岐阜县及爱知县北部地区肺炎链球菌的流行病学分析——2009年

[Epidemiological analysis of Streptococcus pneumoniae in Gifu prefecture and the northern district of Aichi prefecture--2009].

作者信息

Yamagishi Yuka, Mikamo Hiroshige, Sawamura Haruki, Suematsu Hiroyuki, Asano Yuko, Ishigo Shiomi, Hatano Masakazu, Matsubara Shigenori, Ohta Hirotoshi, Matsukawa Yoko, Saeki Hiroikazu, Mutou Toshihiro, Teraji Mayumi, Mouri Tetsuo, Kawahara Yuki, Akita Shigeki, Miyabe Takanori, Okada Masako, Terada Hiroshi, Sakuma Takashi, Morita Eri, Miyamoto Naoya, Tuchiya Yoko, Yamada Yukiji, Yamaoka Kazukiyo, Miyaki Yuki, Tanaka Kaori, Watanabe Kunitomo

机构信息

Department of Infection Control and Prevention, Aichi Medical University Hospital.

出版信息

Jpn J Antibiot. 2012 Feb;65(1):27-47.

PMID:22808692

Abstract

High pathogenicity and drug resistance of Streptococcus pneumoniae are serious problem in clinical practice. Since 1999, we have conducted epidemiologic analyses of S. pneumoniae in Chubu district. We report the results of the analysis conducted in 2009. Three hundred and eight (308) S. pneumoniae isolates with a gene coding for autolysin lyt-A, which had been isolated from patients at 21 medical institutions in Gifu prefecture and the northern part of Aichi prefecture in 2009, were enrolled in this study. The strains were classified according to their drug resistance based on the presence of the pbp mutation, and examined for the presence of the two macrolide-resistance genes, ermB and mefA. Moreover, they were serotyped using type-specific antisera. The mean age of the patients from whom these S. pneumoniae strains were isolated, was 23.4 +/- 30.1 years old, and children aged 15 years old or less accounted for 66% of all the patients. Genotype penicillin-susceptible S. pneumoniae (gPSSP), genotype penicillin-intermediate S. pneumoniae (gPISP) and genotype penicillin-resistant S. pneumoniae (gPRSP) were 22 (7.1%), 131 (42.5%) and 155 (50.3%), respectively. The strains with mefA positive and ermB negative, mefA negative and ermB positive, and mefA positive and ermB positive were 80 (26.0%), 153 (49.7%), and 47 (15.3%), respectively. The MIC90 values of tebipenem (TBPM) and faropenem were 0.06 microg/mL and 0.5 microg/mL, respectively. TBPM showed the high bactericidal activity against gPRSP. In carbapenems, panipenem and biapenem exhibited higher bactericidal activities. Quinolone-resistant S. pneumoniae (QRSP) were isolated from 10 (3.2%). QRSP dominated 5 (7.9%) and 3 (1.5%) among the elderly (over 65 years old) and children, respectively. (As for the serotype, serotypes 6, 19 and 23 were 60 (19.5%), 62 (20.1%), and 44 (14.3%), respectively. Further epidemiologic studies on S. pneumoniae might be required also in the future, including the relationship between the serotype and drug resistance.

摘要

肺炎链球菌的高致病性和耐药性是临床实践中的严重问题。自1999年以来，我们对中部地区的肺炎链球菌进行了流行病学分析。我们报告2009年的分析结果。本研究纳入了2009年从岐阜县和爱知县北部的21家医疗机构的患者中分离出的308株编码自溶素lyt - A基因的肺炎链球菌。根据pbp突变情况对菌株进行耐药性分类，并检测两种大环内酯类耐药基因ermB和mefA的存在情况。此外，使用型特异性抗血清对其进行血清分型。分离出这些肺炎链球菌菌株的患者的平均年龄为23.4±30.1岁，15岁及以下儿童占所有患者的66%。基因型青霉素敏感肺炎链球菌（gPSSP）、基因型青霉素中介肺炎链球菌（gPISP）和基因型青霉素耐药肺炎链球菌（gPRSP）分别为22株（7.1%）、131株（42.5%）和155株（50.3%）。mefA阳性且ermB阴性、mefA阴性且ermB阳性、mefA阳性且ermB阳性的菌株分别为80株（26.0%）、153株（49.7%）和47株（15.3%）。替比培南（TBPM）和法罗培南的MIC90值分别为0.06μg/mL和0.5μg/mL。TBPM对gPRSP显示出高杀菌活性。在碳青霉烯类药物中，帕尼培南和比阿培南表现出更高的杀菌活性。从10株（3.2%）中分离出喹诺酮耐药肺炎链球菌（QRSP）。QRSP在老年人（65岁以上）和儿童中分别占5株（7.9%）和3株（1.5%）。（至于血清型，血清型6、19和23分别为60株（19.5%）、62株（20.1%）和44株（14.3%）。未来可能还需要对肺炎链球菌进行进一步的流行病学研究，包括血清型与耐药性之间的关系。