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拉脱维亚门诊儿童分离的 A 组乙型溶血性链球菌的大环内酯类耐药性。

Macrolide resistance in group A beta haemolytic Streptococcus isolated from outpatient children in Latvia.

机构信息

Department of Pediatrics, Riga Stradins University, Riga, Latvia.

出版信息

APMIS. 2010 May;118(5):366-70. doi: 10.1111/j.1600-0463.2010.02607.x.

Abstract

Group A streptococci (GAS) are responsible for up to 30% of cases of pharyngitis in children, and such children do not benefit from treatment with antibiotics. During the last decade, increased resistance to macrolides has emerged as a critical issue in the treatment of GAS pharyngitis. The objective of this study was to determine the antimicrobial resistance of group A beta haemolytic Streptococcus isolated from outpatient children. From 2002 to 2006, 96 GAS strains were obtained from the pharynx of outpatients having symptoms of acute pharyngitis. Antibiotic resistance was determined by disc susceptibility tests according to CLSI standards. The presence of ermA, ermB and mefA was established by the amplification of streptococcal DNA with specific primers. Antimicrobial susceptibility tests revealed that all the strains tested were sensitive to vancomycin, linezolid, penicillin and ceftriaxone. Simultaneously, high levels of resistance to macrolides were evident; 78% of the isolates were resistant to clindamycin and erythromycin. No significant change in the yearly or seasonal incidence of resistance was observed. We describe high antimicrobial resistance of GAS to macrolides in outpatient children (78%), which can be explained by the frequent use of macrolides in the treatment of such individuals. Therefore, macrolides should not be the first drug of choice.

摘要

A 组链球菌(GAS)可导致高达 30%的儿童咽炎病例,此类儿童无需接受抗生素治疗。在过去十年中,大环内酯类药物的耐药性增加已成为 GAS 咽炎治疗的一个关键问题。本研究旨在确定门诊儿童分离的 A 组β溶血性链球菌的抗菌药物耐药性。2002 年至 2006 年,从出现急性咽炎症状的门诊患者的咽部获得了 96 株 GAS 菌株。根据 CLSI 标准,通过药敏纸片扩散试验来确定抗生素耐药性。通过用特异性引物扩增链球菌 DNA 来确定 ermA、ermB 和 mefA 的存在。药敏试验结果表明,所有受试菌株均对万古霉素、利奈唑胺、青霉素和头孢曲松敏感。同时,大环内酯类药物的耐药性水平很高;78%的分离株对克林霉素和红霉素耐药。未观察到耐药性的年度或季节性变化。我们描述了门诊儿童 GAS 对大环内酯类药物的高度耐药性(78%),这可以通过此类人群经常使用大环内酯类药物治疗来解释。因此,大环内酯类药物不应作为首选药物。

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