Kristinsson K G
Laeknabladid. 1996 Jan;82(1):9-19.
Penicillin resistant and multiresistant pneumococci have become common all over the world. Pneumococci resistant to cefotaxime and ceftriaxone have only become established in the USA, Spain and South Africa, although recently such strains have been described in the UK. Resistance to cefotaxime and ceftriaxone may spread faster than penicillin resistance. With B-lactam resistant and multiresistant pneumococci, the choice of antimicrobials is reduced to a single class of antimicrobials, the glycopeptides. Penicillin resistant pneumococci were introduced in Iceland in 1988, and had gained 20% incidence in pneumococcal infections in 1993. This rapid spread was associated with serogroups 6, 19 and 23, of which serotype 6B (multiresistant) was by far the most prevalent. During this period the incidence of penicillin resistant pneumococci remained low in the other Nordic countries. Since the practice of medicine is very similar in these countries, it was important to search for epidemiological clues that would explain the difference. The following risk factors have been shown to be important in epidemiological studies conducted in Iceland: most Icelandic children attend day-care centres, where they have numerous contacts with children with respiratory tract infections during the long winter months. Antimicrobial usage was high in children attending day care centres. The popularity of the sulpha-trimethoprim combination in Iceland may also be important, as it was shown to be an independent risk factor. Total use of antimicrobial agents declined in Iceland in the years 1991-1993 following a propaganda campaign against misuse and legislative changes that increased the cost of the antimicrobials for patients. The antimicrobial use in day-care centres was significantly reduced from 1992 to 1995. In 1994 the incidence of penicillin resistant pneumococci decreased to 17% (from 20% in 1993). Hopefully reduction in antimicrobial use will continue and contribute to further lowering of resistance levels.
耐青霉素和多重耐药的肺炎球菌在全球已变得很常见。对头孢噻肟和头孢曲松耐药的肺炎球菌仅在美国、西班牙和南非出现，不过最近英国也有此类菌株的报道。对头孢噻肟和头孢曲松的耐药性可能比青霉素耐药性传播得更快。对于耐β-内酰胺和多重耐药的肺炎球菌，抗菌药物的选择只剩下一类，即糖肽类。耐青霉素的肺炎球菌于1988年传入冰岛，到1993年在肺炎球菌感染中的发病率已达20%。这种快速传播与血清群6、19和23有关，其中6B型（多重耐药）是迄今为止最普遍的。在此期间，其他北欧国家耐青霉素肺炎球菌的发病率仍然很低。由于这些国家的医疗实践非常相似，寻找能解释这种差异的流行病学线索很重要。在冰岛进行的流行病学研究表明，以下风险因素很重要：大多数冰岛儿童上日托中心，在漫长的冬季里，他们与呼吸道感染儿童有大量接触。上日托中心的儿童抗菌药物使用率很高。磺胺甲恶唑组合在冰岛很受欢迎也可能很重要，因为它被证明是一个独立的风险因素。1991 - 1993年，冰岛开展了反对滥用抗菌药物的宣传活动，并通过立法提高了患者使用抗菌药物的费用，此后抗菌药物的总使用量有所下降。1992年至1995年，日托中心的抗菌药物使用量显著减少。1994年，耐青霉素肺炎球菌的发病率降至17%（1993年为20%）。希望抗菌药物使用量的减少能持续下去，并有助于进一步降低耐药水平。
