儿童鼻咽部肺炎链球菌携带株研究

目的了解武汉地区健康儿童肺炎链球菌带菌状况、耐药性、耐药基因及血清型流行情况。方法收集武汉地区2所幼儿园469名健康儿童的鼻咽拭子标本,分离鉴定肺炎链球菌,琼脂稀释法测定其对12种抗菌药物的MIC;PCR检测红霉素耐药基因ermB和mefA;“荚膜肿胀”试验进行血清学分型。结果469份鼻咽拭子标本共分离出116株肺炎链球菌,分离率为24.7%。存活的114株中,肺炎链球菌对青霉素的敏感率为51.8%(59/114),对红霉素的敏感率为13.2%(15/114)。99株红霉素耐药肺炎链球菌中,ermB基因总检出率为98.0%(97/99),其中30株(31.6%)同时具有ermB和mefA基因,2株红霉素低耐株仅检出mefA基因。血清分型涉及16个血清型、群,主要分布在19、23、6和14血清群。结论武汉地区肺炎链球菌耐药性高,多为多重耐药菌株,红霉素耐药基因主要为ermB,19、23、6血清群多重耐药株分布广泛。     

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.     

广东省虎门地区儿童肺炎链球菌血清型分布及耐药性监测

目的了解东莞虎门地区儿童肺炎链球菌的血清型分布和对抗菌药物的耐药性,评估几种疫苗,尤其是7价结合疫苗(PCV7)在本地区对肺炎链球菌的覆盖情况,并为临床合理使用抗菌药物提供依据。方法对2011年1月—2012年12月就诊肺炎患儿呼吸道标本中分离的肺炎链球菌,采用荚膜肿胀试验进行血清分型,并采用法国生物梅里埃公司的ATB STREP5肺炎链球菌板条进行药物敏感性试验。采用CLSI 2010年版标准判断结果,数据分析采用WHONET5.5软件。结果共分离到229株肺炎链球菌,主要血清型为19F146株(63.8%)、23F49株(21.4%)、6B12株(5.2%)和14型8株(3.5%)。7价疫苗(PCV7)的覆盖率为95.2%,11价疫苗(PCV11)的覆盖率为95.2%,13价疫苗(PCV13)的覆盖率为97.4%。所分离的肺炎链球菌中青霉素敏感的肺炎链球菌(PSSP)占92.6%(212/229),青霉素中介的肺炎链球菌(PISP)占5.7%(13/229),青霉素耐药的肺炎链球菌(PRSP)占1.7%(4/229)。肺炎链球菌对红霉素、克林霉素、四环素、甲氧苄啶-磺胺甲口恶唑、氯霉素、头孢噻肟、阿莫西林的耐药率依次为95.6%、93.0%、88.2%、86.5%、7.0%、2.2%、0.9%,所有菌株对万古霉素和左氧氟沙星完全敏感。结论该地区儿童肺炎链球菌的血清型主要为19F、23F、6B和14型,PCV7的覆盖率为95.2%,提示可用于本地区的预防接种。肺炎链球菌对红霉素、克林霉素、四环素、甲氧苄啶-磺胺甲口恶唑耐药严重,对万古霉素、左氧氟沙星、青霉素的敏感率较高。     

肺炎链球菌红霉素相关耐药基因与耐药表型的关系

目的:了解肺炎链球菌(Streptococcuspneum oniae,SP)临床分离株红霉素耐药基因的流行状况及和耐药表型的关系。方法:对住院儿童分离到的43株肺炎链球菌进行红霉素药敏试验,并用PCR法检测与红霉素耐药相关的红霉素核糖体甲基化酶基因(ermB)、主动外排转运基因(mefA)。结果:43株肺炎链球菌红霉素药敏试验40株耐药(占93%),3株敏感。红霉素ermB基因总检出率为76.7%(33/43),mefA基因总检出率为23.3%(10/43)。3株红霉素敏感的肺炎链球菌均未检出ermB基因和mefA基因;40株红霉素耐药肺炎链球菌ermB基因和mefA基因的PCR检出率分别为82.5%(33/40)和25%(10/40)。共有35株肺炎链球菌检出ermB基因或/和mefA基因,其中单独携带ermB基因的耐药表型为25株(占71.4%);单独携带mefA基因的耐药表型2株(占5.7%);同时携带ermB基因和mefA基因的耐药表型8株(占22.9)%。结论:ermB基因和mefA基因同时表达或单独表达均可导致红霉素耐药,ermB基因表达是儿童肺炎链球菌对红霉素耐药的主要原因,mefA基因表达是造成对红霉素耐药的次要原因。红霉素已不是治疗肺炎链球菌的有效药物。     

儿童呼吸道感染肺炎链球菌耐药状况测定及机制分析

目的　研究本地区呼吸道感染患儿鼻咽部肺炎链球菌的药物敏感性 ,初步探讨可能的耐药机制。方法　对 845例呼吸道感染患儿的鼻咽拭子进行肺炎链球菌培养、分离 ,以Kirby Bauer纸片扩散法进行药敏试验 ,以套式 -聚合酶链反应及PCR技术进行TEM基因、ermB基因和mefA基因检测 ,加DAN测序分析。结果　 845例呼吸道感染患儿分离到 3 2株肺炎链球菌 ,携带率为 3 78% ,占检出菌 2 4 8% ;分离菌株对常用抗生素耐药为青霉素 2 2 0 % ,克林霉素 66% ,红霉素、阿奇霉素、阿莫西林 /克拉维酸 63 % ,复方甲基异恶唑 5 9% ,但对氯霉素和万古霉素均敏感 ;部分菌株 β内酰胺酶基因 (TEM )、红霉素耐药基因 (甲基化酶基因ermB)表达阳性 ,但未表达红霉素耐药基因 (外排基因mefA)。结论　肺炎链球菌是本地区呼吸道感染儿童主要致病菌 ,对常用抗生素有不同程度耐药 ,部分菌株耐药机制可能是通过表达TEM基因和ermB基因实现的。     

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。     

儿童肺炎链球菌血清型分布及其对抗菌药物的耐药性

目的 了解上海交通大学附属儿童医院临床分离的肺炎链球菌血清型分布和对抗菌药物的耐药状况,为控制耐药菌株的播散和疫苗免疫预防的可行性提供参考依据.方法 2007年10月-2008年5月该院就诊患儿咽喉部分泌物中分离的肺炎链球菌株.采用荚膜肿胀试验进行血清型分析,E试验法检测菌株对8种抗菌药物的敏感性.结果 临床共分离到338株肺炎链球菌,主要血清型依次为19F 138株(41.0 %)、19A 67株(19.8%)、14型30株(8.9 %)、23F 14株(4.1 %)、6B 13株(3.8%)、6A 12株(3.6%)和15B 10株(3.0%).在青霉素不敏感菌株(PNSP)和红霉素耐药株(ERSP)中多价疫苗(PCV7)的覆盖率分别为41.9%(26/62)和59.6%(198/332),PCV13的覆盖率分别为72.6%(45/62)和84.9%(282/332).青霉素不敏感肺炎链球菌(PNSP)的血清型主要集中在19F、19A和未能分型株.除未能分型株之外,血清型的分布在2岁以下婴幼儿和2～5岁儿童之间没有显著差异.338株肺炎链球菌中,青霉素敏感株(PSSP)占81.7%(267/338),青霉素中介株(PISP)占10.9%(37/338),青霉素耐药株(PRSP)占7.4%(25/338).19F和19A型的PNSP(PISP+PRSP)对阿莫西林-克拉维酸、头孢曲松的耐药率显著高于PSSP(P<0.01).未能分型株的PNSP对阿莫西林-克拉维酸、头孢曲松以及头孢呋辛的耐药率显著高于PSSP(P<0.01).结论 该院临床分离的肺炎链球菌最常见血清型为19F、19A、14、23F、6B和6A,PCV13能覆盖多数PNSP和ERSP,应用该疫苗应能有效地预防儿童肺炎链球菌的感染和控制耐药菌株传播.     

肺炎链球菌对抗菌药物的耐药性调查及对大环内酯类抗生素耐药机制研究

目的：调查成都地区肺炎链球菌对抗菌药物的敏感性，研究成都地区肺炎链球菌对大环内酯类抗生素耐药机制。方法：收集2001年9月-2002年9月成都地区临床分离的肺炎链球菌，测定其对13种抗菌药物的耐药性及对大环内酯类抗生素的耐药表型；用聚合酶链反应(PCR)扩增耐药基因ermB和mefA，并对ermB和mefA进行基因序列分析。结果：82株肺炎链球菌中13株对青霉素低度耐药(占15．9％),肺炎链球菌对大环内酯类抗生素和克林霉素表现出较高的耐药率，对红霉素和克林霉素耐药率分别为80．5％(66／82)和68．3％(56／82)。耐大环内酯类肺炎链球菌中,96．4％菌株表现为内在型耐药。标准菌株ATCC49619及16株红霉素敏感菌株均未检测到ermB基因及mefA基因；ermB基因和；mefA基因分别在62和11株耐红霉素肺炎链球菌中检测到，其中7株菌同时检测到ermB基因和mefA基因。所测ermB和mefA基因序列与基因库收录序列高度一致。结论：成都地区临床分离的肺炎链球菌对青霉素耐药率较低，但对大环内酯类抗生素和克林霉素耐药却非常普遍。ermB基因介导的靶位改变是成都地区肺炎链球菌对大环内酯类抗生素的主要耐药机制。     

儿童感染肺炎链球菌的血清型和耐药性分析

目的了解首都医科大学附属北京儿童医院住院患儿肺炎链球菌分离株的血清型分布和耐药性,以指导临床合理用药。方法采用荚膜肿胀试验对首次分离的肺炎链球菌进行血清型分型,用纸片法和BD Phoenix 100全自动微生物仪进行药敏试验。结果 2013年3月-2019年2月共收集非重复肺炎链球菌834株,主要分离自3岁以下患儿(612株,73.4%)。患儿以肺部感染为主(739例,88.6%)。834株肺炎链球菌中分离自脑脊液菌株19株;侵袭性菌株和非侵袭性菌株分别为90 株和744株。共检出43种血清型,常见的血清型为19F、19A、23F、14、6A、6B。青霉素敏感株(PSSP)354株(42.4%),青霉素不敏感株(PNSP)480株(57.6%);未发现利奈唑胺和万古霉素耐药株。肺炎链球菌对莫西沙星、左氧氟沙星和氯霉素的敏感率高(95%);但对红霉素、克林霉素和四环素的耐药率高(94%)。侵袭性菌株和非侵袭性菌株对抗菌药物的耐药率差异无统计学意义。血清型为19F和19A的菌株对多种抗菌药物的耐药率明显高于其他血清型菌株。PNSP对多种抗菌药物的耐药率高于PSSP。结论该院住院患儿感染肺炎链球菌血清型以19F、19A、23F、14、6A、6B为主,对莫西沙星、左氧氟沙星和氯霉素的耐药率低,对红霉素、克林霉素和四环素的耐药率高。血清型19F和19A的菌株对抗菌药物的耐药率高于其他血清型菌株。应加强细菌耐药性监测,根据患儿感染细菌的血清型和药敏试验结果合理选用抗菌药物。     

肺炎链球菌对红霉素耐药机制的研究

目的 研究北京地区肺炎链球菌对红霉素的耐药机制。方法 收集本院1998－1999年分离的对红霉素耐药的肺炎链球菌116株,采用“荚膜肿胀”技术进行血清分型,聚合酶链反应（PCR）检测对红霉素耐药的基因erm/mef,脉冲场凝胶电泳（PFGE)客青霉素结合蛋白（PBP）基因印迹技术追踪菌株之间的同源性。结果 116株红霉素耐药株的血清型主要为23F（30.0%),6A（19.0%),19F（13.8%),15（7.8%),23A（5.2%)。95.7%的青霉素不敏感株同时也耐红霉素;85％的菌株表现为MLS表型,即同时耐克林霉素;86．4％的红霉素耐药株具有erm基因,6％的菌株同时有erm和mef基因,1．7％的菌株只有mef基因,4．2％未能检测到erm或mef基因。PFGE发现2种耐药克隆：1个是青霉素耐药的血清型为23F的克隆株,另1个是青霉素敏感而红霉素耐药的、血清型为6A的克隆株。结论 核糖体突变（erm基因编码）是北京地区肺炎链球菌耐红霉素的主要机制,2种耐药克隆值得关注。     

Antibiotic susceptibility according to genotype of penicillin-binding protein and macrolide resistance genes, and serotype of Streptococcus pneumoniae isolates from community-acquired pneumonia in children

OBJECTIVES: Antibiotic susceptibilities, genes mediating beta-lactam and macrolide resistance, and serotypes were analysed for strains of Streptococcus pneumoniae. METHODS: A total of 392 strains of S. pneumoniae were isolated from paediatric patients with community-acquired pneumonia between May 2002 and 2004. All strains were classified into six genotype patterns according to the mutations found in the pbp1a, pbp2x and pbp2b genes identified by PCR. These results are represented by adding 'g', indicating genotypic identification. RESULTS: Thirty-nine per cent of the isolates showed mutations in either one or two PBP genes (gPISP, where PISP stands for penicillin-intermediate resistant S. pneumoniae) and 52.3% had mutations in three genes (gPRSP, where PRSP stands for penicillin-resistant S. pneumoniae). The majority of the strains had a macrolide resistance gene: mefA, (30.6%); ermB, (48.5%); or both mefA and ermB, (7.7%). The most frequent serotypes of these strains were: 6B (23.2%), 23F (17.6%), 19F (17.3%), 14 (10.5%) and 6A (8.2%). Serotypes of the seven-valent conjugate vaccine covered 70.9% of all isolates, and 89.8% of gPRSP. Serotypes of the strains with cefotaxime MICs of > or =2 mg/L were almost all of a vaccine type. CONCLUSIONS: The results suggest that introduction of conjugate vaccines into infants and children is necessary for the prevention of pneumococcal infections in Japan.     

肺炎链球菌对大环内酯类抗生素耐药机制研究

目的了解肺炎链球菌对大环内酯类抗生素的耐药机制和转座子整合酶的流行情况。方法188株红霉素耐药肺炎链球菌，用E试验和K—B纸片扩散法检测其对11种抗菌药物的敏感性；用双纸片法（红霉素和克林霉素）确定其耐药表型；用PCR扩增这些菌株的耐药基因ermB、mefa、mefE、tetM及转座子整合酶基因intTn。结果188株红霉素耐药株中耐药基因ermB总检出率为91．5％（172／188），mefE总检出率为38．3％，未检出mefA基因。97．9Yoo的红霉素耐药株中存在转座子整合酶intTn。耐药基因组合ermB（＋）mefE（-）和ermB（＋）mef（＋），占91．5％，两者均呈cMLSB耐药表型。ermB（-）mefE（＋）占8．5％，耐药表型为M型。结论我院分离的肺炎链球菌大环内酯耐药以errnB介导的cMLS。耐药表型为主。转座子可能在本地区肺炎链球菌耐药基因的水平转移和克隆播散中起重要作用。     

Antimicrobial resistance of Streptococcus pneumoniae isolated in Taiwan: an island-wide surveillance study between 1996 and 1997

Between August 1996 and July 1997, 550 clinically significant Streptococcus pneumoniae isolates were collected from 14 geographically separate laboratories in Taiwan. These isolates were serotyped and MICs were determined by agar dilution. Among serotypes covered by the 23-valent vaccine, types 19F, 19A, 23F, 23A and 6B dominated, comprising 255 isolates; among non-vaccine serotypes, types 35, 39, 34, 13 and 31 dominated, comprising 118 isolates. Of the 550 isolates, 310 (56.4%) were resistant to penicillin G (MIC 0. 12 mg/L), 238 (43.3%) with intermediate resistance (MIC 0.12-1 mg/L) and 72 (13.1%) with high-level resistance (MIC 2 mg/L). Most non-susceptible pneumococci were of serotypes 19F and 23F; non-susceptible isolates of these serotypes were distributed across all of Taiwan. Fourteen other antibiotics were tested; 83% of the isolates were resistant to tetracycline, 78% to azithromycin, 74% to erythromycin, 54% to clindamycin and 23% to chloramphenicol. Thus, macrolides can no longer be used as first line agents to treat pneumococcal infections in Taiwan. Multi-resistance (isolates resistant to three or more chemically unrelated antibiotics) was found in each serotype or group, but mostly in types 19F and 23F. The emergence of such strains complicates antibiotic selection, but both types are covered by the 23-valent vaccine, as were 82% of the isolates from blood and eight of the nine from cerebrospinal fluid. Good antibiotic control and appropriate use of this vaccine may improve the current problem in Taiwan, especially for the elderly.     

Changing trends in antimicrobial resistance and serotypes of Streptococcus pneumoniae isolates in Asian countries: an Asian Network for Surveillance of Resistant Pathogens (ANSORP) study

Antimicrobial resistance in Streptococcus pneumoniae remains a serious concern worldwide, particularly in Asian countries, despite the introduction of heptavalent pneumococcal conjugate vaccine (PCV7). The Asian Network for Surveillance of Resistant Pathogens (ANSORP) performed a prospective surveillance study of 2,184 S. pneumoniae isolates collected from patients with pneumococcal infections from 60 hospitals in 11 Asian countries from 2008 to 2009. Among nonmeningeal isolates, the prevalence rate of penicillin-nonsusceptible pneumococci (MIC, ≥ 4 μg/ml) was 4.6% and penicillin resistance (MIC, ≥ 8 μg/ml) was extremely rare (0.7%). Resistance to erythromycin was very prevalent in the region (72.7%); the highest rates were in China (96.4%), Taiwan (84.9%), and Vietnam (80.7%). Multidrug resistance (MDR) was observed in 59.3% of isolates from Asian countries. Major serotypes were 19F (23.5%), 23F (10.0%), 19A (8.2%), 14 (7.3%), and 6B (7.3%). Overall, 52.5% of isolates showed PCV7 serotypes, ranging from 16.1% in Philippines to 75.1% in Vietnam. Serotypes 19A (8.2%), 3 (6.2%), and 6A (4.2%) were the most prominent non-PCV7 serotypes in the Asian region. Among isolates with serotype 19A, 86.0% and 79.8% showed erythromycin resistance and MDR, respectively. The most remarkable findings about the epidemiology of S. pneumoniae in Asian countries after the introduction of PCV7 were the high prevalence of macrolide resistance and MDR and distinctive increases in serotype 19A.     

Antimicrobial resistance of Streptococcus pneumoniae isolates of outpatients in Germany, 1999-2000

BACKGROUND: The aim of the study was to determine the prevalence of antimicrobial resistance among clinical isolates of Streptococcus pneumoniae during the winter of 1999-2000 in Germany. METHODS: Pneumococcal isolates were prospectively collected by 14 different clinical microbiology laboratories. Minimal inhibitory concentrations of penicillin G, erythromycin A, clarithromycin, roxithromycin, azithromycin, clindamycin, levofloxacin and telithromycin were determined by the broth microdilution method. RESULTS: Among 328 strains 4.6% were nonsusceptible to penicillin G (intermediate and resistant strains) and 9.5% were resistant to erythromycin A. Analysis of erythromycin-resistant strains for the underlying resistance determinants revealed that 12 (38.7%) belonged to the erm(B) and 19 (61.3%) to the mef(E) type of resistance. Among the macrolide-resistant strains, serotypes 19F (n = 9) and 14 (n = 8) were the predominant types. CONCLUSIONS: Macrolide resistance in Germany is of growing concern and mainly due to the high prevalence of pneumococci expressing the mef(E) type of resistance.     

Serotype distribution of penicillin-resistant pneumococci and their susceptibilities to seven antimicrobial agents

A total of 229 clinical isolates of Streptococcus pneumoniae recovered from 225 patients were serotyped and tested for susceptibility to penicillin G, ampicillin, mezlocillin, cefazolin, erythromycin, clindamycin, chloramphenicol, and sulfamethoxazole-trimethoprim. Of all the isolates, 48 (21.0%) showed intermediate resistance and 17 (7.4%) showed resistance to penicillin G. Penicillin-resistant strains had higher minimal inhibitory concentrations of ampicillin, mezlocillin, and cefazolin than did penicillin-susceptible strains. Resistance to erythromycin and clindamycin was rare (1.3 and 0.9%, respectively). Of the isolates, 8.7% were resistant to sulfamethoxazole-trimethoprim, and all were susceptible to chloramphenicol. Penicillin resistance was associated with 13 serotypes. Serotypes 14, 19F, 19A, and 23F were both highly prevalent and frequently penicillin resistant.     

南京地区肺炎链球菌的耐药变迁及喹诺酮耐药机制研究

目的了解南京地区肺炎链球菌临床分离株的耐药性变迁及对喹诺酮类的耐药机制。方法收集2010-2012年南京7所教学医院共147株肺炎链球菌,琼脂稀释法测定9种抗菌药物的MIC,与南京2006-2007年分离的肺炎链球菌耐药情况进行比较。并对氟喹诺酮耐药株的gyrA、gyrB、parE和parC基因喹喏酮耐药决定区域（QRDR）进行PCR扩增及测序。结果147株肺炎链球菌中,对红霉素的耐药率为89．1％;青霉素不敏感肺炎链球菌（MIC≥4mg／L）占3．4％;对头孢呋辛、头孢曲松、美罗培南、左氧氟沙星、莫西沙星的耐药率分别为26．5％、1．4％、3．4%、1．4％、0．7％;所有分离株对万古霉素、利奈唑胺敏感。与2006-2007年分离株相比,2010-2012年临床分离株对青霉素、头孢呋辛耐药率下降,对红霉素、头孢曲松耐药率变化不大,出现了少数左氧氟沙星及莫西沙星耐药株。对喹诺酮耐药株进行基因测序发现1菌株有gyrA突变（Asn167-Ile）和ParE突变（Ile460～Val）;另1菌株则有ParC突变（Ser81-Gly;Asn94-Asp）。结论南京地区肺炎链球菌对红霉素耐药率居高不下,对青霉素仍较敏感,出现了少数莫西沙星、左氧氟沙星耐药株。喹诺酮耐药株有gyrA、parE和parC的QRDR突变。