Goldstein F W, Garau J
Medical Microbiology Laboratory, Hôpital Saint-Joseph, Paris, France.
Scand J Infect Dis Suppl. 1994;93:55-62.
The emergence of penicillin-resistant Streptococcus pneumoniae (PRSP) is an international problem which has been compounded by the development of high-level, multiple resistance to other beta-lactam antibiotics. Resistance develops in a 'step-wise' but unpredictable manner due to the mutation of penicillin-binding proteins (PBP). This results in a high degree of heterogeneity between bacterial strains. Such mutations can result in the rapid emergence of antibiotic resistance, including extended-spectrum cephalosporins, with reported minimum inhibitory concentration (MIC) values of up to 32 mg/l. The effective treatment of diseases caused by such organisms is dependent upon rapid assessment of antibiotic sensitivities. Therefore, MIC values of a range of antibiotics must be determined in cases of treatment failure and in serious pneumococcal infections. However, pharmacokinetic properties, as determined by the inhibitory quotient, which reflect drug concentrations attainable in different tissues, should also be considered. Beta-lactam antibiotics with good inhibitory activity against pneumococci include: amoxycillin, cefotaxime, ceftriaxone, cefpirome and imipenem. Nevertheless, as the prevalence of PRSP strains is likely to increase, new therapeutic strategies may have to be adopted.
耐青霉素肺炎链球菌（PRSP）的出现是一个国际性问题，对其他β-内酰胺类抗生素产生高水平多重耐药性使这一问题更加复杂。由于青霉素结合蛋白（PBP）发生突变，耐药性以“逐步”但不可预测的方式产生。这导致细菌菌株之间存在高度异质性。此类突变可导致抗生素耐药性迅速出现，包括对超广谱头孢菌素的耐药性，据报道其最低抑菌浓度（MIC）值高达32mg/L。有效治疗由此类病原体引起的疾病取决于对抗生素敏感性的快速评估。因此，在治疗失败和严重肺炎球菌感染的病例中，必须测定一系列抗生素的MIC值。然而，还应考虑由抑制商数所确定的药代动力学特性，该特性反映了不同组织中可达到的药物浓度。对肺炎球菌具有良好抑制活性的β-内酰胺类抗生素包括：阿莫西林、头孢噻肟、头孢曲松、头孢匹罗和亚胺培南。尽管如此，由于PRSP菌株的流行率可能会增加，可能不得不采用新的治疗策略。
