Cohen Robert, Levy Corinne, de La Rocque France, Gelbert Nathalie, Wollner Alain, Fritzell Bernard, Bonnet Eric, Tetelboum Robert, Varon Emmanuelle
Service de Microbiologie, Centre Hospitalier Intercommunal de Creteil, Créteil, France.
Pediatr Infect Dis J. 2006 Nov;25(11):1001-7. doi: 10.1097/01.inf.0000243163.85163.a8.
Penicillin resistance among pneumococci has increased in the past 15 years. The implementation of widespread vaccination with the heptavalent pneumococcal conjugate vaccine (PCV7) and the reduction of inappropriate antibiotic use could help reduce antibiotic resistance.
Between September 2001 and June 2004, 89 pediatricians distributed throughout France took part in this prospective study. We obtained 1906 nasopharyngeal swabs for culture from children aged 6 to 24 months with acute otitis media (AOM). At the same time as PCV7 was introduced into the routine immunization schedule, a plan to promote judicious antibiotic use was established. We recorded the frequency of antibiotic use, as well as the dates of immunization with PCV7.
The proportion of PCV7-vaccinated children (> or =1 dose) increased from 8.2% (year 1) to 61.4% (year 3). The proportion of children who received antibiotics within 3 months before enrollment decreased from 51.8% in year 1 to 40.9% in year 3 (P < 0.001). Overall pneumococcal carriage and carriage of PCV7 serotypes decreased during the 3-year period by 16% (P < 0.001) and 35% (P < 0.001), respectively. Rates of highly penicillin resistant strains (PRP) decreased yearly: 15.4%, 10.6%, 6.7% (P < 0.001), respectively. Risks for PRP carriage were 4.2% for immunized children who had not received antibiotics, 8.6% for those vaccinated who also had received antibiotics, 10.3% for unimmunized children who had not received antibiotics, and 16.2% for unimmunized children who had received antibiotics (P < 0.001).
Implementation of PCV7, combined with a reduction in antibiotic use, in a country with a high prevalence of antibiotic-resistant pneumococci appears to have a strong impact on the carriage of penicillin nonsusceptible pneumococci in children with AOM.
在过去15年中，肺炎球菌对青霉素的耐药性有所增加。广泛接种七价肺炎球菌结合疫苗（PCV7）以及减少不适当的抗生素使用，可能有助于降低抗生素耐药性。
2001年9月至2004年6月期间，法国各地的89名儿科医生参与了这项前瞻性研究。我们从6至24个月大的急性中耳炎（AOM）患儿中获取了1906份鼻咽拭子用于培养。在将PCV7纳入常规免疫接种计划的同时，制定了一项促进合理使用抗生素的计划。我们记录了抗生素使用频率以及PCV7免疫接种日期。
接种PCV7的儿童比例（≥1剂）从第1年的8.2%增至第3年的61.4%。入组前3个月内接受抗生素治疗的儿童比例从第1年的51.8%降至第3年的40.9%（P<0.001）。在3年期间，总体肺炎球菌携带率和PCV7血清型携带率分别下降了16%（P<0.001）和35%（P<0.001）。高度耐青霉素菌株（PRP）的比例逐年下降：分别为15.4%、10.6%、6.7%（P<0.001）。未接受抗生素治疗的免疫儿童PRP携带风险为4.2%，接受过抗生素治疗的接种儿童为8.6%，未接受抗生素治疗的未免疫儿童为10.3%，接受过抗生素治疗的未免疫儿童为16.2%（P<0.001）。
在抗生素耐药肺炎球菌高发的国家，实施PCV7并减少抗生素使用，似乎对AOM患儿中青霉素不敏感肺炎球菌的携带情况有强烈影响。
