Skovbjerg Susann, Söderström Ann, Hynsjö Lars, Normark Birgitta Henriques, Ekdahl Karl, Åhrén Christina
Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden.
Scand J Infect Dis. 2013 Apr;45(4):279-84. doi: 10.3109/00365548.2012.734919. Epub 2012 Oct 31.
Infection caused by Streptococcus pneumoniae is the leading cause of mortality in children worldwide. The aim of this study was to determine if a noted increase in non-susceptibility to penicillin among pneumococcal clinical isolates from young children reflected a similar increase in healthy children.
During 2004-2005, before the conjugate pneumococcal vaccine was introduced in Sweden, 663 healthy children (13-24 months of age) attending 17 child health centres in Gothenburg, Sweden, were cultured for bacteria in the nasopharynx. Social factors were identified through a parental questionnaire. Pneumococcal serotypes and antibiotic resistance rates were determined. Antibiotic resistance was also monitored in 162 simultaneously obtained nasopharyngeal pneumococci isolated from clinical samples.
The healthy children frequently carried pneumococci (45%), Moraxella catarrhalis (54%), and Haemophilus influenzae (22%). The carriage rates for all these pathogens were higher in children attending day care centres compared to children staying at home (p < 0.001). The dominating pneumococcal serotypes were 6B, 19F, 23F, and 6A. Non-susceptibility to penicillin was low (4.0%) and only exceeded by that to trimethoprim-sulfamethoxazole (9.8%). Both rates were higher in the clinical isolates (9.3% and 16.7%, respectively; p < 0.05). No relationships to geographic area, day care attendance, recent antibiotic use, or travel abroad were shown for any specific serotype or for the presence of penicillin-non-susceptible pneumococci in the healthy children.
Pneumococcal resistance rates in the healthy child population were low and did not reflect the higher rates noted at the laboratory in clinical samples obtained before and during the study.
肺炎链球菌感染是全球儿童死亡的主要原因。本研究的目的是确定幼儿肺炎球菌临床分离株中对青霉素不敏感率的显著增加是否反映了健康儿童中类似的增加情况。
在2004 - 2005年期间，瑞典哥德堡17家儿童健康中心的663名健康儿童（13 - 24个月大）接受了鼻咽部细菌培养，当时瑞典尚未引入肺炎球菌结合疫苗。通过家长问卷确定社会因素，测定肺炎球菌血清型和抗生素耐药率。还对从临床样本中同时获得的162株鼻咽肺炎球菌进行了抗生素耐药监测。
健康儿童常携带肺炎球菌（45%）、卡他莫拉菌（54%）和流感嗜血杆菌（22%）。与居家儿童相比，日托中心儿童中所有这些病原体的携带率更高（p < 0.001）。主要的肺炎球菌血清型为6B、19F、23F和6A。对青霉素不敏感率较低（4.0%），仅超过对甲氧苄啶 - 磺胺甲恶唑的不敏感率（9.8%）。临床分离株中的这两种率均更高（分别为9.3%和16.7%；p < 0.05）。对于健康儿童中的任何特定血清型或青霉素不敏感肺炎球菌的存在，均未显示与地理区域、日托中心入托情况、近期抗生素使用或出国旅行有关。
健康儿童群体中的肺炎球菌耐药率较低，并未反映出在研究之前及研究期间实验室在临床样本中所观察到的较高耐药率。
