呼吸道感染肺炎链球菌分离株的耐药性分析

目的研究呼吸道感染患者肺炎链球菌分离株的耐药情况。方法通过细菌培养获得肺炎链球菌，对获得的肺炎链球菌进行药敏实验。结果呼吸道分离肺炎链球菌中青霉素耐药(PRSP)占39．3％，对头孢哌酮／舒巴坦、头孢克洛、头孢呋辛、头孢噻肟、头孢曲松、环丙沙星、左氧氟沙星、红霉素、克林霉素、复方新诺明、万古霉素、利福霉素的耐药率分别为39．3％，13．8％，36．6％，17．2％，35．9％，16．6％，40．0％，36．6％．51．7％，38．6％，60．0％，0和17．2％。结论吉林省肺炎链球菌对青霉素的耐药率已经处于较高水平，耐青霉素菌株对其他抗生素普遍耐药．已经发现对三代头孢菌素耐药菌株，未发现万古霉素耐药菌株。     

肺炎链球菌耐药性研究进展

肺炎链球菌是重要的致病菌,近年来肺炎链球菌对青霉素等多种药物的耐药性在全球普遍呈上升趋势。同时,分子生物学方法的应用使肺炎链球球菌耐药性的发生和传播机制得到了较全面的阐述。     

肺炎患儿肺炎链球菌的分离及耐药性分析

目的 调查肺炎患儿肺炎链球菌的分离及耐药性.方法 通过对415例肺炎患儿痰及咽拭子标本培养,分离SP,予以细菌鉴定和药敏的试验.结果 415例标本中共分离出肺炎链球菌96株（23.13%）,炎链球菌对青霉素的耐药率为41.67%.在检测的β-内酰胺类抗菌药物中,头孢噻肟与头孢曲松较为敏感,分别为66.66%、79.16%.对青霉素敏感和不敏感的肺炎链球菌其对头孢噻肟、头孢曲松、头孢呋辛、红霉素、阿奇霉素及克林霉素的敏感性也各不相同,P〈0.01.结论 肺炎儿童SP分离率高,SP对万古霉素、左氧氟沙星敏感性高,对头孢噻肟、头孢曲松、头孢呋辛及氯霉素比较敏感,对青霉素耐药率比较严重.     

肺炎链球菌对红霉素的耐药表型及耐药基因

目的　研究肺炎链球菌对红霉素的耐药表型及耐药基因。方法　根据美国临床实验室标准化委员会标准使用微量肉汤稀释法 ,检测 192株肺炎链球菌对红霉素、克林霉素、青霉素、喹诺酮类抗菌药物的最低抑菌浓度 (MIC)。应用红霉素、克林霉素、螺旋霉素纸片行三纸片扩散法 ,检测 14 8株红霉素耐药肺炎链球菌的耐药表型。应用PCR检测 14 8株红霉素耐药肺炎链球菌携带的耐药基因。结果　肺炎链球菌对青霉素的耐药率 (中介率 耐药率 )为 4 2 7% ,对红霉素、克林霉素的耐药率分别为 77 6 %、6 6 7%。 14 8株红霉素耐药株中 ,耐药基因以ermB基因 (79 1% )为主 ,耐药表型以内在型耐药 (cMLS) (85 1% )为主。携带ermB基因的肺炎链球菌 ,74 4 %的菌株对红霉素的MIC值 >16 0 μg/ml;而携带mefA基因的肺炎链球菌对红霉素的MIC值在 0 5～ 4 0 μg/ml之间。 结论肺炎链球菌对红霉素的耐药率较高 ;耐药表型以cMLS为主 ,耐药基因以ermB介导的靶位改变多见。     

肺炎链球菌耐药性研究进展和现代抗生素研发趋势

肺炎链球菌是社区获得性感染的常见疾病如肺炎、中耳炎、脑膜炎、败血病等的主要病原菌。长期以来，因肺炎链球菌对青霉素高度敏感，青霉素被作为治疗其感染的首选良药。近年来，由于环境污染，抗生素在临床治疗上的大量使用及不当使用，导致肺炎链球菌对青霉素和大环内酯类抗生素表现出很高的耐药性，并呈现逐年增加的趋势，而且出现对其他抗生素（如喹诺酮类抗生素等）的多重耐药性。     

肺炎链球菌新生儿分离株转座酶基因遗传标记的研究

目的了解常州地区新生儿呼吸道分离到的肺炎链球菌(Sp)接合型转座子存在状况。方法采用PCR扩增技术对新生儿病房分离到47株Sp菌进行转座酶基因遗传标记——intTn916/Tn1545转座酶基因检测。结果47株Sp菌中39株(83.0%)携带intTn916型或/和Tn1545转座酶基因。结论Tn916型和Tn1545型接合型转座子可携带多种耐药基因,本组Sp菌中intTn916/Tn1545转座酶基因高检出率,揭示了Sp菌获得多重耐药性的遗传学特征。Sp菌通过转座酶基因获得并传播耐药基因,在耐药中起重要作用。     

联合疫苗增加青霉素耐药的肺炎球菌克隆株感染率

据Medscape．com12月8日报道(原载J Infect Dis 2004；190：2154—2161)，在以色列南部，研究发现在患有急性中耳炎的儿童中检测到对青霉素不敏感的肺炎链球菌株，故抗肺炎球菌联合疫苗未被推荐。     

猪2型链球菌安徽分离株的毒力基因、溶血性及耐药性分析

目的 了解猪2型链球菌(S. suis 2)安徽分离株的毒力基因分布特征以及溶血性和耐药性。方法 对19株S. suis 2安徽分离株,采用PCR方法检测cps2J、mrp、epf、sly 4种毒力基因,PA法和micro-ELISA法检测溶血类型和溶血价,K-B法检测对25种抗生素的敏感性。结果 11株毒力基因型为cps2J+/mrp+/epf+/sly+,占总菌株的57.9%,为毒力优势基因型;19株均呈α或β溶血,溶血价为1∶4～1∶128;对利福平、头孢他啶、氟苯尼考、头孢唑啉的敏感率较高,平均为84.2%,对强力霉素、四环素、杆菌肽和磺胺异恶唑的耐药率较高,平均为82.9%,且对该4种抗生素的多重耐药率为63.2%。结论 安徽猪群中流行的S. suis 2毒力基因的分布特征与国内相似,与国外存在一定差异,CPS、MRP、EPF和SLY是重要的毒力因子;S. suis 2的溶血类型与其SLY有关,但sly基因的不完整性并不一定改变S. suis 2的溶血性;S. suis 2安徽分离株的多重耐药性严重,耐药谱与其他地区存在一定差异。     

青霉素不敏感的肺炎链球菌pbp2b基因新的变异

目的 调查本地区青霉素不敏感肺炎链球菌(PNSP)的pbp2b基因和氨基酸序列的变异特点.方法 2006年1-12月收集肺炎链球菌临床分离株24株,检测其对青霉素的敏感性,对青霉素不敏感肺炎链球菌的青霉素结合蛋白pbp2b基因进行PCR扩增和测序以及序列比对与生物信息学分析.结果 在13株青霉素不敏感肺炎链球菌[最低抑菌浓度(MIC)≥0.1 mg/L]中,均发生紧邻SSN的Thr445→,Ala替换以及Glu475→Gly、Thr488→Ala/ser的替换;而Glu332→Gly的替换也较常见,存在于12株PNSP(MIC≥0.25 mg/L);另外,在7株青霉素耐药的肺炎链球菌(MIC≥3 mg/L)中,均发生了紧邻KTG之后Ala618→Gly的替换,且这7株菌属于Back's Ⅱ群,与韩国菌株J77的核苷酸及氨基酸序列一致,而菌株14,15,8,11及24的氨基酸序列出现了新的变异,已向GenBank提交序列,获得序列号:EU035970,EU056919,EU056920,EU056921,EUl06886.结论 本地区大多数的青霉素耐药肺炎链球菌pbp2b基因的变异序列高度相似,而青霉素中度敏感肺炎链球菌的基因序列产生新的变异.     

184例儿童感染肺炎链球菌的血清型分布及其耐药性分析

目的分析184例儿童感染肺炎链球菌的血清型分布及其耐药性情况。方法选取2014年1月至2017年12月我院呼吸道感染患儿2828例,进行痰液培养,分析病原菌检出情况,肺炎链球菌分布情况、血清分型以及对抗生素耐药性情况。结果2828例患儿的痰标本共检出674株病原菌(23.83%),其中肺炎链球菌184例,检出率为6.51%。年龄1个月~1岁患儿感染肺炎链球菌发生率为52.17%,明显高于1~3岁、3~6岁患儿的25.54%、22.28%(P<0.05);冬季患儿感染肺炎链球菌发生率为53.26%,明显高于春季、夏季、秋季的19.02%、13.05%、14.67%(P<0.05);184株肺炎链球菌共涉及11个血清型/群,主要分布于19F、19A、14型、9V、23F、6B、8型、7F、7A、其他等,另有11株未能分型。青霉素(脑膜炎)的不敏感率高达83.33%,明显高于青霉素(非脑膜炎)的63.24%(P<0.05);而头孢曲松对感染肺炎链球菌脑膜炎或非脑膜炎患儿的敏感率比较,无统计学意义(P>0.05)。患儿感染肺炎链球菌的青霉素(脑膜炎)、红霉素、四环素、复方新诺明、头孢克罗、克林霉素耐药检出率分别为72.91%、86.96%、89.13%、79.89%、80.43%、77.23%;而万古霉素、氯霉素、左氧氟沙星、氧氟沙星、莫西沙星、头孢曲松敏感率分别为100.00%、95.65%、98.38%、91.85%、92.94%、91.85%。结论儿童感染肺炎链球菌存在明显的年龄、季节、血清分布与耐药性差异,此研究结果对儿童肺炎抗感染治疗经验性抗生素选择有指导意义。     

广州地区耐青霉素肺炎链球菌分离状况及药物敏感性

目的　调查广州地区耐青霉素肺炎链球菌分离状况及其对８ 种抗菌药物体外抗菌活性,用以指导临床治疗时抗菌药物的选择。方法　采用Ｅｔｅｓｔ 方法。结果　从临床分离的１０２ 株肺炎链球菌中低耐药株１２ 株,对８ 种抗菌药物中阿莫西林／ 克拉维酸钾、头孢曲松、头孢呋辛、头孢克罗、氧氟沙星等抗菌活性在敏感范围,以阿莫西林／ 克拉维酸钾和头孢曲松最敏感,对青霉素、苯唑西林、阿齐霉素耐药。结论　广州地区耐青霉素肺炎链球菌的分离率不高,但随着抗生素的广泛使用,耐药株有可能增加,应引起高度重视。     

Streptococcus pneumoniae carriage and penicillin/ ceftriaxone resistance in hospitalised children in Darwin

Background: The prevalence of resistant Streptococcus pneumoniae (SP) is increasing worldwide. Pneumococcal prevalence and susceptibility patterns are not known for children in the Top End of the Northern Territory.
Aims: To determine the prevalence of nasopharyngeal carriage of pneumococci in children hospitalised in Darwin, and the extent of penicillin and ceftriaxone resistance in these isolates.
Methods: Nasopharyngeal swabs were collected on admission from 85 children who had not received antimicrobials for their admission illness. Antimicrobial resistance was determined following selective culture for SP isolates. Minimal inhibitory concentrations (MICs) for penicillin and ceftriaxone were determined using the E-test method.
Results: The overall prevalence of nasopharyngeal SP carriage was 44%. Carriage occurred more often in Aboriginal children from rural areas (56%) than in urban children (24%) (OR 3.94, 95% CI 1.35 - 11.78, p <0.01). Thirty per cent of isolates were penicillin resistant, 35% were ceftriaxone resistant, and 49% were resistant to at least one of these. One isolate showed high-level resistance to both antimicrobials; all other resistant isolates were of intermediate-level resistance. For the same isolate, MICs for ceftriaxone were more often higher than those for penicillin. Five isolates had intermediate resistance to ceftriaxone whilst remaining sensitive to penicillin.
Conclusions: The prevalence of pneumococcal resistance to penicillin and ceftriaxone in hospitalised children in Darwin is much higher than previously reported in Australia. This has implications for future antimicrobial management and highlights the need for regular regional surveillance of SP resistance. The development of conjugate pneumococcal vaccines for children under two years is a priority.     

Penicillin resistance in Streptococcus pneumoniae in Isparta

OBJECTIVE: The first case reports of infection with penicillin-resistant pneumococci were made in Australia in 1967 and South Africa in 1977. Since this time the increasing emergence of penicillin- resistant strains of Streptococcus pneumoniae have been a serious therapeutic problem. Therefore, the aim of the present study was to determine the penicillin resistance of S. pneumoniae strains isolated in the laboratory. The effect of procaine penicillin treatment against these strains was also investigated. METHODS: Sensitivity testing was done by disc diffusion method using oxacillin discs. Minimal inhibitory concentration (MIC) values were determined in tests with penicillin by the use of E-test (AB Biodisc, Solna, Sweden). Patients were treated with 2 x 800,000 U of i.m. procaine penicillin every 12 h for 10 days. RESULTS: Thirty-seven strains of S. pneumoniae were isolated from the sputa of adult patients who had pneumonia. Moderately resistant (0.12-1.00 microg/mL) and penicillin-sensitive (< or = 0.06 microg/mL) strains were identified in nine (24.3%) and 28 (75.7%) isolates, respectively. There were no high-level penicillin-resistant strains in the study. There was no therapeutic failure. CONCLUSION: These results suggest that procaine penicillin may still be useful in the empirical therapy of pneumococcal pneumonia.     

肺炎链球菌对红霉素的耐药性及耐药表型

目的 调查上海地区肺炎链球菌对红霉素，克林霉素的耐药率及红霉素耐药菌的耐药表型。方法 以琼脂稀释法测定345株肺炎链球菌对红霉素，克林霉素的最低抑菌浓度，以双纸片法测定红霉素耐药菌的耐药表型。结果 肺炎链球菌对红霉素及克林霉素及克林霉素的耐药率分别为53.0%（183/345）及49.6%(171/345)。对红霉素耐药菌中，内在型耐药（cMLS)占90.3%(159/176)，诱导型耐药（iMLS)占5.7%(10/176)，M型耐药占4.0%(7/176)。结论 上海地区肺炎链球菌对红霉素的耐药率高，其耐药表型以cMLS为主。     

The impact of penicillin resistance on the outcome of invasive Streptococcus pneumoniae infection in children

Background: Invasive infections caused by Streptococcus pneumoniae with reduced susceptibility to penicillin are increasing in prevalence in Australia. Aims: To determine the impact of reduced susceptibility of S. pneumoniae to penicillin on morbidity, mortality and treatment of invasive infection. Methods: Retrospective case note review of children with invasive S. pneumoniae infection over a 26 month period. Penicillin minimum inhibitory concentrations (MIC) were determined by E test. Primary clinical outcome measures included days to defervescence, duration of hospital stay, complication rates and mortality. The secondary outcome of financial cost was examined. Comparisons between outcomes of patients with infections caused by susceptible and non‐susceptible strains were performed with Student's t test. Pearson χ², Mann‐Whitney U tests and multiple logistic regression. Results: Sixty‐eight episodes of invasive pneumococcal disease were reviewed: 14 isolates (21.1%) had reduced susceptibility or resistance to penicillin (PNSSP, MIC 0.125 mg/L‐1.5 mg/L). Ten patients had meningitis, 21 had pneumonia, 22 had bacteraemia with another focus and 15 had bacteraemia without an obvious focus. PNSSP were more common in patients with meningitis and pneumonia. No patients died. Overall, patients with infections caused by PNSSP had significandy longer hospitalisation and longer time to defervescence. Complication rates were not significantly different between groups. Outcome differences were no longer significant when meningitis patients were excluded from the analysis. The PNSSP group received more expensive intravenous antibiotics and their infections were significandy more costly to treat. Conclusions: Infections widi penicillin non‐susceptible S. pneumoniae are associated with higher morbidity than infections with penicillin susceptible strains, and treatment of diese infections is more expensive, due to higher drug costs and longer hospital stay.     

High nasopharyngeal carriage of drug resistant Streptococcus pneumoniae and Haemophilus influenzae in North Indian schoolchildren

OBJECTIVES: To determine the carriage rate of Streptococcus pneumoniae and Haemophilus influenzae in healthy Indian schoolchildren. The prevalence of antibiotic resistant strains in the community may be used to assess the trends of antibiotic resistance in invasive strains. Prevalence of resistance to various antimicrobial drugs among S. pneumoniae and H. influenzae was estimated. METHODS: Two thousand four hundred subjects, aged 5-10 years, were enrolled from 45 rural and 45 urban schools. A nasopharyngeal swab was collected from each child, after taking informed written consent. Swabs were processed to isolate S. pneumoniae and H. influenzae. All isolates were tested for resistance to chloramphenicol, erythromycin and co-trimoxazole. Streptococcus pneumoniae isolates were also tested against tetracycline and oxacillin while H. influenzae isolates were tested against ampicillin. RESULTS: Nasopharyngeal carriage of S. pneumoniae and H. influenzae was high in healthy schoolchildren. Stratified analysis showed that nasal carriage of pneumococci in urban children was significantly lower than in rural children [46.8% vs. 53.2%, P<0.001]. Carriage rates of H. influenzae in male and female populations were significantly different (47.8% vs. 52.3%, P<0.04). Penicillin resistance in S. pneumoniae was found low (3.3%), but 22.9% of H. influenzae isolates were ampicillin resistant. Resistance to co-trimoxazole was very high in both S. pneumoniae (81.8%) and H. influenzae (67.3%). CONCLUSION: There is high nasopharyngeal carriage of drug resistant S. pneumoniae and H. influenzae in schoolchildren of north India. Currently, in India, co-trimoxazole for 5 days is recommended for treatment of non-severe pneumonia and third generation cephalosporins are drug of choice for management of severe pneumococcal/H. influenzae diseases. We found high co-trimoxazole resistance and low penicillin resistance in pneumococcal isolates. This justifies empirical use of penicillin in management of invasive pneumococcal infections in India.     

肺炎链球菌不同菌株自溶酶基因的克隆、序列分析及重组表达

目的克隆肺炎链球菌自溶酶(LytA)的基因序列，并进行重组表达。方法分别提取不同临床分离株的基因组DNA，根据已知肺炎链球菌野生R6株LytA基因序列设计引物，进行PCR扩增，将获得的目的基因片段克隆人原核表达质粒，然后测序；利用生物信息学方法，对不同临床分离株LytA基因序列进行比较分析，同时进行LytA基因的重组表达。结果从不同临床分离株的基因组中均扩增出完整的LytA基因片段，成功构建了重组质粒pGEX-4T-1-LytA。比较不同临床分离株LytA基因的DNA序列及推测的氨基酸序列，发现各株LytA基因序列及氨基酸序列间存在差异。通过异丙基巯基半乳糖(IPTG)诱导，LytA基因在大肠埃希菌JM109中得到高效表达，十二烷基硫酸钠-聚丙烯酰胺凝胶电泳(SDS-PAGE)结果显示pGEX-4T-1-LytA融合蛋白相对分子质量约62000，与理论预测一致。结论序列分析发现各分离株的LytA基因序列及氨基酸序列间存在差异，但同源性极高，推测LytA基因序列保守，可用于疫苗研发。     

国内耐药肺炎链球菌的流行现状

肺炎链球菌可引起细菌性肺炎、中耳炎和脑膜炎等疾病,是当今发达国家和发展中国家共有的一个重要病原.由于抗生素长期的过度使用,许多肺炎链球菌菌株能够同时耐受多种常用的抗生素,使得临床可应用的有效抗生素越来越少.耐药肺炎链球菌正在朝着"超级细菌"方向发展.这种现状值得我们关注并寻求近期和长期的解决方法.本文对国内肺炎链球菌耐...