Dias R, Caniça M
Antibiotic Resistance Unit, Centre of Bacteriology, National Institute of Health, Dr Ricardo Jorge, Lisbon, Portugal.
Epidemiol Infect. 2008 Jul;136(7):928-39. doi: 10.1017/S0950268807009405. Epub 2007 Aug 16.
Antimicrobial resistance of pneumococci is influenced by serotypes, antimicrobial consumption and vaccine use. Serotyping of 697 out of 1331 pneumococcal isolates, recovered in Portugal from 1994 to 2004, showed that the theoretical rate of heptavalent conjugate vaccine coverage was 91.7% and 63.6% for penicillin and erythromycin non-susceptible strains, respectively, in children up to 1 year old. The use of amoxicillin and erythromycin decreased in the vaccine period 2001-2004 (P=0.04 and P<0.01, respectively) but azithromycin usage increased in the same period (P<0.01). By using linear regression models, we evaluated the role of antimicrobial and vaccine use in the trends of resistance to penicillin and erythromycin among the isolates. The models suggest that the use of macrolides was the main factor associated with an increase of penicillin and erythromycin non-susceptible isolates from adults (P<0.01) and erythromycin non-susceptible isolates among children (P=0.006). These models also suggest that heptavalent vaccine is failing to reduce antimicrobial resistance as expected, possibly due to the increased consumption of azithromycin (P=0.04). The efficient use of new antibiotics may reverse the present trends of antimicrobial resistance.
肺炎球菌的耐药性受血清型、抗菌药物使用及疫苗接种的影响。1994年至2004年在葡萄牙分离出的1331株肺炎球菌中，对其中697株进行血清分型，结果显示，对于1岁以下儿童中对青霉素和红霉素不敏感的菌株，七价结合疫苗的理论覆盖率分别为91.7%和63.6%。在2001 - 2004年疫苗接种期间，阿莫西林和红霉素的使用量下降（P分别为0.04和P<0.01），但同期阿奇霉素的使用量增加（P<0.01）。通过线性回归模型，我们评估了抗菌药物使用和疫苗接种在分离菌株对青霉素和红霉素耐药性趋势中的作用。模型表明，大环内酯类药物的使用是导致成人中对青霉素和红霉素不敏感分离菌株增加（P<0.01）以及儿童中对红霉素不敏感分离菌株增加（P = 0.006）的主要因素。这些模型还表明，七价疫苗未能如预期那样降低抗菌药物耐药性，可能是由于阿奇霉素使用量增加所致（P = 0.04）。有效使用新型抗生素可能会扭转当前抗菌药物耐药性的趋势。
