儿童肺炎链球菌抗生素敏感性监测分析

目的 分析三年本院下呼吸道肺炎链球菌感染患儿对9种常用抗生素的敏感性,为临床合理用药提供依据.方法 连续三年对本院儿科病房的3287例下呼吸道感染患儿的痰液培养分离的肺炎链球菌,采用纸片法及E-Test法对分离株进行抗生素敏感性检测.结果 三年肺炎链球菌检出率分别为6.73％、8.33％、10.30％,呈上升趋势（x2=6.9034,P=0.0336）.三年肺炎链球菌对青霉素敏感率高,分别为97.87％、95.18％和92.68％.在检测的β-内酰胺类抗菌药物中,肺炎链球菌对头孢他啶、阿莫西林克拉维酸钾还保持较高敏感性,均在90.8％以上.其次对头孢曲松、头孢唑啉敏感性达89％以上.对氧氟沙星敏感性95％以上.对红霉素、复方磺胺、克林霉素耐药率都在87.0％以上.儿童下呼吸道感染肺炎链球菌对青霉素、头孢菌素类、氧氟沙星敏感率高,三年药物敏感性比较差异无统计学意义（P＞0.05）.结论 三年下呼吸道肺炎链球菌感染患儿对青霉素、头孢菌素类、氧氟沙星敏感率高,但敏感率逐年下降.红霉素、复方磺胺、克林霉素耐药率高,肺炎链球菌感染下呼吸道可首选青霉素、也可选阿莫西林克拉维酸钾,第一代或第三代头孢可作为替代抗生素.应注意根据此监测调整经验用药方案和公共卫生策略.     

苏州地区肺炎链球菌TEM基因分子流行病学研究

目的 探讨肺炎链球菌(Sp)是否存在TEM基因及其流行状况。方法 对2002年9月至2003年4月苏州大学附属儿童医院就诊呼吸道感染患儿痰标本中分离到的23株Sp进行β-内酰胺酶TEM全长基因聚合酶链反应检测及扩增产物序列与美国GenBank已登录的TEM基因序列比较分析。结果 23株Sp中21株检出TEM基因(阳性率91.3％)。有1株(株号SR017,青霉素耐药)TEM基因序列与已登录的均不相同,存在编码子第182位ATG[M]→ATA[Ⅰ]有义突变,为TEM基因家族新成员,并成功以TEM-129型登录GenBank(登录号:AY452662);其余20株TEM基因均为TEM-1亚型,1号株(株号SR001)TEM-1型序列也以首次发现于Sp登录GenBank(登录号:AY392531)。结论 从Sp中检出β-内酰胺酶TEM基因,其携带率达91.3％,其基因型有TEM-129和TEM-1型。这一发现丰富了对Sp青霉素耐药的认识。     

儿童血培养分离肺炎链球菌的耐药性

目的分析某儿童医院临床送检血标本分离的侵袭性肺炎链球菌耐药特点,指导临床合理用药。方法回顾性分析该院2007年4月—2011年6月临床分离的63株侵袭性肺炎链球菌的药敏资料。结果 63株肺炎链球菌对青霉素的敏感率为22.22%,对红霉素和复方磺胺甲口恶唑的敏感率低,分别为8.93%和28.57%;对阿莫西林、头孢曲松和头孢噻肟的敏感率较高,分别为85.71%、80.96%、85.71%;未检出万古霉素或利奈唑胺不敏感菌株。结论侵袭性肺炎链球菌耐药率高,应做好对其的耐药性监测,以指导临床合理用药,积极有效地治疗侵袭性肺炎链球菌疾病。     

慢性阻塞性肺疾病患者血清抗肺炎链球菌抗体水平的研究

目的 研究慢性阻塞性肺疾病(COPD)急性加重期血清抗肺炎链球菌荚膜多糖特异性抗体水平及COPD患者接种疫苗的可行性.方法 选择COPD急性加重无呼吸衰竭(无呼吸衰竭组)、COPD急性加重伴呼吸衰竭(呼吸衰竭组)、哮喘(哮喘组)、老年健康体检(老年体检组)及青年健康体检(青年体检组)各15例,采用间接ELISA法分别检测各组血清抗肺炎链球菌荚膜多糖特异性IgG、IgM、IgA抗体水平.结果 各组间IgG两两比较差异均无统计学意义(P＞0.05).无呼吸衰竭组和老年体检组IgM与呼吸衰竭组、哮喘组和青年体检组比较差异均有统计学意义(0.554±0.309和0.538±0.327比0.810±0.387、0.887±0.278和0.852±0.305,P＜ 0.05),无呼吸衰竭组与老年体检组及呼吸衰竭组、哮喘组与青年体检组IgM比较差异均无统计学意义(P＞0.05).除无呼吸衰竭组与青年体检组IgA比较差异有统计学意义(0.532±0.297比0.930±0.502,P＜0.05)外,其余各组间IgA两两比较差异均无统计学意义(P＞0.05).结论 COPD患者应建议接种肺炎链球菌疫苗.     

肺炎球菌多糖疫苗的经济学评价

肺炎球菌感染是引起儿童和成人细菌性肺炎、脑膜炎和急性中耳炎的主要病因,而这些疾病是完全可以用肺炎球菌疫苗来预防。根据世界卫生组织估计,每年至少有100万小于5岁的儿童死于肺炎球菌性肺炎。肺炎球菌有90多个不同的血清型,其中有11个血清型引起的肺炎占了肺炎发病人数的72％-83％。而目前上市的23个多价血清型肺炎球菌多糖疫苗（polysaccaride pneumococcal vaccine,PPV）覆盖了大量的血清型。肺炎球菌疫苗的研制迄今已有30多年的历史。由于PPV对2岁以下儿童的免疫原性较差,因此使用受到了一定的限制。2000年2月美国批准了第1个7价肺炎球菌多糖结合疫苗（pneumococcal conjugate vaccine,7PCV）,并在儿童中广泛接种。肺炎球菌多糖结合疫苗能引起细胞免疫回忆,对婴儿有效。7PCV覆盖的血清型适合于欧洲和北美,但对亚洲、非洲和大洋洲并不合适。     

苏州地区儿童肺炎链球菌临床分离株4种抗生素的耐药基因分子流行病学研究

目的 了解苏州地区儿童肺炎链球菌(SP)青霉素、红霉素、四环素和万古霉素耐药基因的流行状况。方法从2002年9月至2003年4月苏州大学附属儿童医院就诊呼吸道感染患儿痰标本中分离SP；对分离到的31株菌进行4种抗生素药敏试验和pbp2B、PrmA／B、mefA、tetM、vanA、vanB等7种基因的聚合酶链反应(PCR)检测；将pbp2B PCR产物进行测序，并与SPR6株(青霉素敏感株，登录号：NC-003098)pbp2B序列比较。结果31株菌中：(1)青霉素敏感株38．7％(n=12)，不敏感株61．3％(n=19)，pbp2B基因突变株64．5％(n=20)；(2)红霉素敏感株9．7％(n=3)，耐药株80．6％(n=25)，中介株9．7％(n=3)，红霉素不敏感率90．3％，检出PrmA／B基因71％(n=22)，mefA基因32．1％(n=10)，ermA／B和／或mefA基因87．1％(n=27)；(3)四环素敏感株9．7％(n=3)，耐药株80．6％(n：25)，中介株9．7％(n=3)，四环素不敏感率90．3％，检出tetM基因株90．3％(n=28)；(4)万古霉素敏感株100％(n=31)，不敏感率0％，31株菌均未检出vanA、vanB基因。结论苏州地区的SP临床分离株对青霉素、红霉素、四环素具多重高耐药性，对万古霉素具高敏感性之特征。青霉素、红霉素、四环素的耐药相关基因检测提供了该菌耐药的遗传学证据。     

200例下呼吸道感染患儿肺炎链球菌耐药性分析

目的分析本院儿科下呼吸道感染患儿肺炎链球菌耐药情况,探讨合理使用抗生素的依据。方法对本科下呼吸道感染患儿的痰标本进行细菌培养,鉴定分离肺炎链球菌,并进行药敏试验,分析其肺炎链球菌耐药情况。结果年龄〈1岁和冬季患儿的肺炎链球菌检出率分别为11．17％、10．76％,显著高于其他组的检出率（P〈0．05）;青霉素不敏感菌株对头孢呋辛、红霉素的耐药率明显高于敏感菌株（P〈0．05）。结论治疗小儿下呼吸道肺炎链球菌感染时,尽量避免滥用广谱抗生素,尽可能根据药敏试验结果选用抗生素。     

肺炎球菌感染与肺炎球菌疫苗

肺炎链球菌,即肺炎球菌。自从1986年W eich-selbaum证明肺炎球菌能引起肺炎等疾病,是人类重要的病原菌,已有一百多年的历史了,但是对肺炎球菌病的防治问题还远未解决。在磺胺药和抗生素问世以前,肺炎球菌感染的发病率和病死率都非常高,故一直是人们关注的课题。肺炎球菌主要引起肺炎、脑膜炎、中耳炎和败血症等疾病,都是人类的常见病,亦是至今重要的全球性疾病,各个年龄组的人都可被感染,老人和儿童是感染的高危人群。1肺炎球菌的血清分型肺炎球菌是革兰氏阳性球菌的双球菌,菌体呈矛尖状,宽端相对,矛尖向外一般呈单个或成对排列,有筴膜。肺…     

肺炎链球菌分子流行病学监测方法

肺炎链球菌是大多数社区获得性肺炎、化脓性脑膜炎、败血症、中耳炎等的主要病原菌，近年来，耐药肺炎链球菌在世界范围内的广泛流行已引起医学界的普遍关注，尽管耐药性监测和血清分仍是主要的手段，但分子分型具有更好的鉴别力，本文有关肺炎链球菌分子流行病学监测方法及应用作了综述。     

Streptococcus pneumoniae serotypes isolated from the middle ear fluid of Costa Rican children following introduction of the heptavalent pneumococcal conjugate vaccine into a limited population

Background

The heptavalent pneumococcal conjugate vaccine (PCV-7) was introduced in high risk children and into the private market in Costa Rica in 2004 (<5% annual birth cohort). The aim of this study was to compare the Streptococcus pneumoniae serotype (ST) distribution, antibiotic resistance patterns and potential coverage before and after partial introduction of PCV-7.

Methods

A comparison between the S. pneumoniae isolates obtained and serotyped from the middle ear fluid (MEF) of Costa Rican children with otitis media between years 1999 and 2003 (before PCV-7 usage) and those isolates obtained from 2004 to 2008.

Results

A total of 145 and 218 MEF S. pneumoniae were serotyped between years 1999 and 2003 and 2004 and 2008, respectively. Considering a 19F outbreak observed between years 1999 and 2003, the following statistically significant changes in serotype distribution were detected between1999 and 2003 and 2004 and 2008: ST 3: 4.8–12.8% (P = 0.01); ST 11A: 0–4.1% (P = 0.01); ST 14: 3.5–21.1% (P < 0.001) and ST 19F: 52.4–18.3% (P < 0.05). Comparison of the two study periods demonstrated that during 2004 and 2008 a statistically significant decrease in penicillin non-susceptible serotypes (36.2–20.4% [P = 0.003]) and a statistically significant increase in trimethoprim-sulfametoxazole resistant serotypes (54.9–68.5%, respectively [P = 0.03]) was observed. Potential pneumococcal vaccines coverage between 1999 and 2003 and between 2004 and 2008 were: for PCV-7: 77.2–60.5%, respectively (P = 0.001); for the 10-valent conjugated vaccine (PCV-10): 78.6–61.4%, respectively (P = 0.0008) and for the 13-valent conjugated vaccine (PCV-13): 84.8–79.3%, respectively (P = 0.2).

Conclusions

Changes in the serotype distribution and antimicrobial susceptibility of MEF S. pneumoniae have been observed in Costa Rican children with OM. Because of the limited use of PCV-7 during the study period, these changes probably cannot be attributed to PCV-7 use. Between 2004 and 2008, PCV-13 offered the highest potential vaccine coverage.     

儿童下呼吸道肺炎链球菌感染临床特征及耐药性

目的分析南京地区下呼吸道肺炎链球菌（SP）感染患儿的临床特征及耐药性。方法回顾性分析2013年7月—2014年6月南京某儿童医院经痰培养确诊为下呼吸道SP感染的患儿临床资料,对菌株进行药物敏感试验和最低抑菌浓度（MIC）检测。结果197例SP感染患儿,＜3岁者占72.59%,秋冬季发病者占63.96%,外周血白细胞升高者占57.87％,临床表现以咳嗽、发热多见,呼吸系统外并发症以消化系统和循环系统多见。SP对阿奇霉素、青霉素及红霉素耐药率分别为94.92%、92.89%、88.83%;对万古霉素、氯霉素、美罗培南、头孢曲松、氧氟沙星敏感率均＞90%,其中对万古霉素敏感率高达98.98%。结论下呼吸道SP感染患儿以3岁内婴幼儿所占比例高,秋冬季节发病多见,对阿奇霉素、青霉素和红霉素耐药率高,临床上应根据药敏结果选择用药。     

深圳地区儿童临床分离的711株肺炎链球菌分布及耐药性分析

目的分析某儿童医院临床分离的肺炎链球菌的分布及其对青霉素与其他12种抗菌药物的耐药情况,指导临床合理用药。方法收集2007年4月-2010年2月新住院及门诊患儿各类标本,经实验室培养、分离,采用VITEK Compact鉴定肺炎链球菌711株;全自动药敏分析系统分析肺炎链球菌对上述抗菌药物的敏感性。结果 711株肺炎链球菌主要分离自痰标本(83.26%),其次为鼻咽拭子(8.86%)及静脉血(4.36%);主要分布在呼吸/消化内科(39.94%)和心血管内科(22.50%)。对青霉素敏感率为15.61%,青霉素不敏感率为84.39%(600株);对红霉素、复方磺胺甲(口恶)唑和阿莫西林的耐药率分别为91.98%、86.32%和31.23%;对万古霉素、利奈唑胺耐药率为0.00%。结论儿童肺炎链球菌耐药情况严峻,必须加强对肺炎链球菌耐药性和抗菌药物使用情况的监测。     

2009年武汉地区住院患儿分离肺炎链球菌的耐药分析

目的了解武汉地区住院患儿感染肺炎链球菌的耐药状况。方法收集医院2009年1-12月住院患儿分离的肺炎链球菌1521株,采用纸片扩散法(K-B法)及E-test法进行抗菌药物敏感试验;按CLSI 2008年版判断结果;使用2χ检验分析耐药性的变化。结果 1521株肺炎链球菌对青霉素、头孢噻肟、红霉素、左氧氟沙星、四环素、磺胺甲噁唑/甲氧苄啶、万古霉素的敏感率分别为75.8%、57.9%、1.8%、99.9%、6.8%、0.4%、100.0%,耐药率分别为5.0%、7.8%、98.2%、0.1%、92.1%、96.5%、0;其中,1124株青霉素敏感肺炎链球菌对上述药物的敏感率分别为100.0%、59.7%、1.0%、100.0%、7.6%、1.0%、100.0%;76株青霉素耐药肺炎链球菌对上述的药物敏感率分别为:0、12.8%、0、97.3%、3.0%、0、100.0%。结论武汉地区住院患儿分离的肺炎链球菌对红霉素、克林霉素、四环素及磺胺甲噁唑/甲氧苄啶的敏感率极低,对左氧氟沙星及万古霉素均有极高的敏感率,对青霉素仍保持较高的敏感率,可作为治疗普通肺炎链球菌感染的首选药物。     

Serotypes and antimicrobial susceptibilities of invasive Streptococcus pneumoniae before and after introduction of 7-valent pneumococcal conjugate vaccine, Hong Kong, 1995-2009

This study analyzed 828 isolates causing invasive pneumococcal disease (IPD) before (1995-2001, n = 265) and after (2007-2009, n = 563) the introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) in Hong Kong. In children <5 years, serotype 14 had declined (36-15.7%, P < 0.01) while 19A had increased (0-12.9%, P < 0.01) in the before and after periods, respectively. In children aged <5 years, the proportion of PCV7 serotypes declined from 89.5% to 65.7% (72.8% if included cross protection against 6A) with time but that of PCV13 serotypes remained stable (91.4-93.2%). In elderly ≥65 years, 9V and 23F decreased from 3.8% to 0.3% (P = 0.01) and from 18.9% to 7.4% (P <0.01), respectively while 7F increased significantly from 0% to 4.1% (P = 0.04) over the same periods. Among isolates from aged <5 years, dual penicillin/erythromycin resistance increased from 44.1% to 64.2% (P = 0.01). The types that often had dual penicillin/erythromycin resistance were 6B, 14, 19F, 23F, 6A and 19A. The emergence of serotype 19A was associated with expansion of sequence type 320.     

Nasopharyngeal carriage of Streptococcus pneumoniae in Taiwan before and after the introduction of a conjugate vaccine

Background

The heptavalent pneumococcal conjugate vaccine was introduced in Taiwan in October 2005. To evaluate the effect of the vaccination, we conducted an active, prospective, large-scale, long-term, and multicenter study to assess the prevalence of nasopharyngeal Streptococcus pneumoniae carriage in Taiwanese children.

Methods

This study was performed at three tertiary teaching hospitals in northern, central, and southern Taiwan. Questionnaires provided demographic, family/household, and medical history data. Pneumococcal isolates were tested for their susceptibility to various antimicrobial agents and serotypes. In addition, influenza virus and Staphylococcus aureus were recovered from nasopharyngeal and nasal swabs, respectively.

Results

Between July 2005 and July 2008, 857 pneumococcal strains were recovered from a total of 6057 children aged >2 months to 5 years (carriage rate, 14.1%). Carriage rates differed geographically and varied with subject age. In a multivariate analysis, having at least one sibling, attendance at day-care centers, a history of otitis media, and history of upper respiratory tract infection in the previous 2 weeks were each associated with a higher risk of pneumococcal colonization of the nasopharynx. Staphylococcus aureus nasal colonization was inversely associated with nasopharyngeal carriage of pneumococcus (p = 0.000; odds ratio [OR]: 0.48; 95% CI: 0.39-0.58). Daycare attendance was the only risk factor for carriage of penicillin non-susceptible S. pneumoniae (OR: 2.37; 95% CI: 1.22-4.88). Although vaccination rates rose from 2005 to 2008, no concomitant decrease in S. pneumoniae carriage occurred. The rate of penicillin resistance among S. pneumoniae isolates was 92.8% (using the meningitis criteria). The prevalence of cefotaxime resistance (21.6%) was higher than that of penicillin (6.9%; non-meningitis criteria). Slightly more than half (57.4%) of the isolates belonged to strains covered by the heptavalent pneumococcal conjugate vaccine when both vaccine and vaccine-related serotypes were included.

Conclusions

Although vaccination rates rose from 2005 to 2008, no concomitant decrease occurred in S. pneumoniae carriage. Interaction between S. aureus and S. pneumoniae may influence vaccination efficacy. These findings provide baseline data to further compare pneumococcal carriage rates and antibiotic resistance patterns in Taiwanese children as vaccination rates continue to increase.     

182株儿童患者肺炎链球菌的分子生物学鉴定及分型

目的对来自患儿的肺炎链球菌进行分型,为肺炎链球菌疫苗的正确选择提供科学依据。方法收集2014年来自河北省儿童医院的182株肺炎链球菌,普通PCR对肺炎链球菌进行种属鉴定,应用多重PCR方法对菌株进行菌型分析。结果经PCR检测182株菌的cpsA基因扩增均为阳性;经多重PCR检测,除8株未分型菌株外,其余174株肺炎链球菌中,以19F、19A和6A/6B型数量最多,分别为68株(37.36%)、33株(18.13%)和26株(14.28%),其余型别有35B型、14型、6C/6D型、23F型、15B/15C型等。结论 182株肺炎链球菌的菌型主要为19F、19A和6A/6B,为该省肺炎链球菌疫苗的正确选择和制订使用策略提供了科学依据。     

2017-2019年苏州地区儿童肺炎链球菌血清分型及耐药特征

目的 了解苏州大学附属儿童医院呼吸道感染儿童肺炎链球菌菌株的血清型分布及耐药特征,为制定肺炎链球菌相关疾病的治疗和预防接种策略提供参考.方法 采用乳胶凝集和荚膜肿胀试验对肺炎链球菌菌株进行血清分型,采用E-test法检测菌株对多种抗生素的耐药性.结果 2017年1月-2019年7月共收集3 652株肺炎链球菌,主要来自...     

Invasive pneumococcal disease among hospitalized children in Brazil before and after the introduction of a pneumococcal conjugate vaccine

BackgroundMost of the available data on invasive pneumococcal disease in Latin America are derived from laboratory-based surveillance systems. There is a lack of epidemiological data on the disease severity and mortality from hospitalized patients with pneumococcal infection.MethodsIn this hospital-based retrospective historical series of hospitalized children with laboratory-confirmed IPD, we evaluated changes in disease episodes, in-hospital fatality rates, and need for intensive care unit admission after the inclusion of PCV10 in the Brazilian vaccination schedule. Invasive pneumococcal strains isolated by culture were serotyped. Changes over time were assessed, and pre-vaccination (2005–2009) to post-vaccination (2011–2015) disease rates and serotypes were compared.Results260 patients with IPD and positive pneumococcal isolates were identified (198 during the pre-PCV10 period). When comparing both periods, hospitalizations were reduced from 20 cases to 5 cases per 10,000 pediatric admissions (p < 0.0001). Likewise, fatalities reduced from 6.6 to 2.0 cases per 10,000 pediatric admissions (p < 0.0001). Pneumonia was the most frequent clinical diagnosis (58%) – of which 49.6% had pleural effusion – followed by meningitis (22%) and bacteremia (15.9%). Overall 30% of cases were sent to ICU, with no percentual changes after PCV10. Additional PCV13 serotypes increased from 7% before vaccine introduction to 21% after PCV10 use. Similarly, serotypes not included in PCV13 increased from 11% to 29%.ConclusionsThere was a significant reduction in the hospitalizations rates, ICU admissions, and fatalities due to IPD after PCV10 introduction in Brazil. Cases due to PCV10 serotypes were reduced, while infections rates caused by non-PCV10 serotypes increased.