Doyle M G, Morrow A L, Van R, Pickering L K
Department of Pediatrics, University of Texas Medical School, Houston.
Pediatr Infect Dis J. 1992 Oct;11(10):831-5. doi: 10.1097/00006454-199210000-00005.
This study was performed to determine the prevalence, serotypes and antibiotic susceptibility patterns of penicillin-resistant Streptococcus pneumoniae in children younger than 3 years of age in day-care centers in Houston, TX. Nasopharyngeal cultures were obtained on two occasions, in March and May, 1989, from 140 children in 4 day-care centers. All penicillin-resistant S. pneumoniae organisms isolated in this study had minimum inhibitory concentrations to penicillin of between 0.1 and 0.5 microgram/ml and were thus intermediately resistant. No highly resistant S. pneumoniae (minimum inhibitory concentration > or = 1.0 microgram/ml) was isolated in this study. Nasal carriage of S. pneumoniae occurred in 39% of children; carriage of intermediately resistant S. pneumoniae occurred in 4% of children. Of the 39% of children who carried S. pneumoniae, 11% carried intermediately resistant strains. In one day-care center with a prior history of intermediately resistant S. pneumoniae (Center 1), the prevalence of intermediate penicillin resistance was significantly (P = 0.047) higher than in the other three centers. Among children surveyed twice 15% of Center 1 children carried an intermediately penicillin-resistant strain at least once, whereas in the other centers 3% of children carried an intermediately resistant strain at least once. Sixty-two percent of intermediately penicillin-resistant strains were resistant to multiple antibiotics and all were serotype 14. Intermediately penicillin-resistant S. pneumoniae isolates were prevalent among young children in day-care centers in Houston and may persist in some day-care centers and become endemic.
本研究旨在确定德克萨斯州休斯顿市日托中心3岁以下儿童中耐青霉素肺炎链球菌的流行情况、血清型及抗生素敏感性模式。1989年3月和5月，从4个日托中心的140名儿童中两次采集鼻咽部培养物。本研究中分离出的所有耐青霉素肺炎链球菌菌株对青霉素的最低抑菌浓度在0.1至0.5微克/毫升之间，因此为中度耐药。本研究未分离出高度耐药的肺炎链球菌（最低抑菌浓度≥1.0微克/毫升）。39%的儿童鼻腔携带肺炎链球菌；4%的儿童携带中度耐药的肺炎链球菌。在携带肺炎链球菌的39%儿童中，11%携带中度耐药菌株。在一个既往有中度耐药肺炎链球菌病史的日托中心（中心1），中度青霉素耐药的发生率显著高于其他三个中心（P = 0.047）。在接受两次调查的儿童中，中心1有15%的儿童至少有一次携带中度耐青霉素菌株，而在其他中心，3%的儿童至少有一次携带中度耐药菌株。62%的中度耐青霉素菌株对多种抗生素耐药，且均为14型。中度耐青霉素肺炎链球菌分离株在休斯顿市日托中心的幼儿中普遍存在，可能在一些日托中心持续存在并成为地方病。
