Division of Bacterial Respiratory Infections, Center for Infectious Diseases, National Institute of Health, Korea Centers for Disease Control and Prevention, Seoul, Korea.
Microb Drug Resist. 2010 Jun;16(2):135-42. doi: 10.1089/mdr.2009.0114.
In total, 301 isolates of Streptococcus pneumoniae collected from patients with respiratory tract infections admitted at primary clinics during 2002-2005 were tested for multidrug-resistance (MDR) phenotypes and their serotypes in Korea. The predominant serotypes were 19F, 19A, 23F, 11A, 3, 6A, and 6B, accounting for 67.8% of all isolates. Their serotype coverage by 23-valent polysaccharide vaccine and 7-valent conjugation vaccine was 73.1% and 39.2%, respectively. For the application of Clinical and Laboratory Standards Institute's new breakpoint for penicillin, the resistance rate of penicillin was 27.9% (but the penicillin resistance was 80.4% based on the previous breakpoint for penicillin of Clinical and Laboratory Standards Institute). Actually, the full resistance rate was only 4.0% (minimum inhibitory concentration >or=8 mg/L). Resistances to erythromycin, clindamycin, and tetracycline were very high (82.9%, 79.4%, and 71.7%, respectively). Especially, 56.1% of all the isolates were MDR, defined as resistant to three or more of the following agents: penicillin, erythromycin, clindamycin, cefotaxime, tetracycline, and levofloxacin. MDR strains were relatively associated with serotypes 19F, 19A, 23F, and 11A, accounting for 58.0% of the isolates. Their serotype coverage by 23-valent polysaccharide vaccine and 7-valent conjugation vaccine was 79.5% and 45.9%, respectively. Levofloxacin, as a representative fluoroquinolone, was active against 88.2% of all MDR isolates. Of particular concern was the high prevalence of MDR pneumococci in non-PCV7 serotypes with an MDR serotype 19A, 11A, 3, and 6A being mostly responsible. It would be prudent to consider more efficient protective strategies for people at high risk for pneumococcal diseases in regions with a high prevalence of MDR pneumococci.
在韩国，2002 年至 2005 年期间，301 株从呼吸道感染患者中分离的肺炎链球菌被检测为多药耐药（MDR）表型及其血清型。主要血清型为 19F、19A、23F、11A、3、6A 和 6B，占所有分离株的 67.8%。23 价多糖疫苗和 7 价结合疫苗对其血清型的覆盖率分别为 73.1%和 39.2%。对于临床和实验室标准协会新青霉素折点的应用，青霉素的耐药率为 27.9%（但根据临床和实验室标准协会之前的青霉素折点，青霉素的耐药率为 80.4%）。实际上，完全耐药率仅为 4.0%（最低抑菌浓度>或=8mg/L）。对红霉素、克林霉素和四环素的耐药率非常高（分别为 82.9%、79.4%和 71.7%）。特别是，所有分离株中有 56.1%为多药耐药，定义为对以下三种或三种以上药物耐药：青霉素、红霉素、克林霉素、头孢噻肟、四环素和左氧氟沙星。MDR 株与血清型 19F、19A、23F 和 11A 相对相关，占分离株的 58.0%。23 价多糖疫苗和 7 价结合疫苗对其血清型的覆盖率分别为 79.5%和 45.9%。左氧氟沙星作为一种代表性的氟喹诺酮类药物，对所有 MDR 分离株的活性为 88.2%。特别值得关注的是，非 PCV7 血清型中 MDR 肺炎球菌的高流行率，其中 MDR 血清型 19A、11A、3 和 6A 是主要原因。在 MDR 肺炎球菌流行率较高的地区，考虑针对肺炎球菌疾病高危人群的更有效的保护策略是谨慎的。
