Department of Laboratory Medicine, Shengjing Hospital of China Medical University, Liaoning Clinical Research Center for Laboratory Medicine, Shenyang, China.
Microbiol Spectr. 2022 Oct 26;10(5):e0054622. doi: 10.1128/spectrum.00546-22. Epub 2022 Aug 8.
Due to the resistance of Streptococcus pneumoniae to β-lactams, macrolides, and tetracyclines, treatment alternatives have become increasingly limited worldwide. We aim to describe the characterization of erythromycin-resistant S. pneumoniae (ERSP) strains in northeastern China over a period of 20 years. A total of 1,240 ERSP strains were collected and classified into five groups based on the ages of the patients. Etest strips and Kirby-Bauer disk diffusion were performed for drug susceptibility testing. The capsule swelling test was used for capsule typing. The phenotype of drug resistance was detected by the erythromycin and clindamycin double-disk method. The , , , and genes were detected by PCR. Among the 1,240 ERSP strains, 510 were invasive isolates, and 730 were noninvasive isolates. The results of drug susceptibility testing showed that the rates of resistance to penicillin, amoxicillin, cefotaxime, ceftriaxone, meropenem, tetracycline, trimethoprim-sulfamethoxazole, and chloramphenicol varied among the different age groups. 19F, 19A, 23F, 14, and 6B were the serotypes that were commonly found among ERSP strains. Among all strains, 99.03% (1,228/1,240) exhibited an MLSB (macrolide-lincosamide-streptogramin B) resistance phenotype, of which 1,221 strains displayed a constitutive MLSB (cMLSB) phenotype and 7 strains showed an inducible MLSB (iMLSB) phenotype. All of these strains carried the gene. In contrast, only 0.97% of strains of M phenotypes were found to carry the gene. Both the and genes were detected in 704 strains that exhibited multidrug resistance, whereas the gene was not detected. Furthermore, 1,185 tetracycline-resistant strains were found to carry the gene. Macrolide antimicrobial drugs should be used cautiously for the empirical treatment of S. pneumoniae infections. This study presents a retrospective analysis using 1,240 clinical erythromycin-resistant Streptococcus pneumoniae (ERSP) isolates collected in northeastern China between January 2000 and December 2019. The serotype distribution, corresponding vaccine coverage, as well as resistance phenotypes, genes, and mechanisms to macrolide and tetracycline of these isolates were systematically described, analyzed, and discussed. We hope that this study will inform clinicians in their respective regions when selecting antimicrobial agents. We also hope that this study is useful for researchers in related fields. Finally, we emphasize in this study that vaccination is the best preventive measure for S. pneumoniae infection considering its resistance to commonly used antibiotics. The determination of the S. pneumoniae serotype distribution also provides valuable empirical evidence for local health authorities when introducing appropriate vaccines in a specific area.
由于肺炎链球菌对β-内酰胺类、大环内酯类和四环素类药物的耐药性，全球治疗选择变得越来越有限。我们旨在描述 20 年来中国东北地区红霉素耐药肺炎链球菌（ERSP）菌株的特征。共收集了 1240 株 ERSP 菌株，并根据患者年龄分为五组。采用 Etest 条和 Kirby-Bauer 纸片扩散法进行药敏试验。用胶囊肿胀试验进行胶囊分型。采用红霉素和克林霉素双纸片法检测耐药表型。通过 PCR 检测 、 、 、 基因。在 1240 株 ERSP 菌株中，510 株为侵袭性分离株，730 株为非侵袭性分离株。药敏试验结果显示，不同年龄组青霉素、阿莫西林、头孢噻肟、头孢曲松、美罗培南、四环素、复方磺胺甲噁唑和氯霉素的耐药率存在差异。19F、19A、23F、14 和 6B 是 ERSP 菌株中常见的血清型。在所有菌株中，99.03%（1228/1240）表现出 MLSB（大环内酯-林可酰胺-链阳菌素 B）耐药表型，其中 1221 株表现出固有 MLSB（cMLSB）表型，7 株表现出诱导性 MLSB（iMLSB）表型。所有这些菌株都携带 基因。相比之下，只有 0.97%的 M 表型菌株被发现携带 基因。表现出多药耐药性的 704 株菌株均检测到 和 基因，而 基因未检出。此外，还发现 1185 株四环素耐药株携带 基因。对于肺炎链球菌感染，应谨慎使用大环内酯类抗菌药物进行经验性治疗。本研究对 2000 年 1 月至 2019 年 12 月期间在中国东北地区收集的 1240 例临床红霉素耐药肺炎链球菌（ERSP）分离株进行了回顾性分析。系统描述、分析和讨论了这些分离株的血清型分布、相应疫苗覆盖率以及对大环内酯类和四环素类药物的耐药表型、基因和机制。我们希望本研究能够为不同地区的临床医生选择抗菌药物提供参考。我们也希望本研究对相关领域的研究人员有所帮助。最后，我们在本研究中强调，考虑到肺炎链球菌对常用抗生素的耐药性，疫苗接种是预防肺炎链球菌感染的最佳措施。肺炎链球菌血清型分布的确定也为当地卫生部门在特定地区引入合适的疫苗提供了有价值的经验证据。
