中山地区儿童呼吸道肺炎链球菌的血清型分布及耐药性

目的了解中山地区儿童呼吸道肺炎链球菌的血清型分布特征及耐药性,为确立当地肺炎链球菌疫苗的组成和疾病防治提供重要的科学依据。方法对2015年本院儿科门诊和住院部诊断为下呼吸道感染患儿的痰标本进行肺炎链球菌分离培养,并进行鉴定及药敏试验。采用多重PCR方法确定血清型。结果 819株肺炎链球菌,主要血清型依次为19F 259株(38.2%)、6型106株(15.6%)、19A 99株(14.6%)、23F 91株(13.4%)、15型40株(5.9%)、3型24株(3.5%)。青霉素耐药肺炎链球菌(PRSP)主要集中在19F和19A。结论中山地区儿童呼吸道肺炎链球菌最常见的血清型为19F、6、19A、23F、15B,19F和19A对抗生素耐药性高于其他血清型。13价疫苗履盖率为89.5%。     

2004～2009年临床分离肺炎链球菌的血清型/群分布及耐药性监测

目的：了解当前本院临床分离肺炎链球菌的血清型/群分布及耐药趋势,为临床合理使用抗生素提供参考。方法：以2004～2009年临床分离的822株肺炎链球菌为研究对象,采用荚膜肿胀试验进行血清分型/群,E-test检测菌种对青霉素、头孢呋辛、头孢地尼、头孢克罗、红霉素、四环素、左氧氟沙星、万古霉素等8种抗生素的敏感性。结果：2004年青霉素不敏感肺炎链球菌（PNSP）的分离率为49.4%,并呈逐年上升趋势,至2006年PNSP分离率高达67.8%,2009年下降至51.0%。822株肺炎链球菌最常见的型/群是19群,其次是23、6、14、3、其他。PNSP在6种血清型/群中所占的比例在2004～2009年期间无显著性变化（P〉0.05）。肺炎链球菌对其他β内酰胺类抗生素的非敏感趋势类似青霉素,对红霉素、四环素的非敏感率始终在60%以上,其中青霉素耐药肺炎链球菌（PRSP）对红霉素和四环素几乎100%耐药,对左氧氟沙星、万古霉素的非敏感率均〈3%。结论：临床分离肺炎链球菌以19群、23群、6群、14群、3群常见;对β内酰胺类抗生素的非敏感率自2007年呈下降趋势,且对左氧氟沙星、万古霉素始终具有较高的敏感性。     

上海地区儿童肺炎链球菌耐药性研究

目的 了解上海地区2001年小儿社区获得性呼吸道感染息儿肺炎链球菌(SP)耐药情况，以指导临床抗生素合理使用。方法 用Kirby—Bauer法和E—test法检测100株SP对青霉素等10种抗菌药物敏感性。结果 SP总分离率29．1％；SP对青霉素耐药率55％，最低抑菌浓度(MIC90)0．75mg/L，MIC均值0．06mg/L；对阿莫西林、阿莫西林/克拉维酸和头孢曲松呈低耐药率，分别为3％、3％和6％；对头孢克洛耐率15％；对头孢映辛29％。SP对氯霉素耐药34％，而对磺胺甲恶唑／甲氧苄啶、红霉素和四环素均呈高度耐药，达80％～82％。结论 小儿SP耐药率远远高于成人，但阿莫西林和头孢曲松依然敏感，抗生素合理使用是重要的。     

儿童肺炎链球菌抗生素敏感性监测

目的 :了解广州地区儿童肺炎链球菌对常用抗生素的敏感性 ,以有效指导临床合理用药。方法 :连续两年对广州市儿童医院就诊的上呼吸道感染患儿的鼻咽分泌物进行细菌培养 ,分离出肺炎链球菌157株 ,采用纸片法及E -Test法对分离株进行常用抗生素敏感性检测。结果 :肺炎链球菌对青霉素不敏感率为53 5 % ,不敏感株对 β-内酰胺类、红霉素、复方磺胺甲基异唑的耐药率明显高于青霉素敏感株 ,且多重耐药率高达90 %以上 ;肺炎链球菌对阿莫西林/克拉维酸、头孢曲松有很好的敏感性 ,而对头孢呋辛敏感性仅为59 % ;其中2001年分离株对头孢克洛耐药率为56 % ,对红霉素耐药率高达78 % ,对四环素耐药率为87 9 % ,对复方磺胺甲基异唑的耐药很突出 (69 % ) ,而对氯霉素仍保持低水平耐药 (33 3 % )。结论 :广州地区儿童肺炎链球菌耐药形势严峻 ,不敏感率已达中等水平 ,且有逐年上升的趋势 ,尤以红霉素、四环素、复方磺胺甲基异唑等多重耐药为主要特点。     

南昌地区肺炎链球菌耐药性分析

目的了解南昌地区肺炎链球菌耐药情况,指导临床合理使用抗生素。方法用琼脂稀释法对临床分离的100株肺炎链球菌进行青霉素等12种抗菌药物最低抑菌浓度（M IC）的测定。结果肺炎链球菌对青霉素的不敏感率为57.0%、,其中高度耐药率25.0%,中度耐药率32.0%;头孢呋辛耐药率为38.0%,头孢噻肟、头孢曲松、氯霉素、左氧氟沙星的耐药率分别为12.0%、17.0%、20.0%和7.0%。对红霉素、阿奇霉素、四环素、复方新诺明、克林霉素有较高耐药率,分别为86.0%、90.0%、89.0%、86.0%和90.0%,未检出对万古霉素耐药的菌珠。结论南昌地区肺炎链球菌耐药严重,且多为多重耐药株,临床应合理选择用药。     

2004—2009年益阳市中心医院临床分离肺炎链球菌的血清型/群分布及耐药性监测

目的了解近5年益阳市中心医院临床分离肺炎链球菌的血清型/群分布及耐药趋势,为临床合理使用抗生素提供参考。方法以2004—2009年期间临床分离的822株肺炎链球菌为研究对象,采用荚膜肿胀试验进行血清分型/群,E-test检测菌种对青霉素、头孢呋辛、头孢地尼、头孢克罗、红霉素、四环素、左氧氟沙星、万古霉素等8种抗生素的敏感性。结果 2004年青霉素不敏感肺炎链球菌(PNSP)的分离率为49.4%,并呈逐年上升趋势,至2006年PNSP分离率高达67.8%,2009年下降至51.5%。822株肺炎链球菌最常见的型/群是19群,其次是23、6、14、3群和其他。PNSP在6种血清型/群中所占的比例在2004—2009年期间无显著性变化(P>0.05)。肺炎链球菌对其他β内酰胺类抗生素的非敏感趋势类似青霉素,对红霉素、四环素的非敏感率始终在60%以上,其中青霉素耐药肺炎链球菌(PRSP)对红霉素和四环素几乎100%耐药,对左氧氟沙星、万古霉素的非敏感率均<3%。结论临床分离肺炎链球菌以19、23、6、14、3群常见;对β内酰胺类抗生素的非敏感率自2007年呈下降趋势,且对左氧氟沙星、万古霉素始终具有较高的敏感性。     

小儿科痰培养肺炎链球菌耐药性分析

目的：研究小儿科痰培养肺炎链球菌对临床常用抗生素的耐药情况。方法：对本院117株肺炎链球菌进行药物敏感试验。结果：青霉素耐药株占21.36%,头孢霉素、四环素以及氯霉素随着青霉素的最低抑菌浓度（MIC）升高而对肺炎链球菌的敏感性下降。青霉素敏感株的7%、中度耐药株的85%和高度耐药株的100%对1种以上的其他抗生素耐药。结论：肺炎链球菌耐药性上升迅速,且耐药程度高,临床上应该注意避免盲目用药,应该及时行药物培养并根据药敏结果酌情用药。     

住院患儿肺炎链球菌血清型与其耐药性的相关性分析

目的：探究住院患儿肺炎链球菌（Streptococcus pneumoniae,SP）血清型及其对抗菌药物耐药情况。方法：选取医院2019年10月—2021年3月收治的SP患儿116例病历资料中分离出的SP菌株作为研究对象,统计患儿入院后采集的咽喉部痰液标本中SP菌株培养和鉴定结果,分析SP血清分型及其对常用抗菌药物耐药特点。结果：116株SP分离菌株中,血清型分型检出116株,其中血清型分布TOP 5分别为19F、6A、14、19A和23F;23价多糖疫苗覆盖血清型疫苗PCV 23(1～5 B、6B、7F、8N、9N、9V、10A、11A、12F、14B、15B、17F、18C、19A、19F、20F、22F、23F、33F)菌株覆盖率可达到67.24%,13价SP-PCV13(1A、3～5 A、6A、6B、7F、9V、14C、18C、19A、19F和23F)覆盖率为5.17%;药敏试验结果发现116株SP分离菌株对敏感性TOP 5药物为青霉素、头孢曲松、万古霉素、左氧氟沙星和利奈唑胺,其对红霉素和阿奇霉素的耐药率分别为98.28%、96.55%;PCV13覆盖与非PCV13覆菌株对...     

肺炎链球菌耐药性研究及治疗进展

肺炎链球菌是社区获得性感染的常见致病菌,可以引起肺炎、中耳炎、鼻窦炎、脑膜炎、败血症等多种疾病。在过去的40年中,在世界的许多地方,肺炎链球菌对β-内酰胺类、红霉素、四环素等抗生素耐药性持续增加,尤其是近10年来,耐药菌株广泛传播,在一些亚洲国家和地区出现肺炎链球菌对氟喹诺酮类等新型抗菌药耐药,以及对万古霉素耐药菌株的出现。本文对我国各地区肺炎链球菌耐药性研究作一综述,并对耐青霉素肺炎链球菌(PRSP)所致严重感染的治疗提出建议。     

抗生素诱导的细胞感受态与肺炎链球菌的耐药性

针对环境中的压力,细菌会采取不同的响应以维持自身的稳定。某些抗生素能够诱导肺炎链球菌转变为感受态细胞,提高细胞转化率,从而产生更适宜生存的耐药突变株。本文根据近年来有关感受态的研究,重点阐述肺炎链球菌中抗生素诱导的感受态与耐药性之间的关系。     

某院肺炎链球菌感染的临床分布及耐药性分析

目的 了解该院肺炎链球菌的临床分布及耐药性,为临床医师选择合理的抗感染治疗方案提供参考依据。方法 收集2012年1月至2015年12月中国医科大学附属盛京医院住院的病人为研究对象,按照美国临床实验室标准化委员会推荐的方法进行肺炎链球菌的初步筛选,用VITEK 2 Compact和VITEK MS进行细菌鉴定和药敏实验,用Excel进行数据统计分析。结果 2012—2015年共分离出292株肺炎链球菌,主要分布于儿科,共211株;主要来源于痰液标本,共115株。感染人群主要为5岁以下及50岁以上的病人。药敏结果显示肺炎链球菌对红霉素、四环素、青霉素G(脑膜炎)具有较高的耐药性,耐药率依次为96.77%、90.46%、80.85%;万古霉素、利奈唑胺和莫西沙星对肺炎链球菌具有良好的抗菌活性,耐药率依次为0.00%、0.34%、0.37%。结论 临床上肺炎链球菌感染的高发人群为5岁以下及50岁以上的病人,并且对多种抗菌药物都有很强的耐药性,应加强病原菌培养及耐药性监测,指导临床医师合理使用抗菌药物。     

Paediatric community-acquired pneumonia: current concept in pharmacological control

Community-acquired pneumonia (CAP) is one of the most frequent infections in childhood but it is not easy to establish a rational therapeutic approach for a number of reasons, including difficulties in identifying the aetiology, the fact that the most frequent bacterial pathogens become resistant to commonly used antibiotics and the lack of certain information concerning the possible preventive role of conjugate vaccines. This leads paediatricians to treat almost all cases of CAP with antibiotics, often using a combination of different antimicrobial classes. In order to avoid unnecessary antibiotic use and limit the spread of antibiotic resistance, consensus guidelines for the management of CAP in childhood should be developed and used by practitioners in their offices and hospitals.     

老年下呼吸道院内感染细菌耐药性分析

目的通过对老年下呼吸道院内感染细菌耐药性的分析，为临床合理使用抗生素提供依据。方法对下呼吸道院内感染的患者中分离出来的细菌，以珠海黑马生物工程有限公司做微生物分析系统BACT-TST稀释法做药敏试验。以美国临床实验室标准委员会（NCCLS）2002年推荐的表型确认试验检测超广谱β-内酰胺酶（ESBLs）。结果老年医院获得性肺炎（Hospital acquired pneumoniae HAP）和社区获得性肺炎（Community acquired pneumoniae CAP）细菌对16种抗生素的耐药率分别为：青霉素95．2％和90、8％，哌拉西林80％和76％，头孢噻肟钠39．5％和35．6％，西力欣46．2％和42．3％，头孢哌酮40％和30％．阿米卡星48．6％和42．8％，环丙沙星56％和51．6％，左氧氟沙星50％和41．7％，头孢哌酮／舒巴坦3．5％和1．23％．阿莫西林／克拉维酸钾10．5％和6．7％，哌拉西林／他唑巴坦2．2％和1．03％，氨苄西林／舒巴坦3．8％和2．36％，头孢他定16．7％和11．7％，头孢曲松14．6％和10.2％，亚胺培南0，万古霉素0。其中亚胺培南，万古霉素，头孢哌酮／舒巴坦。哌拉西林／他唑巴坦对产生ESBLs耐药率最低，分别是0、0、0、5.8％。结论老年下呼吸道院内感染细菌耐药性和ESBLs检出率均显著高于院外感染者，亚胺培南、头孢哌酮／舒巴坦、哌拉西林／他唑巴坦、万古霉素是治疗产ESBLs菌株感染引起的有效抗生素。     

Safety and tolerability of pneumococcal vaccines in children

ABSTRACT

Introduction: A number of pneumococcal vaccines have long been available and have been used to reduce the medical, social, and economic problems associated with Streptococcus pneumoniae-related diseases.

Areas covered: The main purpose of this review was to analyze what has been, until recently, the established doctrine regarding the safety and tolerability of pneumococcal vaccines that have been used in the past and are currently being used in children.

Expert opinion: Pneumococcal vaccines available on the market are all safe and are highly recommended in clinical practice. In children, pneumococcal conjugate vaccines (PCVs) are considered the preparations of choice because of their enhanced immunogenicity and superior ability to impact nasopharyngeal carriage. All PCVs are considered safe because the incidence of severe adverse events (AEs) is marginal. Nonetheless, evidence has emerged from post-marketing surveillance regarding the occurrence of very rare but significant potential AEs following PCV administration. Therefore, post-marketing surveillance should be maintained to confirm the existence of these AEs. Over the next few years, other pneumococcal vaccines will be developed. When these new products are licensed and reach the market, new technologies and innovative epidemiological methods will permit a more rapid and more effective evaluation of AEs.     

小儿细菌眭肺炎的病原菌及其耐药性分析

目的探讨小儿细菌性肺炎的病原菌及其耐药性。方法2382例确诊为细菌性肺炎患儿痰培养标本为研究对象,分析其感染病原菌的分布及耐药性情况。结果小儿细菌性肺炎病原菌以革兰阴性菌为主,共477株,占比83．45％,其中肺炎克雷伯菌26．44％,大肠埃希菌25．22％,鲍氏不动杆菌10．68％;革兰阳性菌共64株,占比11．23％,其中金黄色葡萄球菌7．71％。阿米卡星、亚胺培南对各种病原菌均较敏感,美洛培南除对鲍氏不动杆菌不敏感外,对其他菌类均敏感;环丙沙星、庆大霉素对金黄色葡萄球菌均较为敏感,氨苄西林对肺炎克雷伯菌、大肠埃希菌、鲍氏不动杆菌、阴沟肠杆菌、铜绿假单胞菌的敏感性均较差。结论小儿细菌性肺炎病原菌以革兰阴性菌为主,临床用药应以药敏试验为指导,合理使用抗生素,避免或减少细菌耐药性的产生。     

Population antibiotic susceptibility for Streptococcus pneumoniae and treatment outcomes in common respiratory tract infections

PURPOSE: Antibiotic-resistant Streptococcus pneumoniae potentially threatens the successful treatment of common respiratory tract infections (RTIs); however, the relationship between antibiotic resistance and treatment outcomes remains unclear. We aimed to test the hypothesis that higher in vitro penicillin and erythromycin nonsusceptibility levels among clinical isolates of S. pneumoniae are associated with higher risk of treatment failure in suppurative acute otitis media (AOM), acute sinusitis, and acute exacerbation of chronic bronchitis (AECB). METHODS: We conducted a population-level analysis using treatment outcomes data from a national, managed-care claims database, and antibiotic susceptibility data from a national repository of antimicrobial susceptibility results between 1997 and 2000. Treatment outcomes in patients with suppurative AOM, acute sinusitis, or AECB receiving selected macrolides or beta-lactams were assessed. Associations between RTI-specific treatment outcomes and antibiotic nonsusceptibility were determined using Spearman correlation coefficients with condition-specific paired outcome and susceptibility data for each region and each year. RESULTS: There were 649 552 available RTI outcomes and 7252 susceptibility tests performed on S. pneumoniae isolates. There were no statistically significant trends across time for resolution proportions following treatment by either beta-lactams or macrolides among any of the RTIs. Correlation analyses found no statistically significant association between S. pneumoniae susceptibility and RTI treatment outcomes apart from a significant positive association between of erythromycin nonsusceptibility in ear isolates and macrolide treatment resolution for suppurative AOM. CONCLUSION: On the population level, in vitro S. pneumoniae nonsusceptibility to macrolide or beta-lactam antibiotics was not associated with treatment failure in conditions of probable S. pneumoniae etiology.     

Indirect effects of a 7 year PCV7/PCV13 mass vaccination program in children on the incidence of pneumonia among adults: a comparative study based on two Polish cities

Background and objectives:

In 2006 the city of Kielce, Poland, introduced a mandatory PCV7 (replaced by PCV13 in 2011) vaccination program against S. pneumoanie for all children under 2 years old. At that time, the neighboring city of Ostrowiec ?wi?tokrzyski had no such large-scale vaccination program in place. This created an opportunity to observe the results of the vaccination by comparing the incidence of pneumonia in these two cities. The aim of this study was to analyze how the incidence of pneumonia among adults was indirectly affected by the PCV7/PCV13 vaccination program in children during the 7 year follow-up period.

Methods:

We performed a retrospective study. PCV7/PCV13 vaccinations were delivered according to a 2?+?1 schedule. The vaccination rate in the analyzed period amounted to almost 99%. The following age groups were analyzed: 30–49, 50–64 and 65+. The Cochran–Armitage test was used to investigate the significance of the observed trend in pneumonia morbidity. The significance of deviations from a linear trend was also tested. In addition, the importance of the trend (in the case of deviations from linearity) was confirmed with the use of the Mantel test.

Results:

In the 65+ age group there was a decrease of 66.5% in the incidence of diagnosed pneumonia (p?<?0.0001). This was followed by smaller, but statistically significant, declines in the other age groups: 30.75% in the 30–49 age group (p?=?0.001) and 56.8% in the 50–64 age group (p?<?0.0001). This decreasing trend continued for seven consecutive years of observation. In addition, we demonstrated a statistically significant higher rate of pneumonia in all age groups in the City of Ostrowiec ?wi?tokrzyski.

Conclusions:

The results clearly indicate that the indirect effectiveness of the PCV7/PCV13 vaccine program, performed according to the 2?+?1 schedule and applied in Kielce, Poland, is statistically significant.     

96例小儿肺炎支原体感染情况及耐药性分析

目的 分析呼吸道感染患儿肺炎支原体(MP)感染和耐药情况,指导临床合理用药.方法 用MP快速鉴定培养基对本院2010年11月至2011年10月收治的429例呼吸道感染的患儿的咽拭子进行MP培养及药敏试验.结果 429例呼吸道感染患儿咽拭子标本中,MP培养阳性96例,总阳性率22.4％;其中男性阳性率21.3％,女性阳性率23.6％,男、女比较差异无统计学意义(P＞0.05).一年中,春季发病率最高(29.2％),夏季发病率最低(15.7％),夏季与春季比较差异有统计学意义(P＜0.05),夏季分别与秋、冬季比较差异无统计学意义(P＞0.05).药敏试验:对红霉素的耐药性最高45.8％,对罗红霉索的耐药率(44.8％)次之,对左氧氟沙星和司帕沙星的耐药率最低(均为19.8％).结论 肺炎支原体是小儿呼吸道感染的重要病原体,一年四季均可发病,对大环内酯类抗生素耐药性较高,应根据药敏试验结果指导临床合理用药,使患者得到及时有效的治疗.