Decousser J-W, Ovetchkine P, Collignon A, Chaplain C, Estrangin E, Fremaux A, Reinert P, Foucaud P, Ghnassia J-C, Cohen R, Gaudelus J, Allouch P-Y
Department of Hospital Health, Centre Hospitalier de Versailles, 177 rue de Versailles, 78157, Le Chesnay Cedex, France.
Eur J Clin Microbiol Infect Dis. 2004 Jan;23(1):27-33. doi: 10.1007/s10096-003-1032-1. Epub 2003 Dec 2.
Between January 1997 and April 2002, 73 consecutive invasive strains of Streptococcus pneumoniae were isolated from children under 16 years of age in four hospitals in suburban Paris. Their genetic diversity was investigated by serotyping and analysis of pulsed-field gel electrophoresis restriction patterns. Antibiotic susceptibility patterns were analysed by disk susceptibility testing and determination of minimal inhibitory concentrations. The genetic basis of macrolide resistance was investigated by polymerase chain reaction. Studies of penicillin and vancomycin tolerance were performed for each strain. Despite the high prevalence (45.2%) of penicillin-nonsusceptible Streptococcus pneumoniae, resistance to amoxicillin (1.4%) was rare, and no strain was resistant to cefotaxime. Overall, 4.1% of pneumococcal strains were resistant to penicillin. Penicillin or vancomycin tolerance was not detected in any of the 73 strains studied. Of the erythromycin-resistant strains (48%), all but one carried the ermB gene. No strains showing a decreased susceptibility to ciprofloxacin (MIC, >4 mg/l) or overexpressing an efflux pump inhibited by reserpine were isolated. The serotypes found, in order of frequency, were as follows: 18C, 14, 6B, 19F, 19A, 9V, 23F, 1, 7F, 9A, 38. Strains of penicillin-nonsusceptible Streptococcus pneumoniae belonged predominantly to serotypes 14, 6B, 9V, 9A, 23F, 19F and 19A. The seven-valent conjugated vaccine covered 85.5% of the serogroups isolated in children under 2 years of age and 65.6% of the serogroups identified in children over 2 years of age. The genetic analysis showed a high identity for some serotypes, such as 14/9V, 6B and 23F. The use of the seven-valent conjugated vaccine is a critical measure to prevent invasive pneumococci infections in children in the Ille de France area.
1997年1月至2002年4月期间,在巴黎郊区的四家医院中,从16岁以下儿童体内连续分离出73株肺炎链球菌侵袭性菌株。通过血清分型和脉冲场凝胶电泳限制性图谱分析对其遗传多样性进行了研究。通过纸片药敏试验和最低抑菌浓度测定分析抗生素敏感性模式。通过聚合酶链反应研究大环内酯类耐药的遗传基础。对每个菌株进行了青霉素和万古霉素耐受性研究。尽管青霉素不敏感的肺炎链球菌患病率很高(45.2%),但对阿莫西林的耐药性(1.4%)很少见,且没有菌株对头孢噻肟耐药。总体而言,4.1%的肺炎球菌菌株对青霉素耐药。在所研究的73株菌株中,未检测到青霉素或万古霉素耐受性。在耐红霉素的菌株(48%)中,除一株外均携带ermB基因。未分离出对环丙沙星敏感性降低(最低抑菌浓度,>4 mg/l)或过表达受利血平抑制的外排泵的菌株。按频率顺序发现的血清型如下:18C、14、6B、19F、19A、9V、23F、1、7F、9A、38。青霉素不敏感的肺炎链球菌菌株主要属于血清型14、6B、9V、9A、23F、19F和19A。七价结合疫苗覆盖了2岁以下儿童分离出的血清群的85.5%和2岁以上儿童鉴定出的血清群的65.6%。遗传分析显示某些血清型具有高度同一性,如14/9V、6B和23F。使用七价结合疫苗是预防法兰西岛地区儿童侵袭性肺炎球菌感染的关键措施。