Division of Infectious Disease, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea.
Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea.
PLoS One. 2019 Jan 30;14(1):e0210520. doi: 10.1371/journal.pone.0210520. eCollection 2019.
Despite the availability of a pneumococcal National Immunization Program, which provides free PPSV23 vaccination for older adults aged ≥65 years in South Korea, pneumococcal pneumonia remains one of the most common respiratory infections, with increasing antimicrobial resistance. From January to December in 2015, all pneumococcal isolates were collected from a 1,050-bed teaching hospital in South Korea. All isolates were analyzed for serotype, genotype, and antimicrobial susceptibility. Demographic, clinical and microbiological data were compared between ceftriaxone susceptible and non-susceptible cases. Among 92 microbiologically identified pneumococcal isolates, ceftriaxone non-susceptible pneumococci (CNSP) accounted for 32 cases (34.8%). Some of these cases also showed levofloxacin resistance (25%, 8/32 isolates) and all CNSP cases were multidrug resistant. Compared to patients with ceftriaxone susceptible pneumococci (CSP), long-term care facility residents (odds ratio [OR] 7.0, 95% confidence interval [CI] 0.8-62.1) and patients with chronic lung (OR 4.1, 95% CI 1.1-15.0) and renal diseases (OR 9.1, 95% CI 1.2-70.5) were more common among those with CNSP on multivariate analysis. PPSV23-unique serotypes not included in PCV13 were more common in CNSP than in CSP (34.4% versus 13.3%, p = 0.02). Regarding genotypes, ST320 (10 cases), ST166 (7 cases) and ST8279 (3 cases) were dominant in CNSP, and ST8279 was only detected in previous long-term care facility residents. Clonal expansion and spread of CNSP strains should be monitored among patients with chronic lung/renal diseases and residents of long-term care facilities.
尽管韩国已经实施了肺炎球菌性疾病国家免疫计划，为 65 岁及以上老年人提供了免费的 23 价肺炎球菌多糖疫苗（PPSV23）接种，但肺炎球菌仍然是最常见的呼吸道感染之一，且其对抗微生物药物的耐药性也在不断增加。2015 年 1 月至 12 月，所有肺炎球菌分离株均来自韩国一家拥有 1050 张病床的教学医院。所有分离株均进行血清型、基因型和抗菌药物敏感性分析。比较了头孢曲松敏感和不敏感病例的人口统计学、临床和微生物学数据。在 92 例微生物学鉴定的肺炎球菌分离株中，头孢曲松不敏感肺炎球菌（CNSP）占 32 例（34.8%）。其中一些病例还表现出对左氧氟沙星的耐药性（25%，8/32 株），所有 CNSP 病例均为多药耐药。与头孢曲松敏感肺炎球菌（CSP）患者相比，长期护理机构居民（比值比 [OR] 7.0，95%置信区间 [CI] 0.8-62.1）和患有慢性肺部（OR 4.1，95% CI 1.1-15.0）和肾脏疾病（OR 9.1，95% CI 1.2-70.5）的患者更常见于多变量分析中的 CNSP 患者。CNSP 中更为常见的是 PPSV23 独特血清型，这些血清型未包含在 PCV13 中（34.4%比 13.3%，p = 0.02）。在基因型方面，ST320（10 例）、ST166（7 例）和 ST8279（3 例）在 CNSP 中占主导地位，而 ST8279 仅在之前的长期护理机构居民中检测到。应监测慢性肺部/肾脏疾病患者和长期护理机构居民中 CNSP 菌株的克隆扩张和传播。
