Steele R W, Warrier R, Unkel P J, Foch B J, Howes R F, Shah S, Williams K, Moore S, Jue S J
Division of Infectious Diseases, Department of Pediatrics, Louisiana State University School of Medicine, New Orleans, USA.
J Pediatr. 1996 Apr;128(4):531-5. doi: 10.1016/s0022-3476(96)70365-7.
Because of susceptibility to severe pneumococcal infection, children with sickle cell disease (SCD) routinely receive penicillin prophylaxis. Increasing rates of penicillin resistance have been reported throughout the world. Our objective was to assess the prevalence of nasopharyngeal colonization with Streptococcus pneumoniae and to assess the antimicrobial susceptibility of the organisms in children with SCD.
Nasopharyngeal cultures for S. pneumoniae were obtained from all children with SCD attending clinics in a statewide university-based network. Background colonization rates were determined in children attending day care centers in some of the same locations. All recovered S. pneumoniae organisms were tested for susceptibility to penicillin, and all resistant strains were examined for susceptibility to other antibiotics.
Overall nasopharyngeal pneumococcal colonization rates among children with SCD were 12%. Colonization was associated with age less than 2 years (p <0.001) and day care attendance for more than 20 hr/wk (p = 0.00005). More than half of these strains (62%) were resistant to penicillin, 33% having intermediate resistance (minimal inhibitory concentration 0.06 to 1 microgram/ml) and 29%, high level resistance (minimal inhibitory concentration > or = 2.0 microgram/ml). Penicillin resistance was associated with penicillin prophylaxis (p <0.01). Many of these organisms were also resistant to other classes of antibiotics.
Although penicillin prophylaxis and pneumococcal vaccine for patients with SCD have reduced overall nasopharyngeal colonization and disease caused by S. pneumoniae (p <0.001), a higher percentage of colonizing strains are now resistant both to penicillin and to other antimicrobial agents (p <0.01). Newer strategies for preventing disease and early management of suspected pneumococcal infection in these children must be developed.
由于镰状细胞病（SCD）患儿易患严重肺炎球菌感染，故常规接受青霉素预防性治疗。世界各地均有青霉素耐药率上升的报道。我们的目的是评估SCD患儿鼻咽部肺炎链球菌定植的患病率，并评估这些病原体的抗菌药敏情况。
从全州范围内以大学为基础的网络诊所就诊的所有SCD患儿中获取鼻咽部肺炎链球菌培养物。在部分相同地点的日托中心儿童中测定背景定植率。对所有分离出的肺炎链球菌菌株进行青霉素药敏测试，对所有耐药菌株进行其他抗生素药敏检测。
SCD患儿总体鼻咽部肺炎球菌定植率为12%。定植与年龄小于2岁（p<0.001）以及每周日托时间超过20小时（p = 0.00005）相关。这些菌株中超过一半（62%）对青霉素耐药，33%为中度耐药（最低抑菌浓度为0.06至1微克/毫升），29%为高度耐药（最低抑菌浓度≥2.0微克/毫升）。青霉素耐药与青霉素预防性治疗相关（p<0.01）。许多这些病原体对其他种类抗生素也耐药。
尽管针对SCD患者的青霉素预防性治疗和肺炎球菌疫苗已降低了总体鼻咽部定植以及由肺炎链球菌引起的疾病（p<0.001），但现在更高比例的定植菌株对青霉素和其他抗菌药物均耐药（p<0.01）。必须制定预防这些儿童疾病的新策略以及对疑似肺炎球菌感染的早期管理方法。
