Seppälä H, Nissinen A, Järvinen H, Huovinen S, Henriksson T, Herva E, Holm S E, Jahkola M, Katila M L, Klaukka T
Antimicrobial Research Unit, National Institute of Public Health, Turku, Finland.
N Engl J Med. 1992 Jan 30;326(5):292-7. doi: 10.1056/NEJM199201303260503.
The use of erythromycin in Finland nearly tripled from 1979 to 1989. In 1988, we observed an unusually high frequency of resistance to erythromycin in group A streptococci in one geographic region. Because routine testing does not detect the sensitivity of these organisms to antibiotics, we initiated a national study to evaluate the extent of this resistance.
We studied 272 isolates of group A streptococci obtained from blood cultures from 1988 through 1990. In 1990 we collected from six regional laboratories 3087 consecutive isolates from throat swabs and 1349 isolates from pus samples. Resistance was indicated by growth on blood agar containing 2 micrograms of erythromycin per milliliter after incubation in 5 percent carbon dioxide. We also evaluated the clinical importance of erythromycin resistance in a retrospective study of consecutive patients with pharyngitis.
The frequency of resistance to erythromycin in group A streptococci from blood cultures increased from 4 percent in 1988 to 24 percent in 1990. From January to December 1990, the frequency of resistance in isolates from throat swabs increased from 7 percent to 20 percent, and resistance in isolates from pus increased from 11 percent to 31 percent. In four communities within 50 km of each other, the frequency of erythromycin resistance ranged from 2 to 5 percent to 26 to 44 percent. Several distinct DNA restriction profiles and serotypes were found among resistant isolates from the same area, suggesting a multiclonal origin. The treatment of pharyngitis with erythromycin failed in 9 of 19 patients infected with erythromycin-resistant group A streptococci, as compared with 1 of 26 patients with erythromycin-susceptible isolates (47 percent vs. 4 percent, P = 0.008).
In Finland since 1988 there has been a rapid and substantial increase in resistance to erythromycin in group A streptococci. The extent of this resistance is particularly serious since there are only a few alternative antibiotics available for peroral treatment of group A streptococcal infections.
1979年至1989年期间，芬兰红霉素的使用量几乎增长了两倍。1988年，我们在一个地理区域观察到A组链球菌对红霉素的耐药频率异常高。由于常规检测无法检测这些微生物对抗生素的敏感性，我们启动了一项全国性研究以评估这种耐药性的程度。
我们研究了1988年至1990年从血培养中获得的272株A组链球菌分离株。1990年，我们从六个区域实验室收集了3087株连续的咽拭子分离株和1349株脓液样本分离株。在含5%二氧化碳的环境中孵育后，在每毫升含2微克红霉素的血琼脂上生长表明存在耐药性。我们还在一项对连续性咽炎患者的回顾性研究中评估了红霉素耐药性的临床重要性。
血培养中A组链球菌对红霉素的耐药频率从1988年的4%增至1990年的24%。1990年1月至12月，咽拭子分离株的耐药频率从7%增至20%，脓液分离株的耐药频率从11%增至31%。在彼此相距50公里以内的四个社区，红霉素耐药频率从2%至5%到26%至44%不等。在同一地区的耐药分离株中发现了几种不同的DNA限制性图谱和血清型，提示多克隆起源。19例感染红霉素耐药A组链球菌的患者中，9例使用红霉素治疗咽炎失败，而26例感染红霉素敏感分离株的患者中1例失败（47%对4%，P = 0.008）。
自1988年以来，芬兰A组链球菌对红霉素的耐药性迅速且大幅增加。由于口服治疗A组链球菌感染的替代抗生素很少，这种耐药程度尤其严重。
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