Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Nobels väg 9, 171 77 Stockholm, Sweden.
BMC Infect Dis. 2010 Mar 31;10:85. doi: 10.1186/1471-2334-10-85.
Streptococcus pneumoniae is the most significant bacterial cause of community-acquired pneumonia among children under five years worldwide. Updated resistance information of S. pneumoniae among children is essential to adjust the recommendations for empirical treatment of community-acquired pneumonia, which will have immense implications for local and global health. This study investigated the prevalence of antibiotic resistance in isolated strains of S. pneumoniae and relationship with antibiotic use and demographic factors of children under five in rural Vietnam in 2007.
In Bavi district, 847 children 6 to 60 months were selected from 847 households. The main child-caregivers in the households were interviewed weekly using structured questionnaires to collect information of daily illness symptoms and drug use for the selected child over a four-week period (from March through June 2007). In the 3rd week, the children were invited for a clinical examination and to collect nasopharyngeal samples for S. pneumoniae identification. Etest and disk diffusion were used to test antibiotic susceptibility.
Of 818 participating children, 258 (32%) had ongoing respiratory infections, 421 (52%) carried S. pneumoniae, and 477 (58%) had used antibiotics within the previous three weeks. Of the 421 isolates, 95% were resistant to at least one antibiotic (401/421). Resistance to co-trimoxazole, tetracycline, phenoxymethylpenicillin, erythromycin and ciprofloxacin was 78%, 75%, 75%, 70% and 28%, respectively. Low resistance was noted for amoxicillin (4%), benzylpenicillin (4%), and cefotaxime (2%). The intermediate resistance to amoxicillin was 32%. Multidrug-resistance was seen in 60%. The most common pattern was co-resistance to co-trimoxazole, tetracycline and erythromycin. The proportion of children carrying resistant bacteria was higher among the children who had used antibiotics in the previous three weeks.
Resistance to commonly used antibiotics and multidrug-resistance of S. pneumoniae in the area is remarkably high. High-dose amoxicillin is the only investigated oral antibiotic that can possibly be used for treatment of community-acquired pneumococcal infections. Strategies to promote appropriate prescribing and dispensing of effective antibiotics should be immediately implemented for the benefit of local and global health.
肺炎链球菌是全球五岁以下儿童社区获得性肺炎的主要细菌性病因。更新肺炎链球菌的耐药信息对于调整社区获得性肺炎经验性治疗的建议至关重要，这将对当地和全球健康产生巨大影响。本研究调查了 2007 年越南农村地区五岁以下儿童分离肺炎链球菌的抗生素耐药情况及其与抗生素使用和人口统计学因素的关系。
在巴维区，从 847 户家庭中选择了 847 名 6 至 60 个月大的儿童。主要的儿童照顾者每周使用结构化问卷对家庭进行访谈，以收集所选儿童在四周内（2007 年 3 月至 6 月）的日常疾病症状和药物使用信息。在第三周，邀请儿童进行临床检查，并采集鼻咽样本以鉴定肺炎链球菌。使用 Etest 和纸片扩散法检测抗生素敏感性。
在 818 名参与研究的儿童中，258 名（32%）患有持续性呼吸道感染，421 名（52%）携带肺炎链球菌，477 名（58%）在过去三周内使用过抗生素。在 421 株分离株中，95%至少对一种抗生素耐药（401/421）。对复方新诺明、四环素、苯氧甲基青霉素、红霉素和环丙沙星的耐药率分别为 78%、75%、75%、70%和 28%。对阿莫西林（4%）、青霉素 G（4%）和头孢噻肟（2%）的耐药性较低。对阿莫西林的中介耐药率为 32%。多重耐药性为 60%。最常见的模式是对复方新诺明、四环素和红霉素的共同耐药。在过去三周内使用过抗生素的儿童携带耐药菌的比例更高。
该地区肺炎链球菌对常用抗生素的耐药率和多重耐药率均很高。高剂量阿莫西林是唯一可用于治疗社区获得性肺炎链球菌感染的研究口服抗生素。应立即实施促进合理处方和使用有效抗生素的策略，以造福当地和全球健康。
