Belongia E A, Proctor M, Vandermause M, Ahrabi-Fard S, Knobloch M J, Keller P, Bergs R, Chyou P H, Davis J P
Marshfield Medical Research Foundation and Marshfield Clinic, WI 54449, USA.
WMJ. 2000 Aug;99(5):55-9.
Streptococcus pneumoniae is a major cause of community acquired infections in the United States, and rates of antibiotic resistance have increased dramatically in the past decade. Statewide rates of pneumococcal resistance to penicillin and other antibiotics have not been previously reported in Wisconsin. To determine these rates, we assessed invasive pneumococcal isolates for reduced susceptibility to nine different antibiotics.
Pneumococcal isolates from blood, cerebrospinal fluid or other normally sterile body sites were submitted by 91% of laboratories that perform invasive bacterial cultures. Isolates were tested for susceptibility to penicillin, cefotaxime, ceftriaxone, levofloxacin, meropenem, erythromycin, vancomycin, sulfamethoxazole-trimethoprim and chloramphenicol.
There were 409 invasive pneumococcal isolates identified in 1999 among Wisconsin residents, including 385 (94%) isolates from blood. The mean patient age was 42.5 years (range, < 1 year to 96 years), and 213 (52%) were male. Of the pneumococcal isolates, 24% were not susceptible to penicillin, including 10% with high level resistance. Isolates with reduced penicillin susceptibility were also likely to have reduced susceptibility to other antibiotics. Patients with penicillin nonsusceptible (intermediate and fully resistant) pneumococcal isolates were significantly younger (mean, 37.0 years) than those with susceptible isolates (mean, 44.3 years) (p = .04). The proportion of patients with a penicillin nonsusceptible isolate varied by region, ranging from 12.8% in northeastern Wisconsin to 35.5% in northern Wisconsin.
The proportion of invasive pneumococcal isolates with penicillin resistance in Wisconsin is similar to other regions of the United States. Inappropriate antibiotic use contributes to the emergence of resistant pneumococcal infections, and educational efforts are underway to promote judicious antibiotic use in Wisconsin.
肺炎链球菌是美国社区获得性感染的主要病因，在过去十年中抗生素耐药率急剧上升。此前威斯康星州尚未报告过全州范围内肺炎链球菌对青霉素和其他抗生素的耐药率。为确定这些耐药率，我们评估了侵袭性肺炎链球菌分离株对九种不同抗生素的敏感性降低情况。
进行侵袭性细菌培养的实验室中有91%提交了来自血液、脑脊液或其他通常无菌身体部位的肺炎链球菌分离株。对分离株进行了对青霉素、头孢噻肟、头孢曲松、左氧氟沙星、美罗培南、红霉素、万古霉素、磺胺甲恶唑 - 甲氧苄啶和氯霉素的敏感性测试。
1999年在威斯康星州居民中鉴定出409株侵袭性肺炎链球菌分离株，其中385株（94%）来自血液。患者平均年龄为42.5岁（范围为<1岁至96岁），213例（52%）为男性。在肺炎链球菌分离株中，24%对青霉素不敏感，其中10%具有高水平耐药性。对青霉素敏感性降低的分离株也可能对其他抗生素敏感性降低。青霉素不敏感（中介和完全耐药）肺炎链球菌分离株的患者明显比敏感分离株的患者年轻（平均37.0岁对44.3岁）（p = 0.04）。青霉素不敏感分离株患者的比例因地区而异，从威斯康星州东北部的12.8%到威斯康星州北部的35.5%不等。
威斯康星州侵袭性肺炎链球菌分离株对青霉素耐药的比例与美国其他地区相似。不适当的抗生素使用导致耐药肺炎链球菌感染的出现，目前正在开展教育工作以促进威斯康星州合理使用抗生素。
