Saha Samir K, Baqui Abdullah H, Darmstadt Gary L, Ruhulamin M, Hanif Mohammed, El Arifeen Shams, Santosham Mathuram, Oishi Kazunori, Nagatake Tsuyoshi, Black Robert E
Department of Microbiology, Dhaka Shishu (Children) Hospital, Bagladesh Institute of Child Health, Dhaka, Bangladesh.
J Clin Microbiol. 2003 Dec;41(12):5582-7. doi: 10.1128/JCM.41.12.5582-5587.2003.
The nasopharyngeal carriage of Streptococcus pneumoniae is thought to pose a risk for invasive pneumococcal diseases, and the evaluation of carriage strains is thus often used to inform antibiotic treatment and vaccination strategies for these diseases. In this study, the age-specific prevalences, resistance to antibiotics, and serotype distributions of 1,340 carriage strains were analyzed and compared to 71 pneumococcal strains isolated from the cerebrospinal fluid of children under 5 years old with meningitis. Overall, the nasal carriage rate was 47%. One-fourth (26%) of the infants under 1 month of age and one-half (48%) of the infants under 12 months of age were colonized with S. pneumoniae. Rural children were colonized earlier than those from urban areas. Approximately one-fourth and one-half of the cases of pneumococcal meningitis occurred in the first 3 and 6 months of life, respectively. The respective rates of resistance for carriage and meningitis strains to penicillin (7 and 3%), cotrimoxazole (77 and 69%), and erythromycin (2 and 1%) were similar, whereas chloramphenicol resistance was lower among carriage strains (3%) than among meningitis strains (15.5%). The predominant serogroups of carriage and invasive isolates were variable and widely divergent. Thus, hypothetical 7-, 9-, and 11-valent vaccines, based on the predominant carriage strains of the present study, would cover only 23, 26, and 30%, respectively, of the serotypes causing meningitis. Further, currently available 7-, 9-, and 11-valent vaccines would protect against only 26, 43, and 48%, respectively, of these meningitis cases. In conclusion, while the surveillance of carriage strains for resistance to antibiotics appears useful in the design of empirical treatment guidelines for invasive pneumococcal disease, data on the serotypes of carriage strains have limited value in vaccine formulation strategies, particularly for meningitis cases.
肺炎链球菌的鼻咽部携带被认为是侵袭性肺炎球菌疾病的一个风险因素，因此对携带菌株的评估常常被用于为这些疾病的抗生素治疗和疫苗接种策略提供依据。在本研究中，分析了1340株携带菌株的年龄特异性患病率、抗生素耐药性和血清型分布，并与从5岁以下患脑膜炎儿童的脑脊液中分离出的71株肺炎球菌菌株进行了比较。总体而言，鼻腔携带率为47%。1个月以下婴儿中有四分之一（26%）以及12个月以下婴儿中有一半（48%）被肺炎链球菌定植。农村儿童比城市儿童更早被定植。分别约有四分之一和一半的肺炎球菌脑膜炎病例发生在生命的前3个月和6个月。携带菌株和脑膜炎菌株对青霉素（7%和3%）、复方新诺明（77%和69%）以及红霉素（2%和1%）的耐药率相似，而携带菌株中氯霉素耐药率（3%）低于脑膜炎菌株（15.5%）。携带菌株和侵袭性分离株的主要血清群各不相同且差异很大。因此，基于本研究中主要的携带菌株的假设性7价、9价和11价疫苗分别仅能覆盖引起脑膜炎的血清型的23%、26%和30%。此外目前可用的7价、9价和11价疫苗分别仅能预防这些脑膜炎病例的26%、43%和48%。总之，虽然对携带菌株的抗生素耐药性监测在侵袭性肺炎球菌疾病经验性治疗指南的制定中似乎有用，但携带菌株血清型的数据在疫苗配方策略中的价值有限，尤其是对于脑膜炎病例。
