Norris C F, Mahannah S R, Smith-Whitley K, Ohene-Frempong K, McGowan K L
Division of Hematology, Children's Hospital of Philadelphia, Pennsylvania 19104, USA.
J Pediatr. 1996 Dec;129(6):821-7. doi: 10.1016/s0022-3476(96)70025-2.
The goals of this prospective study were to define the Streptococcus pneumoniae colonization rate in children with sickle cell disease (SCD) at the Children's Hospital of Philadelphia and to determine the serotype and antibiotic susceptibility of all isolates.
Children with SCD followed at the hospital were sampled for colonization with S. pneumoniae by means of a throat or nasopharyngeal swab on one or two occasions. Patient information was obtained when the specimen was collected. Specimens were isolated on gentamicin-blood agar plates and modified Avery broth. Antibiotic susceptibility was determined by a commercially available test (E-test). Isolates were serotyped with the use of type-specific antisera. The relationship between the data noted above and certain clinical parameters was examined.
A total of 490 specimens were obtained from 278 patients. Twenty-eight patients had a culture positive for S. pneumoniae, resulting in an overall colonization rate of 10%. Thirty-three percent (11/33) of all isolates were resistant to penicillin-seven intermediately resistant and four highly resistant. Twelve percent of isolates were also resistant to cefotaxime. Eight different serotypes were identified; all but one are included in the current 23-valent pneumococcal vaccine. Penicillin prophylaxis did not increase the rate of colonization with resistant strains of pneumococcus.
Our results do not support a change in the current use of penicillin prophylaxis nor in the acute management of the febrile child with SCD.
这项前瞻性研究的目的是确定费城儿童医院镰状细胞病（SCD）患儿的肺炎链球菌定植率，并确定所有分离株的血清型和抗生素敏感性。
对在该医院随访的SCD患儿，通过一次或两次咽拭子或鼻咽拭子采样检测肺炎链球菌定植情况。采集标本时获取患者信息。标本在庆大霉素血琼脂平板和改良艾弗里肉汤中分离培养。采用市售检测方法（E-test）测定抗生素敏感性。使用型特异性抗血清对分离株进行血清分型。研究上述数据与某些临床参数之间的关系。
共从278例患者中获取490份标本。28例患者肺炎链球菌培养呈阳性，总体定植率为10%。所有分离株中有33%（11/33）对青霉素耐药，其中7株为中度耐药，4株为高度耐药。12%的分离株也对头孢噻肟耐药。鉴定出8种不同血清型；除一种外，其余均包含在目前的23价肺炎球菌疫苗中。青霉素预防并未增加肺炎球菌耐药菌株的定植率。
我们的结果不支持改变目前青霉素预防的使用方式，也不支持改变SCD发热患儿的急性处理方式。
