led to the critical need for alternative antimicrobial therapy. METHODS: To assess the activities of antimicrobial combinations, including cefotaxime, ceftriaxone, vancomycin and meropenem, time-kill studies were conducted against five strains of penicillin- and cephalosporin-resistant S. pneumoniae at clinically achievable antimicrobial concentrations in cerebrospinal fluid. RESULTS: Combinations of an extended-spectrum cephalosporin with vancomycin were not synergistic. Meropenem had a comparable bactericidal activity to those combinations, and its killing activity was not affected by the addition of cefotaxime, ceftriaxone or vancomycin. CONCLUSIONS: It is suggested that meropenem could be an effective alternative for the treatment of penicillin- and cephalosporin-resistant pneumococcal meningitis. However, more clinical data are required before it can be recommended as an effective antimicrobial agent for such cases.     

Antibiotic therapy and acute outcome of meningitis due to Streptococcus pneumoniae considered intermediately susceptible to broad-spectrum cephalosporins.

Children with meningitis due to Streptococcus pneumoniae isolates that are relatively or fully resistant to penicillin and have decreased susceptibility to broad-spectrum cephalosporins (MIC, > or = 2.0 micrograms/ml) who have failed treatment with broad-spectrum cephalosporins have been reported. The National Committee for Clinical Laboratory Standards has newly revised guidelines indicating that S. pneumoniae isolates associated with meningitis for which the MICs are > or = 0.5 micrograms/ml should be considered resistant to broad-spectrum cephalosporins. This recommendation is not clearly based on data related to clinical outcome and may be too conservative. We present data on five children who had S. pneumoniae meningitis due to isolates that were relatively or fully resistant to penicillin (MIC range, 0.125 to 4.0 micrograms/ml) and had cefotaxime or ceftriaxone MICs of 0.50 to 2.0 micrograms/ml. Their clinical courses and outcomes were comparable to those of five children with S. pneumoniae meningitis due to strains that were relatively or fully resistant to penicillin and were inhibited by cefotaxime at concentrations of < or = 0.25 micrograms/ml, as well as to those of 25 patients with S. pneumoniae meningitis due to penicillin-susceptible isolates identified during the same period. Children with meningitis due to S. pneumoniae with cefotaxime or ceftriaxone MICs of < or = 1.0 micrograms/ml may be adequately treated with these antibiotics. Further clinical data are required before solid recommendations can be made regarding cephalosporin breakpoints for S. pneumoniae.     

In vivo correlates for Streptococcus pneumoniae penicillin resistance in acute otitis media.

Eighty-four children suffering from acute otitis media caused by Streptococcus pneumoniae were treated prospectively with cefuroxime axetil suspension (30 mg/kg of body weight twice daily for 8 days). The high incidence of isolates with decreased susceptibilities to penicillin (42 of 84 isolates) allowed us to establish a relationship between clinical success and the penicillin MICs for pneumococcal isolates. It was found that cefuroxime axetil is clinically effective in the treatment of acute otitis media caused by penicillin-susceptible and penicillin-intermediate strains of S. pneumoniae. The results indicate that the risk of treatment failure with cefuroxime axetil was increased in children with otitis media caused by S. pneumoniae when the penicillin MIC were greater than or equal to 2 mg/liter.     

Activity of moxifloxacin and twelve other antimicrobial agents against 216 clinical isolates of Streptococcus pneumoniae

BACKGROUND: An increased incidence of macrolide resistance in penicillin-resistant Streptococcus pneumoniae has been described. METHODS: With this in mind, 216 S. pneumoniae isolates were evaluated for their in vitro susceptibility to a new fluoroquinolone, moxifloxacin, which was compared with penicillin, amoxicillin, cefuroxime, cefotaxime, ceftriaxone, erythromycin, clarithromycin, ciprofloxacin, sparfloxacin, ofloxacin, vancomycin and teicoplanin. A broth microdilution assay was performed in cation- adjusted Mueller-Hinton broth with 5% (v/v) lysed horse blood according to NCCLS guidelines. RESULTS: Erythromycin resistance was observed in all the 22 penicillin-resistant S. pneumoniae (10.1%). All the penicillin- susceptible S. pneumoniae were susceptible to cephalosporins, whereas all the penicillin-resistant ones showed resistance to cefuroxime and only intermediate susceptibility to cefotaxime and ceftriaxone. The 216 tested strains were inhibited by sparfloxacin and moxifloxacin at concentrations of 0.12-0.5 mg/l and 0.06-0.25 mg/l, respectively, regardlesss of whether the strain was penicillin and/or erythromycin resistant. Seven penicillin-resistant strains displayed resistance to ofloxacin. All isolates were susceptible to vancomycin; teicoplanin MIC values ranged from 0.03 to 0.12 mg/l. The excellent in vitro activity of moxifloxacin against S. pneumoniae was not affected by penicillin and/or macrolides. CONCLUSION: Moxifloxacin appears to be a promising choice for the treatment of pneumococcal infections, including situations where therapeutic choices are limited due to penicillin and macrolide resistance.     

Antimicrobial susceptibility and serotype distribution of Streptococcus pneumoniae causing meningitis in Egypt, 1998-2003

OBJECTIVES: To determine the antimicrobial susceptibility and serotype distribution of 205 isolates of Streptococcus pneumoniae, collected from the CSF of meningitis patients identified between 1998-2003, during sentinel meningitis surveillance in Egypt. METHODS: Antimicrobial susceptibility was evaluated against six antibiotics using disc diffusion and Etest methods. Serotyping was performed by latex agglutination and the Quellung test. RESULTS: Forty-nine percent of all isolates were found to be non-susceptible to penicillin (46% intermediate, MIC range 0.12-1.0 mg/L; 3% resistant, MIC = 2.0 mg/L), and 6% of the isolates were non-susceptible to ceftriaxone (5% intermediate, MIC = 1.0 mg/L; 1.3% resistant, MIC >/= 2 mg/L). Resistance rates for tetracycline and trimethoprim/sulfamethoxazole were high (52 and 59.7%, respectively), but those for erythromycin and chloramphenicol were lower (11 and 9%, respectively). Five serotypes (6B, 1, 19A, 23F and 6A) accounted for 37% of the total isolates. Ten isolates (5%) were non-typeable. Overall, 29 and 42% of serotypes were represented in the 7- and 11-valent conjugate vaccines, respectively. However, vaccine coverage for children <2 years was 38 and 56% for the 7- and 11-valent, respectively. CONCLUSIONS: Resistance to penicillin may be increasing among S. pneumoniae strains causing meningitis in Egypt, and a moderate proportion of these strains are not covered by current pneumococcal conjugate vaccines. In addition to intensifying education efforts about judicious use of antibiotics, laboratory-based surveillance for other forms of invasive pneumococcal disease, especially pneumonia, is needed before decisions can be made regarding the most effective vaccines for control of this disease in Egypt.     

Comparative susceptibilities of penicillin-resistant pneumococci to co-trimoxazole, vancomycin, rifampicin and fourteen beta-lactam antibiotics

Eighty-four isolates of penicillin-resistant pneumococci were tested for susceptibility to vancomycin, rifampicin, cotrimoxazole, and 14 beta-lactam antibiotics by agar and microbroth dilution methods. Twenty-three were from adult patients with pneumococcal disease, 57 from nasopharingeal carriers (preschool children) and four were resistant South African isolates. For all isolates tested, imipenem (N-formimidoyl thienamycin), rifampicin, ceftriaxone and cefotaxime had the greatest activity ( MIC90 : 0 X 12, 0 X 25, 0 X 5 mg/l, respectively). Cefoxitin and latamoxef were the least active of the drugs studied. The remaining beta-lactams tested had less activity than that of penicillin. All strains were inhibited by 1 mg/l of vancomycin and all but one were resistant to cotrimoxazole. The excellent in-vitro activities of the newer beta-lactam agents (ceftriaxone, cefotaxime and, particularly, imipenem ) and vancomycin against penicillin-resistant pneumococci offer a considerable promise for their use in the treatment of pneumococcal meningitis caused by these strains.