13 价肺炎球菌结合疫苗时代后，基层医疗机构分离的儿童肺炎链球菌对常用抗生素的耐药性上升。
Rising Pneumococcal Antibiotic Resistance in the Post-13-Valent Pneumococcal Conjugate Vaccine Era in Pediatric Isolates From a Primary Care Setting.
机构信息
Center for Infectious Diseases and Immunology, Rochester General Hospital Research Institute, Rochester, New York, USA.
School of Mathematical Sciences, College of Science, Rochester Institute of Technology, Rochester, New York, USA.
出版信息
Clin Infect Dis. 2021 Mar 1;72(5):797-805. doi: 10.1093/cid/ciaa157.
BACKGROUND
Antibiotic-resistant Streptococcus pneumoniae strains may cause infections that fail to respond to antimicrobial therapy. Results reported from hospitalized patients with invasive, bacteremic infections may not be the same as those observed in a primary care setting where young children receive care for noninvasive infections. Young children experience the highest burden of pneumococcal disease. The aim of this study was to determine the antibiotic susceptibility of S. pneumoniae strains isolated from children in a primary care setting in the post-13-valent pneumococcal conjugate vaccine (PCV13) era.
METHODS
This was a prospective collection of 1201 isolates of S. pneumoniae from 2006 through 2016 in a primary care setting. Antibiotic susceptibility testing to 16 different antibiotics of 10 classes was performed. Participants were children aged 6-36 months. Nasopharyngeal swabs were obtained from patients during acute otitis media (AOM) visits and routine healthy visits. Middle ear fluid was obtained by tympanocentesis.
RESULTS
After introduction of PCV13, antibiotic susceptibility of pneumococci, especially to penicillin, initially improved largely due to disappearance of serotype 19A, included in PCV13. However, beginning in 2013, antibiotic susceptibility among pneumococcal strains began decreasing due to new serotypes not included in PCV13. In addition to reduced susceptibility to penicillin, the most recent isolates show reduced susceptibility to third-generation cephalosporins, fluoroquinolones, and carbapenems, antibiotics commonly used to treat life-threatening, invasive pneumococcal diseases.
CONCLUSIONS
In recent years, pneumococcal nasopharyngeal and AOM isolates from children exhibit reduced susceptibility to penicillin, third-generation cephalosporin, fluoroquinolone, and carbapenem antibiotics. The new strains have a different profile of resistance compared to the pre-PCV13 era.
背景
耐抗生素肺炎链球菌株可能导致对抗菌治疗无反应的感染。在接受侵入性、菌血症感染的住院患者中报告的结果可能与在初级保健环境中观察到的结果不同，在初级保健环境中，年幼的儿童接受非侵入性感染的治疗。年幼的儿童经历最高的肺炎球菌病负担。本研究的目的是确定在 13 价肺炎球菌结合疫苗（PCV13）时代后在初级保健环境中从儿童中分离出的肺炎链球菌株的抗生素敏感性。
方法
这是一项前瞻性收集了 2006 年至 2016 年期间在初级保健环境中分离的 1201 株肺炎链球菌的研究。对 10 类 16 种不同抗生素进行了抗生素敏感性测试。参与者为 6-36 月龄的儿童。在急性中耳炎（AOM）就诊和常规健康就诊期间从患者中采集鼻咽拭子。通过鼓膜切开术从中耳中获取中耳液。
结果
在 PCV13 推出后，由于包括在 PCV13 中的 19A 血清型的消失，肺炎球菌的抗生素敏感性，特别是对青霉素的敏感性最初得到了很大改善。然而，从 2013 年开始，由于 PCV13 未包括的新血清型，肺炎链球菌株的抗生素敏感性开始下降。除了对青霉素的敏感性降低外，最近的分离株还显示出对第三代头孢菌素、氟喹诺酮类和碳青霉烯类抗生素的敏感性降低，这些抗生素通常用于治疗危及生命的侵袭性肺炎球菌病。
结论
近年来，儿童鼻咽和 AOM 肺炎链球菌分离株对青霉素、第三代头孢菌素、氟喹诺酮类和碳青霉烯类抗生素的敏感性降低。与 PCV13 前时代相比，新菌株具有不同的耐药谱。
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