肺炎链球菌青霉素敏感性修订断点对脑膜和非脑膜肺炎球菌菌株耐药率的影响

Impact of the revised penicillin susceptibility breakpoints for Streptococcus pneumoniae on antimicrobial resistance rates of meningeal and non-meningeal pneumococcal strains.

作者信息

Al-Waili Badria R, Al-Thawadi Sahar, Hajjar Sami Al

机构信息

Department of Pediatrics, Infectious Disease Division, King Faisal Hospital & Research Centre, Riyadh 11211, Saudi Arabia.

出版信息

Ann Saudi Med. 2013 Mar-Apr;33(2):111-5. doi: 10.5144/0256-4947.2013.111.

DOI:10.5144/0256-4947.2013.111

PMID:23562996

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6078623/

Abstract

BACKGROUND AND OBJECTIVES

In January 2008, the Clinical Laboratory Standard Institute (CLSI) revised the Streptococcus pneumoniae breakpoints for penicillin to define the susceptibility of meningeal and non-meningeal isolates. We studied the impact of these changes. In addition, the pneumococcal resistance rate to other antimicrobial agents was reviewed.

DESIGN AND SETTING

Laboratory data on peumococcal isolates collected retrospectively from hospitalized children in tertiary care hospital in Riyadh, Saudi Arabia from January 2006 to March 2012.

PATIENTS AND METHODS

Only sterile samples were included from cerebrospinal fluids, blood, sterile body fluids and surgical tissue. Other samples such as sputum and non sterile samples were excluded. We included samples from children 14 years old or younger. The minimum inhibitory concentration (MIC) for penicillin, cefuroxime, ceftriaxone and meropenem were determined by using the E-test, while susceptibility to erythromycin, cotrimoxazole and vancomycin were measured using the disc diffusion methods following the guideline of CLSI.

RESULTS

Specimens were analyzed in two different periods: from January 2006 to December 2007 and from January 2008 to March 2012. During the two periods there were 208 samples of which 203 were blood samples. Full penicillin resistance was detected in 6.6% in the first period. There was decrease in penicillin nonmeningeal resistance to 1.5% and an increase in resistance in penicillin meningeal 68.2% in the second period (P=.0001). There was an increase in rate of resistance among S pneumoniae isolates over the two periods to parenteral cefuroxime, erythromycin and cotrimoxazole by 34.6%, 35.5% and 51.9%, respectively. Total meropenem resistance found 4.3% and no vancomycin resistance was detected.

CONCLUSIONS

The current study supports the use of the revised CLSI susceptibility breakpoints that promote using penicillin to treat nonmeningeal pneumococcal disease, and might slow the development of resistance to broader-spectrum antibiotics.

摘要

背景与目的

2008年1月，临床实验室标准协会（CLSI）修订了肺炎链球菌对青霉素的折点，以界定脑膜和非脑膜分离株的敏感性。我们研究了这些变化的影响。此外，还回顾了肺炎球菌对其他抗菌药物的耐药率。

设计与地点

回顾性收集2006年1月至2012年3月在沙特阿拉伯利雅得一家三级护理医院住院儿童的肺炎球菌分离株的实验室数据。

患者与方法

仅纳入来自脑脊液、血液、无菌体液和手术组织的无菌样本。排除痰液等其他样本和非无菌样本。我们纳入了14岁及以下儿童的样本。采用E-test法测定青霉素、头孢呋辛、头孢曲松和美罗培南的最低抑菌浓度（MIC），同时按照CLSI指南采用纸片扩散法测定对红霉素、复方新诺明和万古霉素的敏感性。

结果

样本在两个不同时期进行分析：2006年1月至2007年12月以及2008年1月至2012年3月。这两个时期共有208个样本，其中203个为血样。在第一个时期，检测到6.6%的菌株对青霉素完全耐药。在第二个时期，青霉素非脑膜耐药率降至1.5%，而青霉素脑膜耐药率升至68.2%（P = 0.0001）。在这两个时期，肺炎链球菌分离株对肠外头孢呋辛、红霉素和复方新诺明的耐药率分别上升了34.6%、35.5%和51.9%。发现美罗培南总耐药率为4.3%，未检测到万古霉素耐药。