Leibovitz E, Dragomir C, Sfartz S, Porat N, Yagupsky P, Jica S, Florescu L, Dagan R
Pediatric Infectious Disease Unit, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Int J Infect Dis. 1999 Summer;3(4):211-5. doi: 10.1016/s1201-9712(99)90027-9.
The study compared nasopharyngeal carriage of resistant pneumoniae in human immunodeficiency virus (HIV)-seropositive and -seronegative children.
Nasopharyngeal colonization with Streptococcus pneumoniae was investigated during May 1996 in 162 HIV-negative infants and children (age range, 1-38 mo) and 40 HIV-infected children (age range, 39-106 mo) living in an orphanage in Iasi, northeastern Romania. The HIV-infected children lived separated from the other children and were cared for by a different staff. Streptococcus pneumoniae was isolated from 12 of 40 (30%) HIV-infected and from 81 of 160 (50%) HIV-negative children. Antimicrobial susceptibility to penicillin and ceftriaxone was determined by E-test, and to another five antibiotics by disk diffusion. Serotyping was performed by the Quellung method on 81 of 93 (87%) isolates.
Serotypes 6A, 6B, 19A, and 23F together represented 98% of all isolates. Ninety-nine percent of S. pneumoniae isolates were resistant to penicillin, and 74% were highly resistant to penicillin (minimum inhibitory concentration [MIC] > 1 mg/mL); MIC50 and MIC90 to penicillin of the isolates were 2 mg/mL and 8 mg/mL, respectively. Eighty-nine of ninety-one isolates were susceptible to ceftriaxone; 99%, 87%, 87%, 48%, and 21% of the isolates were resistant to trimethoprim-sulphamethoxazole, erythromycin, clindamycin, tetracycline, and chloramphenicol, respectively. Eighty-two (89%) isolates were multidrug resistant (resistant to =/>3 antibiotic classes); 37 of 92 (40%) isolates were resistant to 5 or more antibiotic classes, and 16 of these 37 (43%) belonged to serotype 19A. All serotype 19 isolates were highly resistant to penicillin.
No significant differences were observed in the resistance rates of S. pneumoniae in HIV-infected children compared to HIV-negative children. Multidrug-resistant pneumococci were highly prevalent in this Romanian orphanage in both HIV-negative and older HIV-infected children. The observed high prevalence of multidrug-resistant pneumococci (coupled with high penicillin resistance) with a limited number of circulating serotypes emphasizes the need to further evaluate the conjugate vaccines in children at risk for invasive pneumococcal infection.
本研究比较了人类免疫缺陷病毒（HIV）血清学阳性和阴性儿童中耐药肺炎链球菌的鼻咽部携带情况。
1996年5月，对罗马尼亚东北部雅西一家孤儿院的162名HIV阴性婴幼儿及儿童（年龄范围1 - 38个月）和40名HIV感染儿童（年龄范围39 - 106个月）进行了肺炎链球菌鼻咽部定植情况调查。HIV感染儿童与其他儿童分开居住，并由不同的工作人员照料。40名HIV感染儿童中有12名（30%）分离出肺炎链球菌，160名HIV阴性儿童中有81名（50%）分离出肺炎链球菌。采用E试验测定对青霉素和头孢曲松的药敏情况，采用纸片扩散法测定对另外五种抗生素的药敏情况。对93株分离株中的81株（87%）采用荚膜肿胀试验进行血清分型。
6A、6B、19A和23F血清型共占所有分离株的98%。99%的肺炎链球菌分离株对青霉素耐药，74%对青霉素高度耐药（最低抑菌浓度[MIC]＞1mg/mL）；分离株对青霉素的MIC50和MIC90分别为2mg/mL和8mg/mL。91株分离株中有89株对头孢曲松敏感；分离株对复方新诺明、红霉素、克林霉素、四环素和氯霉素的耐药率分别为99%、87%、87%、48%和21%。82株（89%）分离株为多重耐药（对≥3类抗生素耐药）；92株分离株中有37株（40%）对5类或更多类抗生素耐药，其中这37株中的16株（43%）属于19A血清型。所有19型血清型分离株对青霉素均高度耐药。
与HIV阴性儿童相比，HIV感染儿童中肺炎链球菌的耐药率未观察到显著差异。在这家罗马尼亚孤儿院，多重耐药肺炎球菌在HIV阴性儿童和年龄较大的HIV感染儿童中都非常普遍。观察到的多重耐药肺炎球菌的高流行率（以及高青霉素耐药率）和有限的循环血清型数量强调了有必要进一步评估侵袭性肺炎球菌感染高危儿童中使用的结合疫苗。
