Schrag S J, Beall B, Dowell S F
Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Clin Microbiol Rev. 2000 Oct;13(4):588-601. doi: 10.1128/CMR.13.4.588.
Streptococcus pneumoniae infections are a leading cause of respiratory illness in young children, the elderly, and persons with chronic medical conditions. The emergence of multidrug-resistant pneumococci has compromised the effectiveness of antibiotic therapy for pneumococcal infections. As antibiotic-resistant strains increase in prevalence, there is a need for interventions that minimize the spread of resistant pneumococci. In this review we provide a framework for understanding the spread of pneumococcal resistance and evaluate proposed interventions to reduce this spread. Pneumococci differ from many drug-resistant pathogens because asymptomatic carriers play a key role in transmission of resistant strains and the genes encoding resistance are spread primarily by transformation and conjugative transposons. Evidence suggests that modifications of treatment regimens that have proved effective at limiting resistance in other pathogens may not prevent the spread of pneumococcal resistance. In contrast, programs encouraging more judicious antibiotic use have been shown to be effective. Additionally, a newly developed conjugate pneumococcal vaccine holds great potential as an "antiresistance vaccine" that simultaneously reduces the burden of invasive disease and the prevalence of resistant strains. Several areas of future epidemiologic and laboratory research hold promise to contribute to the reduced spread of pneumococcal resistance.
肺炎链球菌感染是幼儿、老年人及患有慢性疾病者发生呼吸道疾病的主要原因。多重耐药肺炎球菌的出现削弱了肺炎球菌感染抗生素治疗的有效性。随着耐药菌株患病率的增加，需要采取干预措施以尽量减少耐药肺炎球菌的传播。在本综述中，我们提供了一个理解肺炎球菌耐药性传播的框架，并评估了为减少这种传播而提出的干预措施。肺炎球菌与许多耐药病原体不同，因为无症状携带者在耐药菌株传播中起关键作用，且编码耐药性的基因主要通过转化和接合转座子传播。有证据表明，已证明在限制其他病原体耐药性方面有效的治疗方案调整可能无法防止肺炎球菌耐药性的传播。相比之下，鼓励更合理使用抗生素的项目已被证明是有效的。此外，一种新开发的肺炎球菌结合疫苗作为“抗耐药疫苗”具有巨大潜力，可同时减轻侵袭性疾病负担并降低耐药菌株的患病率。未来流行病学和实验室研究的几个领域有望有助于减少肺炎球菌耐药性的传播。
