Chiou Christine C, Hseih Kai-Sheng
Department of Pediatrics, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung First Road, Kaohsiung, Taiwan.
Acta Paediatr Taiwan. 2003 Mar-Apr;44(2):67-74.
Streptococcus pneumoniae is one of the most common bacterial causes of otitis media, sinusitis, bacteremia, pneumonia and bacterial meningitis in the pediatric population. The resistance of S. pneumoniae to penicillin and other antimicrobial agents is increasing in many parts of the world. In Taiwan, extremely high prevalence (70%) of penicillin-resistant S. pneumoniae among children with nasopharyngeal carriage has been reported. The mechanism of resistance to penicillin is the alteration of penicillin binding protein (PBP) instead of the production of beta-lactamase. Thus beta-lactamase inhibitors are not the solution to the treatment of infections caused by penicillin-resistant S. pneumoniae. The adequate treatment of infections caused by penicillin-resistant S. pneumoniae should be based on (1) site of infection (2) degree of resistance. Currently, the MIC breakpoints for S. pneumoniae are divided to 2 categories; one for CNS infection and the other for non-CNS infections. For non-CNS infections caused by susceptible or intermediate S. pneumoniae, penicillin still remains the drug of choice with excellent bactericidal activity. Vancomycin should not be the first choice in treating all pneumococcal infections.
肺炎链球菌是儿科人群中耳炎、鼻窦炎、菌血症、肺炎和细菌性脑膜炎最常见的细菌病因之一。在世界许多地区，肺炎链球菌对青霉素和其他抗菌药物的耐药性正在增加。在台湾，据报道，携带鼻咽部肺炎链球菌的儿童中青霉素耐药肺炎链球菌的患病率极高（70%）。对青霉素耐药的机制是青霉素结合蛋白（PBP）的改变，而不是β-内酰胺酶的产生。因此，β-内酰胺酶抑制剂不是治疗青霉素耐药肺炎链球菌引起感染的解决方案。对青霉素耐药肺炎链球菌引起感染的适当治疗应基于（1）感染部位（2）耐药程度。目前，肺炎链球菌的最低抑菌浓度（MIC）断点分为两类；一类用于中枢神经系统感染，另一类用于非中枢神经系统感染。对于由敏感或中度肺炎链球菌引起的非中枢神经系统感染，青霉素仍然是具有出色杀菌活性的首选药物。万古霉素不应作为治疗所有肺炎球菌感染的首选药物。
