Altraja A, Naaber P, Tamm E, Meriste S, Kullamaa A, Leesik H
Department of Pulmonary Medicine, University of Tartu, Estonia.
J Chemother. 2006 Dec;18(6):603-9. doi: 10.1179/joc.2006.18.6.603.
Antimicrobial resistance among clinical isolates of Streptococcus pneumoniae (n = 49), Haemophilus influenzae (n = 66) and Moraxella catarrhalis (n = 25) from adults with community-acquired lower respiratory tract infections (CALRTI) was assessed in a national surveillance study in Southern Estonia during 2000-2003. In S. pneumoniae, no penicillin resistance and only 2.0% resistance to clarithromycin was present, although intermediate resistance to trimethoprim-sulphamethoxazole (TMP-SMX) reached 24.5%. Beta-lactamase production rate was 96.0% in M. catarrhalis, but only 3.0% in H. influenzae. Both Gram-negative strains lacked resistance to ciprofloxacin. Clarithromycin resistance was 12% in M. catarrhalis but lacking among H. influenzae (except for 18.2% intermediate resistance). Resistance to TMP-SMX was 12.0% and 24.2% in M. catarrhalis and H. influenzae, respectively. In summary, a favorable resistance pattern of the main CALRTI pathogens is preserved in Estonia to core antibacterials. Nevertheless, use of TMP-SMX in CALRTI is discouraged and clinical response should be carefully monitored, when clarithromycin is chosen against M. catarrhalis or H. influenzae.
2000年至2003年期间，在爱沙尼亚南部开展的一项全国性监测研究中，对社区获得性下呼吸道感染（CALRTI）成年患者的肺炎链球菌（n = 49）、流感嗜血杆菌（n = 66）和卡他莫拉菌（n = 25）临床分离株的抗菌药物耐药性进行了评估。在肺炎链球菌中，不存在青霉素耐药性，对克拉霉素的耐药率仅为2.0%，不过对甲氧苄啶-磺胺甲恶唑（TMP-SMX）的中介耐药率达到了24.5%。卡他莫拉菌的β-内酰胺酶产生率为96.0%，而流感嗜血杆菌仅为3.0%。两种革兰氏阴性菌对环丙沙星均无耐药性。卡他莫拉菌对克拉霉素的耐药率为12%，而流感嗜血杆菌中不存在耐药情况（除18.2%的中介耐药）。卡他莫拉菌和流感嗜血杆菌对TMP-SMX的耐药率分别为12.0%和24.2%。总之，爱沙尼亚主要CALRTI病原体对核心抗菌药物仍保持良好的耐药模式。尽管如此，不建议在CALRTI中使用TMP-SMX，当选择克拉霉素治疗卡他莫拉菌或流感嗜血杆菌感染时，应密切监测临床反应。
