Department of Laboratory Medicine, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Department of Emergency, Huashan Hospital, Fudan University, Shanghai, China.
Pediatr Pulmonol. 2020 Aug;55(8):2135-2141. doi: 10.1002/ppul.24877. Epub 2020 Jun 7.
Streptococcus pneumoniae is a major cause of bacterial infection among infants and young children with high morbidity and mortality. The serotype distribution of S. pneumoniae varies with geography, time, age, and disease.
We aimed to investigate the current status of molecular characteristics of S. pneumoniae strains isolated from pediatric patients in Shanghai, China.
Between 2016 and 2018, 73 clinical S. pneumoniae isolates were characterized by capsular serotype, multilocus sequence typing, antibiotic susceptibility, and resistant genes.
The most common serotypes were 19F (39.7%), 19A (16.4%), 6A (11.0%), 14 (9.6%), and 6B (8.2%). The coverage rates of the 7-, 10- and 13-valent pneumococcal conjugate vaccines were 64.4%, 64.4%, and 91.8%, respectively. The five predominant sequence types were ST271 (37.0%), ST320 (19.2%), ST3173 (11.0%), ST876 (6.8%), and ST81 (4.1%), which were mainly associated with serotypes 19F, 19A, 6A, 14, and 23F, respectively. The rates of resistance to penicillin and ceftriaxone were 21.9% and 39.7%, respectively. All strains displayed resistance to macrolides, 54.8% of which possessed both erm(B) and mef(A/E) genes, and 41.1% carried the erm(B) gene alone. Tn2010 (41.1%) was the most common transposon.
Clonal complex 271 (Taiwan19F-14 clone) played a dominant role in the dissemination of pneumococcal isolates. The prevalent serotypes indicated a lack of the 7-valent pneumococcal conjugate vaccine, which has not been included in national immunization programs in mainland China. The high rate of macrolide resistance made the empirical use of macrolides alone not suitable for treating pediatric pneumococcal disease.
肺炎链球菌是导致婴幼儿细菌感染的主要原因，发病率和死亡率较高。肺炎链球菌的血清型分布因地理位置、时间、年龄和疾病而异。
我们旨在研究中国上海地区儿童患者分离的肺炎链球菌株的分子特征现状。
2016 年至 2018 年，对 73 株临床分离的肺炎链球菌进行荚膜血清型、多位点序列分型、抗生素敏感性和耐药基因分析。
最常见的血清型为 19F（39.7%）、19A（16.4%）、6A（11.0%）、14（9.6%）和 6B（8.2%）。7、10 和 13 价肺炎球菌结合疫苗的覆盖率分别为 64.4%、64.4%和 91.8%。五个主要序列型为 ST271（37.0%）、ST320（19.2%）、ST3173（11.0%）、ST876（6.8%）和 ST81（4.1%），分别与血清型 19F、19A、6A、14 和 23F 相关。青霉素和头孢曲松的耐药率分别为 21.9%和 39.7%。所有菌株均对大环内酯类药物耐药，54.8%的菌株同时携带 erm(B)和 mef(A/E)基因，41.1%的菌株单独携带 erm(B)基因。Tn2010（41.1%）是最常见的转座子。
克隆复合体 271（台湾 19F-14 克隆）在肺炎链球菌分离株的传播中发挥主导作用。流行的血清型表明缺乏未包含在中国大陆国家免疫规划中的 7 价肺炎球菌结合疫苗。大环内酯类药物耐药率高，表明经验性单独使用大环内酯类药物不适合治疗儿童肺炎球菌病。
