Sener Burçin, Köseoğlu Ozgen, Fişenk Inci, Hasçelik Gülşen, Günalp Ayfer
Hacettepe Universitesi Tip Fakültesi Mikrobiyoloji ve Klinik Mikrobiyoloji Anabilim Dali, Ankara.
Mikrobiyol Bul. 2002 Apr;36(2):125-31.
Over the last two decades, antimicrobial resistance in Streptococcus pneumoniae has been detected at an increasing rate. There have been several reports of increasing rate of macrolide resistance among the penicillin-resistant S. pneumoniae strains. The rapid evolution of such resistance necessitated new antimicrobials, such as streptogramins, oxazolidinones and ketolides, against beta-lactam and macrolide resistant pneumococci. This study was undertaken to determine the prevalence of macrolide resistance in pneumococci isolated in a Turkish University hospital and also to determine the activity of these newly developed agents against pneumococci. For that purpose a total of 264 pneumococci, isolated from clinical specimens, were tested for susceptibility against penicillin, erythromycin, clarithromycin, clindamycin, quinupristin/dalfopristin, linezolid and telithromycin by agar dilution method. Penicillin resistance and intermediate penicillin resistance was found in 7.6% and 40% of isolates respectively, while resistance rates of the tested isolates against erythromycin, clarithromycin and clindamycin were as 15.9%, 13.6% and 13.6%, respectively. Resistance to macrolides and clindamycin was higher among the penicillin-resistant isolates. No resistance was detected against quinupristin/dalfopristin, linezolid and telithromycin, except for four strains which had minimal inhibitory concentration (MIC) values of intermediately susceptible category to quinupristin/dalfopristin. These data indicate the presence of an important percentage of macrolide resistant pneumococci in our hospital. It can also be concluded that streptogramins, oxazolidinones and ketolides may be used as good alternatives especially in case of infections due to macrolide resistant pneumococci.
在过去二十年中，肺炎链球菌的抗菌药物耐药性检出率不断上升。有几份报告指出，耐青霉素肺炎链球菌菌株中的大环内酯类耐药率在上升。这种耐药性的快速演变使得有必要研发新的抗菌药物，如链阳菌素、恶唑烷酮和酮内酯，以对抗对β-内酰胺类和大环内酯类耐药的肺炎球菌。本研究旨在确定在一家土耳其大学医院分离出的肺炎球菌中大环内酯类耐药性的流行情况，并确定这些新研发药物对肺炎球菌的活性。为此，采用琼脂稀释法对从临床标本中分离出的总共264株肺炎球菌进行了青霉素、红霉素、克拉霉素、克林霉素、奎奴普丁/达福普汀、利奈唑胺和泰利霉素的药敏试验。分别在7.6%和40%的分离株中发现了青霉素耐药和中度青霉素耐药，而受试分离株对红霉素、克拉霉素和克林霉素的耐药率分别为15.9%、13.6%和13.6%。耐青霉素分离株中对大环内酯类和克林霉素的耐药性更高。除了四株对奎奴普丁/达福普汀的最低抑菌浓度（MIC）值处于中度敏感范围的菌株外，未检测到对奎奴普丁/达福普汀、利奈唑胺和泰利霉素的耐药性。这些数据表明我们医院存在相当比例的大环内酯类耐药肺炎球菌。还可以得出结论，链阳菌素、恶唑烷酮和酮内酯尤其在由大环内酯类耐药肺炎球菌引起的感染情况下可作为良好的替代药物。
