Yenişehirli Gülgün, Sener Burçin
Hacettepe Universitesi Tip Fakültesi, Mikrobiyoloji ve Klinik Mikrobiyoloji Anabilim Dali, Ankara.
Mikrobiyol Bul. 2003 Jan;37(1):1-11.
The emergence of penicillin and multidrug resistant pneumococci has become a global concern. In this study, the in-vitro susceptibilities of 212 Streptococcus pneumoniae strains, isolated from different clinical specimens, to penicillin, erythromycin, cefaclor, cefotaxime, vancomycin, rifampin, tetracycline, chloramphenicol and ciprofloxacine were tested by agar dilution method. Penicillin resistance and intermediate penicillin resistance were found in 7.08% and 41.51% of isolates, respectively. Overall percentages of resistance to erythromycin, cefaclor, cefotaxime, rifampin, tetracycline, chloramphenicol and ciprofloxacine were 13.7%, 17.5%, 2.3%, 2.1%, 18.9%, 2.3% and 1%, respectively. Vancomycin resistance was not detected in the tested strains. All penicillin-susceptible S. pneumoniae isolates were also found to be susceptible to cefaclor, cefotaxime, chloramphenicol and ciprofloxacine. Resistance to other antimicrobial agents was higher among the penicillin-resistant group than the penicillin-susceptible one. Although high level penicillin resistance rate was low, 41.51% of pneumococci were intermediately resistant to penicillin. These results indicated that penicillin resistant S. pneumoniae isolates might probably become a major problem in the near future. Serotyping of penicillin intermediate and resistant S. pneumoniae isolates (n:103) by the capsular swelling test (Quellung reaction) revealed serotypes 19 (n:21), 23 (n:17), 9 (n:8), 14 (n:5), 6 (n:5), 3 (n:4), 15 (n:3), 8 (n:2), 1 (n:2), 20 (n:2) and serotypes 5, 10, 33, 22, 7 and 4 as single isolates. Twenty six S. pneumoniae isolates failed to be serotyped by the antisera set used. All serotype 9 pneumococci strains were found to be multidrug-resistant. Other multidrug-resistant pneumococci strains belonged to serotypes 19, 23 and nontypable group. The serotypes detected among the penicillin intermediate and resistant pneumococci in our study, are among the serotypes covered by 23-valent and 7-valent conjugated pneumococcal vaccine, indicating the possible preventive role of the vaccine against drug-resistant pneumococcal infections.
青霉素和多重耐药肺炎球菌的出现已成为全球关注的问题。在本研究中，采用琼脂稀释法检测了从不同临床标本中分离出的212株肺炎链球菌对青霉素、红霉素、头孢克洛、头孢噻肟、万古霉素、利福平、四环素、氯霉素和环丙沙星的体外敏感性。分别有7.08%和41.51%的分离株对青霉素耐药和中介耐药。对红霉素、头孢克洛、头孢噻肟、利福平、四环素、氯霉素和环丙沙星的总体耐药率分别为13.7%、17.5%、2.3%、2.1%、18.9%、2.3%和1%。在所检测的菌株中未检测到对万古霉素耐药的菌株。所有对青霉素敏感的肺炎链球菌分离株对头孢克洛、头孢噻肟、氯霉素和环丙沙星也敏感。青霉素耐药组对其他抗菌药物的耐药率高于青霉素敏感组。虽然高水平青霉素耐药率较低，但41.51%的肺炎球菌对青霉素中介耐药。这些结果表明，青霉素耐药的肺炎链球菌分离株可能在不久的将来成为一个主要问题。通过荚膜肿胀试验（Quellung反应）对103株青霉素中介和耐药的肺炎链球菌分离株进行血清分型，结果显示血清型19（21株）、23（17株）、9（8株）、14（5株）、6（5株）、3（4株）、15（3株）、8（2株）、1（2株）、20（2株）以及血清型5、10、33、22、7和4各1株。26株肺炎链球菌分离株未能用所用的抗血清进行血清分型。所有血清型9的肺炎球菌菌株均为多重耐药。其他多重耐药肺炎球菌菌株属于血清型19、23和不可分型组。在我们的研究中，在青霉素中介和耐药的肺炎球菌中检测到的血清型，属于23价和7价结合肺炎球菌疫苗所涵盖的血清型，这表明该疫苗对耐药肺炎球菌感染可能具有预防作用。
