Chesney P J, Wilimas J A, Presbury G, Abbasi S, Leggiadro R J, Davis Y, Day S W, Schutze G E, Wang W C
Department of Pediatrics, University of Tennessee, Memphis, USA.
J Pediatr. 1995 Oct;127(4):526-32. doi: 10.1016/s0022-3476(95)70107-9.
We investigated the possibility that antimicrobial-resistant pneumococci were causing invasive disease in children with sickle-cell disease (SCD).
Records of all children with SCD observed at the Mid-South Sickle Cell Center (MSSCC) at LeBonheur Children's Medical Center were reviewed from January 1990 to June 1994. Children with SCD and pneumococcal sepsis were identified. The Streptococcus pneumoniae isolates from these children were examined for serotype and antimicrobial susceptibilities. Two additional children not observed in the MSSCC had pneumococcal sepsis caused by penicillin-resistant isolates and were also included.
Antimicrobial susceptibility testing of the six penicillin-resistant isolates revealed that four were resistant to trimethoprim-sulfamethoxazole, two to erythromycin, and one to clindamycin. The two isolates that were resistant to ceftriaxone also were multiply resistant. From the MSSCC, 26 children had pneumococcal sepsis during the 4 1/2-year period studied. Five of these children (19%) died. Four (15%), including one who died, were infected with penicillin-resistant strains.
Pneumococcal sepsis, meningitis, and infections of other foci in children with SCD may be caused by S. pneumoniae that is resistant to one or more antimicrobial agents, including penicillin. The addition of vancomycin to the antibiotics currently used for initial management should be considered in areas where the antibiotic resistance of S. pneumoniae is prevalent.
我们调查了耐抗菌药物肺炎球菌导致镰状细胞病（SCD）患儿侵袭性疾病的可能性。
回顾了1990年1月至1994年6月在勒邦赫尔儿童医疗中心中南镰状细胞中心（MSSCC）观察到的所有SCD患儿的记录。确定了患有SCD和肺炎球菌败血症的患儿。对这些患儿分离出的肺炎链球菌进行血清型和抗菌药物敏感性检测。另外两名未在MSSCC观察到的患儿也因耐青霉素菌株引起肺炎球菌败血症而被纳入研究。
对6株耐青霉素菌株进行的抗菌药物敏感性检测显示，4株对甲氧苄啶 - 磺胺甲恶唑耐药，2株对红霉素耐药，1株对克林霉素耐药。对头孢曲松耐药的2株菌株也具有多重耐药性。在研究的4年半期间，MSSCC有26名患儿发生肺炎球菌败血症。其中5名患儿（19%）死亡。4名患儿（15%），包括1名死亡患儿，感染了耐青霉素菌株。
SCD患儿的肺炎球菌败血症、脑膜炎和其他病灶感染可能由对一种或多种抗菌药物（包括青霉素）耐药的肺炎链球菌引起。在肺炎链球菌抗生素耐药普遍的地区，应考虑在目前用于初始治疗的抗生素中加用万古霉素。
