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中国住院成年患者肺炎链球菌血清型分布及抗生素耐药谱:一项回顾性多中心监测研究(2018 - 2019年)

Distribution of serotypes and antibiotic resistance profiles of Streptococcus pneumoniae in hospitalized adult patients: aretrospective multicenter surveillance in China (2018-2019).

作者信息

Zhao Chunjiang, Zhang Feifei, Wang Zhanwei, Yang Shuo, Chen Hongbin, Wang Hui

机构信息

Department of Clinical Microbiology, Peking University People's Hospital, Beijing, China.

出版信息

BMC Infect Dis. 2025 Aug 5;25(1):980. doi: 10.1186/s12879-025-11377-5.

Abstract

BACKGROUND

Streptococcus pneumoniae (S. pneumoniae) remains a major cause of community acquired pneumonia (CAP), particularly among older adults. In China, pneumococcal infections pose a substantial disease burden, with rising antibiotic resistance. Although vaccines have effectively reduced disease worldwide, data on adult serotype distribution and resistance in China are scarce. This study investigates serotype patterns and antimicrobial susceptibility of S. pneumoniae among Chinese adults.

METHODS

We collected a total of 474 S. pneumoniae isolates from adult patients diagnosed with pneumococcal infections in 14 cities across five geographic regions of China between 2018 and 2019. Clinical specimens included sputum, blood, bronchoalveolar lavage fluid (BALF), cerebrospinal fluid (CSF), pharyngeal and nasal swabs, and middle ear fluid. Minimum inhibitory concentrations (MICs) of antimicrobial agents were determined using the agar dilution method. Pneumococcal serotyping was performed using the Pneumotest-Latex kit and type-specific antisera.

RESULTS

Serotype 19F was the most prevalent across all age groups, specimen types, and regions. 20-valent pneumococcal conjugate vaccine (PCV20) is expected to provide the highest serotype coverage (69.4%) among all vaccines evaluated. Multidrug resistance was detected in over 94% of isolates, with high resistance to macrolides, tetracycline, and clindamycin. β-lactam resistance varied by syndrome and region. Non-invasive isolates showed slightly higher resistance than invasive ones. Serotypes covered by higher-valency vaccines were more likely to be antibiotic-resistant, although fluoroquinolone and vancomycin resistance remained low.

CONCLUSIONS

Our findings highlight a high burden of antimicrobial resistance and predominance of specific serotypes, particularly 19F, among adult S. pneumoniae isolates in China. The broad serotype coverage of PCV20 suggests its potential advantage in future adult immunization strategies. Continued surveillance of serotype distribution and resistance patterns is essential to inform vaccine policy and guide effective antibiotic use.

摘要

背景

肺炎链球菌仍是社区获得性肺炎(CAP)的主要病因,在老年人中尤为常见。在中国,肺炎球菌感染造成了巨大的疾病负担,且抗生素耐药性不断上升。尽管疫苗已在全球有效减少了疾病发生,但中国成人血清型分布和耐药性的数据却很匮乏。本研究调查了中国成年人肺炎链球菌的血清型模式和抗菌药物敏感性。

方法

2018年至2019年期间,我们从中国五个地理区域14个城市的成年肺炎球菌感染患者中总共收集了474株肺炎链球菌分离株。临床标本包括痰液、血液、支气管肺泡灌洗液(BALF)、脑脊液(CSF)、咽拭子和鼻拭子以及中耳液。采用琼脂稀释法测定抗菌药物的最低抑菌浓度(MIC)。使用肺炎球菌检测乳胶试剂盒和型特异性抗血清进行肺炎球菌血清分型。

结果

19F血清型在所有年龄组、标本类型和地区中最为普遍。在所有评估的疫苗中,20价肺炎球菌结合疫苗(PCV20)预计能提供最高的血清型覆盖率(69.4%)。超过94%的分离株检测到多重耐药,对大环内酯类、四环素和克林霉素耐药性高。β-内酰胺类耐药性因综合征和地区而异。非侵袭性分离株的耐药性略高于侵袭性分离株。高价疫苗覆盖的血清型更有可能具有抗生素耐药性,不过氟喹诺酮类和万古霉素耐药性仍然较低。

结论

我们的研究结果突出了中国成人肺炎链球菌分离株中抗菌药物耐药性的高负担以及特定血清型(尤其是19F)的优势。PCV20广泛的血清型覆盖率表明其在未来成人免疫策略中的潜在优势。持续监测血清型分布和耐药模式对于制定疫苗政策和指导有效使用抗生素至关重要。

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