Welby P L, Keller D S, Cromien J L, Tebas P, Storch G A
Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63110.
Pediatr Infect Dis J. 1994 Apr;13(4):281-7. doi: 10.1097/00006454-199404000-00007.
During a 12-month period we tested all isolates of Streptococcus pneumoniae recovered from patients at St. Louis Children's Hospital for resistance to penicillin and other antibiotics. Twenty-seven (20%) of 136 had relative penicillin resistance (minimum inhibitory concentration 0.1 to 1.0 microgram/ml) and 8 (6%) were fully resistant (minimum inhibitory concentration > or = 2.0 micrograms/ml). Sixteen percent from blood and cerebrospinal fluid were resistant, compared with 30% from other body sites. The resistant isolates were of diverse serotypes and included 38% intermediate and 6% resistant to cefotaxime, 40% resistant to trimethoprim-sulfamethoxazole and 20% resistant to erythromycin. Patients with resistant isolates were more likely to have taken antibiotics of the aminopenicillin class and to be of the white race. We conclude that penicillin-resistant pneumococci, including some with resistance to third generation cephalosporins and some with multidrug resistance to non-beta-lactam antibiotics, are widespread in the St. Louis area. The presence of these stains requires reconsideration of current approaches to the antibiotic therapy of a variety of infectious diseases in which pneumococci play a prominent role.
在12个月的时间里，我们对从圣路易斯儿童医院患者身上分离出的所有肺炎链球菌菌株进行了青霉素及其他抗生素耐药性检测。136株菌株中有27株（20%）对青霉素相对耐药（最低抑菌浓度为0.1至1.0微克/毫升），8株（6%）完全耐药（最低抑菌浓度≥2.0微克/毫升）。血液和脑脊液分离株的耐药率为16%，其他身体部位分离株的耐药率为30%。耐药菌株血清型多样，其中对头孢噻肟中度耐药的占38%，耐药的占6%；对甲氧苄啶-磺胺甲恶唑耐药的占40%；对红霉素耐药的占20%。分离出耐药菌株的患者更有可能使用过氨基青霉素类抗生素，且多为白人。我们得出结论，耐青霉素肺炎球菌，包括一些对第三代头孢菌素耐药以及对非β-内酰胺类抗生素多重耐药的菌株，在圣路易斯地区广泛存在。这些菌株的出现需要重新考虑当前针对多种肺炎球菌起重要作用的传染病的抗生素治疗方法。
