Koutouzis Emmanouil I, Michos Athanasios, Koutouzi Foteini I, Chatzichristou Panagiota, Parpounas Konstantinos, Georgaki Angeliki, Theodoridou Maria, Tsakris Athanasios, Syriopoulou Vassiliki P
From the *First Department of Pediatrics, †Department of Otolaryngology Head and Neck Surgery, ‡Department of Clinical Microbiology, Aghia Sophia Children's Hospital, University of Athens, Athens, Greece; and §Department of Microbiology, Medical School, University of Athens, Athens, Greece.
Pediatr Infect Dis J. 2016 Mar;35(3):292-6. doi: 10.1097/INF.0000000000000995.
To determine whether serotype distribution and antibiotic resistance of Streptococcus pneumoniae acute mastoiditis (AM) in children have changed in the post pneumococcal conjugate vaccines (PCVs) era.
Medical records of pneumococcal AM cases, in a tertiary pediatric hospital were reviewed from January 1999 to December 2014. S. pneumoniae isolates were serotyped using the quellung reaction and tested for antibiotic susceptibility by E-test and for macrolide resistance genes by polymerase chain reaction.
Among 334 children with AM, S. pneumoniae was isolated from 89 (26.6%) with median age 22 months (interquartile range: 12-30 months). S. pneumoniae was recovered from ear fluid (58%), mastoid specimens (35.2%) and blood (6.8%). Resistance to penicillin, erythromycin and clindamycin was 12.4%, 49.4% and 18%, respectively. Distribution of pneumococcal serotypes before (1999-2005), after the introduction of PCV7 (2006-2010) and after PCV13 (2011-2014) was found: for the PCV7 serotypes 81%, 25% and 0% (P < 0.0001), for PCV13 additional serotypes 16.3%, 70.8% and 63.6% (P < 0.0001) and for non-PCV serotypes 2.3%, 4.1% and 36.3% (P = 0.0002), respectively. Significant increase was detected for the serotype 19A after PCV7, and this trend was not changed after PCV13 (2.3%, 50% and 50%, respectively; P < 0.0001). A significant proportion of resistant isolates to penicillin (54.5%) and erythromycin (34.8%) was identified as 19A.
After the introduction of PCV7, a significant increase of serotype 19A and replacement of PCVs serotypes was identified. After PCV13, the overall proportion of pneumococcal mastoiditis and the incidence of serotype 19A were not significantly declined. A significant proportion of resistant isolates to penicillin and erythromycin is attributed to serotype 19A.
确定在肺炎球菌结合疫苗（PCV）时代，儿童肺炎链球菌急性乳突炎（AM）的血清型分布及抗生素耐药性是否发生了变化。
回顾了1999年1月至2014年12月一家三级儿科医院中肺炎球菌性AM病例的病历。采用荚膜肿胀反应对肺炎链球菌分离株进行血清分型，通过E试验检测抗生素敏感性，并通过聚合酶链反应检测大环内酯类耐药基因。
在334例AM患儿中，89例（26.6%）分离出肺炎链球菌，中位年龄22个月（四分位间距：12 - 30个月）。肺炎链球菌从耳液（58%）、乳突标本（35.2%）和血液（6.8%）中分离得到。对青霉素、红霉素和克林霉素的耐药率分别为12.4%、49.4%和18%。发现肺炎球菌血清型在引入PCV7之前（1999 - 2005年）、引入PCV7之后（2006 - 2010年）和引入PCV13之后（2011 - 2014年）的分布情况：对于PCV7血清型分别为81%、25%和0%（P < 0.0001），对于PCV13额外血清型分别为16.3%、70.8%和63.6%（P < 0.0001），对于非PCV血清型分别为2.3%、4.1%和36.3%（P = 0.0002）。在PCV7之后检测到19A血清型显著增加，且在PCV13之后这一趋势未改变（分别为2.3%、50%和50%；P < 0.0001）。相当比例的对青霉素（54.5%）和红霉素（34.8%）耐药的分离株被鉴定为19A血清型。
引入PCV7后，鉴定出19A血清型显著增加且PCV血清型被替代。引入PCV13后，肺炎球菌性乳突炎的总体比例和19A血清型的发病率并未显著下降。相当比例的对青霉素和红霉素耐药的分离株归因于19A血清型。
