Laboratory of Biochemical Systematics, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil.
Pediatr Infect Dis J. 2012 Jan;31(1):30-6. doi: 10.1097/INF.0b013e31822f8a92.
Here, we report a laboratory-based study of Streptococcus pneumoniae recovered from patients with meningitis in Rio de Janeiro State, Brazil.
The aim of this study was to determine the evolution of β-lactam resistance, antimicrobial susceptibility pattern, serotypes, and genetic diversity of S. pneumoniae, isolated from meningitis patients between 2000 and 2008.
A total of 264 S. pneumoniae recovered from patients between 2000 and 2008 were included. Susceptibility testing (E-test) of S. pneumoniae showed resistance to penicillin, ceftriaxone, oxacillin, cotrimoxazole, tetracycline, ofloxacin, erythromycin, chloramphenicol, and rifampicin. Penicillin resistance (PEN-R, minimal inhibitory concentration [MIC] ≥ 0.12 μg/mL) increased from 8% of isolates in 2000-2002, to 12% in 2003-2005, and to 20% in 2006-2008. Ceftriaxone resistance (MIC ≥ 1.0 μg/mL) was detected among some PEN-R isolates (13%) from 2004 onward. Within the PEN-R isolates, serotypes that are included in 10-valent pneumococcal conjugate vaccine predominated (90%), and resistance was detected mostly in isolates of serotypes 14 (61%), 23F (16%), 6B (10%), and 19F (3%). Multilocus sequence typing showed that 52% of the PEN-R isolates, and 89% of those with MICs ≥ 0.5 μg/mL, were sequence type (ST)-156 or single-locus variants of this ST (ST-557 or ST-4388); all of these isolates were serotype 14 and were assigned to the Spain-3 clone.
β-lactam resistance increased recently among cerebrospinal fluid isolates and was mainly due to the surge of the ST-4388, a previously undescribed gki single-locus variants of ST-156. Regional surveillance is shown to be essential to provide optimal antimicrobial therapy, monitor highly successful clones, and formulate adequate vaccination strategy.
本研究报告了巴西里约热内卢州脑膜炎患者分离的肺炎链球菌的实验室研究结果。
本研究旨在确定 2000 年至 2008 年间分离的脑膜炎患者的肺炎链球菌的β-内酰胺类药物耐药性演变、抗菌药物敏感性模式、血清型和遗传多样性。
共纳入 2000 年至 2008 年期间分离的 264 株肺炎链球菌。肺炎链球菌的药敏试验（E 试验）显示对青霉素、头孢曲松、苯唑西林、复方磺胺甲噁唑、四环素、氧氟沙星、红霉素、氯霉素和利福平耐药。青霉素耐药（PEN-R，最小抑菌浓度 [MIC]≥0.12μg/ml）从 2000-2002 年的 8%上升到 2003-2005 年的 12%，再到 2006-2008 年的 20%。2004 年以后，一些 PEN-R 分离株（13%）检测到头孢曲松耐药（MIC≥1.0μg/ml）。在 PEN-R 分离株中，10 价肺炎球菌结合疫苗包含的血清型占优势（90%），耐药主要发生在血清型 14（61%）、23F（16%）、6B（10%）和 19F（3%）的分离株中。多位点序列分型显示，52%的 PEN-R 分离株和 89%的 MIC≥0.5μg/ml 的分离株为血清型 14 的 ST-156 或其单一位点变异型（ST-557 或 ST-4388）；所有这些分离株均为血清型 14，属于西班牙 3 型克隆。
脑脊液分离株的β-内酰胺类药物耐药性最近有所增加，主要是由于 ST-4388 的激增，ST-4388 是以前未描述的 ST-156 的 gki 单一位点变异型。区域监测对于提供最佳抗菌治疗、监测高度成功的克隆和制定适当的疫苗接种策略非常重要。
