Chenoweth C E, Saint S, Martinez F, Lynch J P, Fendrick A M
Department of Internal Medicine, University of Michigan Health System, Ann Arbor 48109-0378, USA.
Mayo Clin Proc. 2000 Nov;75(11):1161-8. doi: 10.4065/75.11.1161.
Streptococcus pneumoniae is the leading cause of community-acquired pneumonia. During the past decade, the prevalence of penicillin resistance in S pneumoniae has increased dramatically, with resistance rates approaching 45% in some areas of the United States. Streptococcus pneumoniae has also acquired resistance to other commonly used antimicrobials, including cephalosporins, macrolides, and trimethoprim-sulfamethoxazole. While vancomycin and the newer quinolones are currently highly active against most strains of S pneumoniae, reduced susceptibilities to these agents have been identified in some strains. Prior use of antimicrobial agents is the major risk factor for colonization and infection with antibiotic-resistant strains. beta-Lactam antibiotics remain the treatment of choice for infections caused by susceptible S pneumoniae. The optimum therapy for penicillin-resistant strains remains unclear. Appropriate empirical therapy for patients with community-acquired pneumonia depends in part on the community-specific resistance patterns of S pneumoniae to various antibiotics. In this article, we provide an overview of the development of S pneumoniae resistance to commonly used antibiotics and discuss the implications of the development of resistance on treatment decisions.
肺炎链球菌是社区获得性肺炎的主要病因。在过去十年中，肺炎链球菌对青霉素的耐药率急剧上升，在美国某些地区耐药率接近45%。肺炎链球菌还对其他常用抗菌药物产生了耐药性，包括头孢菌素、大环内酯类和甲氧苄啶-磺胺甲恶唑。虽然万古霉素和新型喹诺酮类药物目前对大多数肺炎链球菌菌株具有高度活性，但在一些菌株中已发现对这些药物的敏感性降低。先前使用抗菌药物是定植和感染耐抗生素菌株的主要危险因素。β-内酰胺类抗生素仍然是敏感肺炎链球菌所致感染的首选治疗药物。对耐青霉素菌株的最佳治疗方法仍不明确。社区获得性肺炎患者的适当经验性治疗部分取决于社区中肺炎链球菌对各种抗生素的特异性耐药模式。在本文中，我们概述了肺炎链球菌对常用抗生素耐药性的发展情况，并讨论了耐药性发展对治疗决策的影响。
