Mališová L, Urbášková P, Jakubů V, Španělová P, Kozáková J, Musílek M, Žemličková H
Epidemiol Mikrobiol Imunol. 2019 Spring;68(2):75-81.
The purpose of the surveillance performed from October to December in 2010-2017 was to monitor the trends in the susceptibility to beta-lactam and macrolide antibiotics in Streptococcus pneumoniae isolates from respiratory tract infections in the Czech Republic.
Between 42 and 55 laboratories participated in the study every year. Consecutive non-duplicate pneumococcal isolates from relevant microbiological specimens from patients with community-acquired bacterial respiratory tract infection were sequentially included in the study. Laboratories recorded qualitative results of penicillin and erythromycin susceptibility testing; susceptibility to antibiotics was determined by the disk diffusion method. Penicillin non-susceptible and/or erythromycin resistant isolates were referred to the National Reference Laboratory for Antibiotics, where the minimum inhibitory concentration of each antibiotic was tested using the broth microdilution method, and their serotyping was performed in the National Reference Laboratory for Streptococcal Infections. Twenty-six isolates from 2017 were analysed by the multilocus sequence typing method.
In total, 7 491 pneumococcal strains were examined, of which 53.7% (4 023) were from the upper respiratory tract and 47.7% (3 573) from children under 15 years of age. Non-susceptibility to penicillin decreased from 2.6% in 2010 to 1.2% in 2017, while resistance to erythromycin increased from 7.4% to 9.7% over the same period. Penicillin non-susceptible isolates were mostly of serotypes 19A, 19F, and 15A. Macrolide resistant but penicillin susceptible isolates were predominantly represented by serotypes 19A and 3. The presence of the Taiwan19F-14 clone was confirmed in penicillin non-susceptible isolates by MLST, and the most frequently identified sequence type (ST) in macrolide resistant isolates was ST416 classified into the Netherlands15B-37 clone.
The respiratory study of antibiotic resistance in S. pneumoniae confirmed the decreasing trend of resistance to penicillin but revealed a growing resistance to macrolide antibiotics in the Czech Republic. The results of our study confirm that antibiotic resistance in the vaccination era is associated primarily with the non-vaccine serotypes, and the clonal expansion of macrolide resistant serotype 19A was apparently supported by the growing prescription of macrolide antibiotics.
2010 - 2017年10月至12月进行监测的目的是监测捷克共和国呼吸道感染患者肺炎链球菌分离株对β-内酰胺类和大环内酯类抗生素敏感性的变化趋势。
每年有42至55个实验室参与该研究。来自社区获得性细菌性呼吸道感染患者相关微生物标本的连续非重复肺炎球菌分离株依次纳入研究。实验室记录青霉素和红霉素敏感性试验的定性结果；采用纸片扩散法测定抗生素敏感性。对青霉素不敏感和/或红霉素耐药的分离株送交国家抗生素参考实验室，在那里使用肉汤微量稀释法检测每种抗生素的最低抑菌浓度，并在国家链球菌感染参考实验室进行血清分型。对2017年的26株分离株采用多位点序列分型法进行分析。
共检测了7491株肺炎球菌菌株，其中53.7%（4023株）来自上呼吸道，47.7%（3573株）来自15岁以下儿童。对青霉素的不敏感性从2010年的2.6%降至2017年的1.2%，而同期对红霉素的耐药性从7.4%升至9.7%。青霉素不敏感分离株大多为19A、19F和15A血清型。对大环内酯类耐药但对青霉素敏感的分离株主要为19A和3血清型。通过多位点序列分型在青霉素不敏感分离株中证实了Taiwan19F - 14克隆的存在，在大环内酯类耐药分离株中最常鉴定的序列型（ST）是属于Netherlands15B - 37克隆的ST416。
肺炎链球菌抗生素耐药性的呼吸道研究证实了捷克共和国对青霉素耐药性呈下降趋势，但显示对大环内酯类抗生素的耐药性在增加。我们的研究结果证实，疫苗接种时代的抗生素耐药性主要与非疫苗血清型相关，大环内酯类抗生素处方量的增加显然支持了对大环内酯类耐药的19A血清型的克隆扩张。
