Song Jae-Hoon
Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Asia Pacific Foundation for Infectious Diseases (APFID), Seoul, Korea . +82 234 100 320 +82 234 100 328
Expert Rev Respir Med. 2013 Oct;7(5):491-8. doi: 10.1586/17476348.2013.816572.
Antimicrobial resistance and serotypes in Streptococcus pneumoniae have been evolving with the widespread use of antibiotics and the introduction of pneumococcal conjugate vaccines (PCV). Particularly, among various types of antimicrobial resistance, macrolide resistance has most remarkably increased in many parts of the world, which has been reported to be >70% among clinical isolates from Asian countries. Penicillin resistance has dramatically decreased among nonmeningeal isolates due to the changes in resistance breakpoints, although resistance to other β-lactams such as cefuroxime has increased. Multidrug resistance became a serious concern in the treatment of invasive pneumococcal diseases, especially in Asian countries. After PCV7 vaccination, serotype 19A has emerged as an important cause of invasive pneumococcal diseases which was also associated with increasing prevalence of multidrug resistance in pneumococci. Widespread use of PCV13, which covers additional serotypes 3, 6A and 19A, may contribute to reduce the clonal spread of drug-resistant 19A pneumococci.
随着抗生素的广泛使用以及肺炎球菌结合疫苗（PCV）的引入，肺炎链球菌的抗菌耐药性和血清型一直在演变。特别是，在各种类型的抗菌耐药性中，大环内酯类耐药性在世界许多地区显著增加，据报道，亚洲国家临床分离株中的大环内酯类耐药率>70%。由于耐药性断点的变化，非脑膜分离株中的青霉素耐药性已大幅下降，尽管对其他β-内酰胺类药物（如头孢呋辛）的耐药性有所增加。多重耐药性成为侵袭性肺炎球菌疾病治疗中的一个严重问题，尤其是在亚洲国家。在接种PCV7疫苗后，19A血清型已成为侵袭性肺炎球菌疾病的一个重要病因，这也与肺炎球菌多重耐药性患病率的增加有关。广泛使用覆盖额外血清型3、6A和19A的PCV13可能有助于减少耐药性19A肺炎球菌的克隆传播。
