Slobodnikova L, Kotulova D, Kapellerova A, Kotzigova A
Institute of Microbiology, School of Medicine, Comenius University, Bratislava, Slovakia.
Bratisl Lek Listy. 1999 Nov;100(11):587-92.
The most frequent nasopharyngeal carriers of Streptococcus pneumoniae are young children. Frequent use of antimicrobial therapy in children facilitates the selection of penicillin-resistant strains in this population. These strains, especially if highly resistant, may cause serious therapeutic problems. Aim of the study was to monitor penicillin- and multidrug-resistant S. pneumoniae strains in hospitalized children with respiratory tract infections. Hospitalized children up to five years were examined for S. pneumoniae presence in their upper respiratory tract. Susceptibility to penicillin, erythromycin, trimethoprim/sulfamethoxazole, tetracycline, and chloramphenicol was determined by the disk-diffusion method. The minimal inhibitory concentrations (MIC) of penicillin, erythromycin and trimethoprim/sulfamethoxazole were measured by the E-test. S. pneumoniae strain was isolated from 60 (34.7%) out of 173 microbiologically examined children; 2 different strains were isolated in 9 cases. Nine strains (13.0%) were penicillin resistant with MICs ranging from 1.5 to 8 mg/L, and 17 strains (24.6%) had intermediate susceptibility. Seventeen (24.6%) strains were erythromycin resistant (MIC > or = 1 mg/L). Eighteen strains (26.1%) were resistant and 7 strains (10.1%) were intermediately susceptible to trimethoprim/sulfamethoxazole. Ten strains (14.5%) were not susceptible to tetracycline, and 11 (15.9%) to chloramphenicol. Non-susceptibility (resistance or intermediate susceptibility) to the tested antimicrobials was more prevalent in penicillin-nonsusceptible strains. The current level of S. pneumoniae resistant to antimicrobial drugs in children with respiratory tract infections in the hospital department monitored in our study do not cause problems in the choice of antibacterial therapy. Penicillins still can remain the drug of choice in cases when typical bacterial causing agents of respiratory tract infections are suspected. (Tab. 3, Fig. 2, Ref. 31.)
肺炎链球菌最常见的鼻咽部携带者是幼儿。儿童频繁使用抗菌治疗促使该人群中耐青霉素菌株的产生。这些菌株，尤其是高度耐药的菌株，可能会导致严重的治疗问题。本研究的目的是监测住院呼吸道感染儿童中耐青霉素和耐多药的肺炎链球菌菌株。对5岁以下住院儿童的上呼吸道进行肺炎链球菌检测。采用纸片扩散法测定对青霉素、红霉素、甲氧苄啶/磺胺甲恶唑、四环素和氯霉素的敏感性。通过E试验测定青霉素、红霉素和甲氧苄啶/磺胺甲恶唑的最低抑菌浓度（MIC）。在173例接受微生物学检查的儿童中，60例（34.7%）分离出肺炎链球菌菌株；9例分离出2种不同菌株。9株（13.0%）对青霉素耐药，MIC范围为1.5至8mg/L，17株（24.6%）为中介敏感。17株（24.6%）对红霉素耐药（MIC≥1mg/L）。18株（26.1%）对甲氧苄啶/磺胺甲恶唑耐药，7株（10.1%）为中介敏感。10株（14.5%）对四环素不敏感，11株（15.9%）对氯霉素不敏感。对所测试抗菌药物的不敏感（耐药或中介敏感）在耐青霉素菌株中更为普遍。在我们研究监测的医院科室中，呼吸道感染儿童中肺炎链球菌对抗菌药物的耐药现状在抗菌治疗选择上并未造成问题。当怀疑呼吸道感染的典型细菌病原体时，青霉素仍然可以作为首选药物。（表3，图2，参考文献31）
