Abdelnour Arturo, Soley Carolina, Guevara Silvia, Porat Nurith, Dagan Ron, Arguedas Adriano
Instituto de Atención Pediátrica, San José, Costa Rica.
BMC Pediatr. 2009 Aug 14;9:52. doi: 10.1186/1471-2431-9-52.
After the introduction of the seven valent-pneumococcal conjugated vaccine into our National Immunization Program, it is important to establish and track local serotype distribution in order to evaluate its impact specially because serotype replacement phenomena has been described.To describe the clinical, epidemiological and antimicrobial resistance patterns of Costa Rican children with otitis media caused by Streptococcus pneumoniae serotype 3.
Middle ear fluid samples were obtained from Costa Rican children with otitis media who participated in various antimicrobial clinical trials between 1992 and 2007. Streptococcus pneumoniae was identified according to laboratory standard procedures. Strains were serotyped and antimicrobial susceptibility to penicillin, amoxicillin, cefuroxime, ceftriaxone, azithromycin and levofloxacin was determined by E-test.
Throughout 1992-2007 a total of 1919 tympanocentesis were performed in children with otitis media (median age: 19 months) and yielded a total of 1208 middle ear isolates. The most common pathogens were: Streptococcus pneumoniae, 511 isolates (49%); Non-Typable Haemophilus influenzae, 386 isolates (37%); Moraxella catarrahalis, 100 isolates (9.5%); and Streptococcus pyogenes, 54 isolates (5%). Streptococcus pneumoniae serotyping was performed in 346/511 isolates (68%) recovered during years 1999-2006. The most common serotypes were 19F (101/30.0%), 14 (46/13.7%), 3 (34/10.1%), 6B (30/8.9%) and 23F (23/6.8%). Analysis performed per years showed a higher prevalence of serotype 3 Streptococcus pneumoniae during the study period 2004 and 2005. During the entire study period (1999-2006) serotype 3 was most commonly isolated in children older than 24 months (61.2% vs 40.6%;P = 0.05) and showed a lower rate of penicillin non-susceptibility (4.0% vs 18%; P = 0.003).
Streptococcus pneumoniae serotype 3 is an important pathogen in Costa Rican children with otitis media, especially in children older than 24 months of age (P = 0.05). Most serotype 3 isolates were susceptible to penicillin, cephalosporins, macrolides and quinolones.
在我国国家免疫规划中引入七价肺炎球菌结合疫苗后，确定并追踪当地血清型分布以评估其影响非常重要，特别是因为已经描述了血清型替换现象。描述由肺炎链球菌3型引起的哥斯达黎加中耳炎患儿的临床、流行病学和抗菌药物耐药模式。
从1992年至2007年期间参加各种抗菌药物临床试验的哥斯达黎加中耳炎患儿中获取中耳液样本。根据实验室标准程序鉴定肺炎链球菌。对菌株进行血清分型，并通过E试验测定对青霉素、阿莫西林、头孢呋辛、头孢曲松钠、阿奇霉素和左氧氟沙星的抗菌药物敏感性。
在1992年至2007年期间，共对中耳炎患儿进行了1919次鼓膜穿刺术（中位年龄：19个月），共获得1208株中耳分离株。最常见的病原体为：肺炎链球菌，511株（49%）；不可分型流感嗜血杆菌，386株（37%）；卡他莫拉菌，100株（9.5%）；化脓性链球菌，54株（5%）。对1999年至2006年期间分离出的346/511株（68%）肺炎链球菌进行了血清分型。最常见的血清型为19F（101/30.0%）、14（46/13.7%）、3（34/10.1%）、6B（30/8.9%）和23F（23/6.8%）。按年份进行的分析显示，在2004年和2005年的研究期间，肺炎链球菌3型的患病率较高。在整个研究期间（1999年至2006年），3型血清型在24个月以上儿童中最常分离到（61.2%对40.6%；P=0.05），并且青霉素不敏感率较低（4.0%对18%；P=0.003）。
肺炎链球菌3型是哥斯达黎加中耳炎患儿的重要病原体，尤其是在24个月以上的儿童中（P=0.05）。大多数3型血清型分离株对青霉素、头孢菌素、大环内酯类和喹诺酮类敏感。
