Baek Jin Yang, Kang Cheol-In, Kim So Hyun, Ko Kwan Soo, Chung Doo Ryeon, Peck Kyong Ran, Lee Nam Yong, Song Jae-Hoon
Asia Pacific Foundation for Infectious Diseases (APFID), Seoul, Republic of Korea; Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Diagn Microbiol Infect Dis. 2018 Jul;91(3):287-290. doi: 10.1016/j.diagmicrobio.2018.02.010. Epub 2018 Feb 16.
The use of fluoroquinolones to treat respiratory tract infections and pneumonia due to Streptococcus pneumoniae has affected the emergence of resistance to this class of drugs. Increasing pneumococcal resistance to levofloxacin has become a major public health concern. We investigated the prevalence and genetic characteristics of levofloxacin-nonsusceptible S. pneumoniae (LNSP) clinical isolates in Korea. A total of 43 LNSP isolates collected from a national surveillance study at 13 tertiary hospitals between 2008 and 2014 were analyzed for serotype and antimicrobial susceptibilities to 19 antimicrobial agents as well as the quinolone resistance-determining region mutation. Multilocus sequence typing was performed to investigate the genetic relatedness among LNSP isolates. All LNSP isolates (MIC, ≥4 μg/mL) exhibited multidrug-resistant or even extensively drug-resistant (XDR) phenotypes (8 isolates, 18.6%). Most LNSP isolates belonged to sequence type (ST) 8279 and its variants (16 isolates, 37.2%). ST8279 is a double-locus variant of ST156, which is identical to the pneumococcal Spain-3 international clone. The high prevalence of nonvaccine types in LNSP isolates could pose significant therapeutic challenges. A limited number of clones dominated the population of LNSP XDR isolates, and homogeneous antimicrobial resistance profiles support the possibility of clonal dissemination of LNSP. More information on the emergence and spread of these LNSP isolates is necessary in order to prevent its spread.
使用氟喹诺酮类药物治疗肺炎链球菌引起的呼吸道感染和肺炎，已影响到这类药物耐药性的出现。肺炎链球菌对左氧氟沙星耐药性的增加已成为一个主要的公共卫生问题。我们调查了韩国左氧氟沙星不敏感肺炎链球菌（LNSP）临床分离株的流行情况和基因特征。对2008年至2014年间从13家三级医院的一项全国监测研究中收集的43株LNSP分离株进行了血清型分析、对19种抗菌药物的药敏试验以及喹诺酮耐药决定区突变分析。进行多位点序列分型以研究LNSP分离株之间的基因相关性。所有LNSP分离株（最低抑菌浓度≥4μg/mL）均表现出多重耐药甚至广泛耐药（XDR）表型（8株，18.6%）。大多数LNSP分离株属于序列类型（ST）8279及其变体（16株，37.2%）。ST8279是ST156的双位点变体，与肺炎链球菌西班牙-3国际克隆相同。LNSP分离株中非疫苗型的高流行率可能带来重大的治疗挑战。少数克隆主导了LNSP XDR分离株群体，且抗菌耐药谱一致支持LNSP克隆传播的可能性。为防止这些LNSP分离株的传播，有必要获取更多关于其出现和传播的信息。
