Rijal B, Tandukar S, Adhikari R, Tuladhar N R, Sharma P R, Pokharel B M, Gami F C, Shah A, Sharma A, Gaushan P, Sherchand J B, Burlakoti T, Upreti H C, Lalitha M K, Thomas K, Steinhoff M
Department of Microbiology, Medical Campus and Tribhuvan University Teaching Hospital, Maharajganj, Kathmandu, Nepal. rijal_basista@hotmail. com
Kathmandu Univ Med J (KUMJ). 2010 Apr-Jun;8(30):164-8. doi: 10.3126/kumj.v8i2.3551.
Invasive pneumococcal disease is a significant cause of morbidity and mortality worldwide and it is a major cause for childhood deaths in Nepal.
The aim of this study was to establish the antimicrobial susceptibility pattern of Streptococcus pneumoniae and perform serotype responsible for pneumococcal disease in Nepal.
All together 3774 children from 2 to 60 months who fulfilled the enrollment criteria for suspect of bacterial pneumonia, sepsis or meningitis were enrolled for etiologic studies of severe illness. During the study period 60 isolates of Streptococcus pneumoniae were isolated and the antimicrobial susceptibility testing and serotyping were performed.
The study showed that 24 (52. 17%) isolates were resistant to Cotrimoxazole, 3 (6. 5%) isolates were intermediately resistant to Penicillin but no Penicillin resistant strains were isolated. The 1 (2. 17%) isolate was recorded as Erythromycin and Chloramphenicol resistant and only 1 (2. 17%) isolate was found intermediately resistant to Cefotaxime. Of the 60 isolates, serotyping result was available only for 46 isolates. The most common serotypes were serotype 1 (27. 65%) followed by serotype 5 (19. 14%) and serotype 4 (8. 5%) respectively followed by serotype 39, 23F, 7F, 19B, 12A, 14, 18F, 6B, 32, 16, 19F and 25F.
Alarming level of Cotrimoxazole resistance demands revision of pneumonia treatment policy in Nepal and rising tendency of other drug resistance against Streptococcus pneumoniae showed use of these drugs for the treatment of meningitis, pneumonia and other serious infections needs extended research. The common serotype 1, 5 and 4 need to be incorporated in pneumococcal vaccine to immunise children in Nepal.
侵袭性肺炎球菌病是全球发病和死亡的重要原因，也是尼泊尔儿童死亡的主要原因。
本研究旨在确定尼泊尔肺炎链球菌的抗菌药物敏感性模式，并确定引起肺炎球菌病的血清型。
共有3774名年龄在2至60个月之间符合细菌性肺炎、败血症或脑膜炎疑似病例纳入标准的儿童被纳入重症疾病的病因学研究。在研究期间，分离出60株肺炎链球菌，并进行了抗菌药物敏感性测试和血清分型。
研究表明，24株（52.17%）分离株对复方新诺明耐药，3株（6.5%）分离株对青霉素中度耐药，但未分离出耐青霉素菌株。1株（2.17%）分离株对红霉素和氯霉素耐药，仅1株（2.17%）分离株对头孢噻肟中度耐药。在60株分离株中，仅46株获得了血清分型结果。最常见的血清型分别是1型（27.65%），其次是5型（19.14%）和4型（8.5%），随后是39型、23F型、7F型、19B型、12A型、14型、18F型、6B型、32型、16型、19F型和25F型。
复方新诺明耐药的惊人水平要求尼泊尔修订肺炎治疗政策，肺炎链球菌对其他药物耐药性的上升趋势表明，将这些药物用于治疗脑膜炎、肺炎和其他严重感染需要进一步研究。常见血清型1、5和4需要纳入肺炎球菌疫苗，以便为尼泊尔儿童进行免疫接种。
