Felmingham D, Farrell D J, Reinert R R, Morrissey I
GR Micro Ltd, London, UK.
J Infect. 2004 Jan;48(1):39-55. doi: 10.1016/s0163-4453(03)00140-3.
To determine the susceptibility of bacterial respiratory tract pathogens, isolated from children (0-12 years) as part of the global PROTEKT surveillance study (1999-2000), to a range of antibacterials, including the ketolide telithromycin.
Minimum inhibitory concentrations of the antibacterials studied were determined at a central laboratory using the NCCLS microdilution broth method. Macrolide resistance mechanisms were detected by PCR.
Of 779 Streptococcus pneumoniae isolates worldwide, 43% were non-susceptible to penicillin (18% intermediate; 25% resistant) and 37% were resistant to erythromycin, with considerable intercountry variation. Eighteen per cent of 653 Haemophilus influenzae and >90% of 316 Moraxella catarrhalis isolates produced beta-lactamase. Of 640 Streptococcus pyogenes isolates, 10% were resistant to erythromycin, with considerable intercountry variation. All S. pneumoniae and 99.8% of H. influenzae isolates were susceptible to telithromycin using breakpoints proposed to the NCCLS (<or=1 and <or=4 mg/L, respectively). All M. catarrhalis and 97% of S. pyogenes and isolates were susceptible to <or=1 mg/L telithromycin.
Antibacterial resistance complicates the empirical treatment of respiratory tract infections in children and requires continued monitoring. Telithromycin may be a useful therapeutic alternative as it is highly active against strains exhibiting various resistance phenotypes.
作为全球PROTEKT监测研究（1999 - 2000年）的一部分，确定从0至12岁儿童中分离出的细菌性呼吸道病原体对包括酮内酯类药物泰利霉素在内的一系列抗菌药物的敏感性。
在一个中心实验室采用美国国家临床实验室标准化委员会（NCCLS）微量稀释肉汤法测定所研究抗菌药物的最低抑菌浓度。通过聚合酶链反应（PCR）检测大环内酯类耐药机制。
在全球779株肺炎链球菌分离株中，43%对青霉素不敏感（18%为中介；25%为耐药），37%对红霉素耐药，国家间差异显著。在653株流感嗜血杆菌分离株中，18%产生β-内酰胺酶，在316株卡他莫拉菌分离株中，>90%产生β-内酰胺酶。在640株化脓性链球菌分离株中，10%对红霉素耐药，国家间差异显著。按照向NCCLS提议的断点（分别为≤1mg/L和≤4mg/L），所有肺炎链球菌和99.8%的流感嗜血杆菌分离株对泰利霉素敏感。所有卡他莫拉菌以及97%的化脓性链球菌分离株对≤1mg/L泰利霉素敏感。
抗菌药物耐药性使儿童呼吸道感染的经验性治疗变得复杂，需要持续监测。泰利霉素可能是一种有用的治疗选择，因为它对表现出各种耐药表型的菌株具有高度活性。
