Renneberg J, Niemann L L, Gutschik E
Department of Clinical Microbiology, University of Copenhagen, Denmark.
J Antimicrob Chemother. 1997 Feb;39(2):135-40. doi: 10.1093/oxfordjournals.jac.a020858.
A total of 278 streptococci isolated from blood (including 66 strains of Streptococcus pneumoniae) were tested for their MIC to penicillin G, gentamicin, rifampicin, clindamycin, erythromycin, vancomycin and teicoplanin to determine the current state of resistance among streptococci isolated from blood at a University Hospital in Copenhagen, Denmark, and thereby to assess alternative treatment for patients who are infected with a penicillin-resistant streptococcal strain or allergic to penicillin. Danish Blood Sensitivity Agar and the Etest were used. Overall, resistance to penicillin among Streptococcus mitis strains was 44.4% (37% intermediately susceptible and 7.4% resistant). As penicillin resistance in S. mitis may be an early indication of emerging penicillin resistance among other streptococcal species, this finding is a matter of concern. Except for this observation, penicillin remains the best and a safe choice for treatment of streptococcal infection. For alternative treatment when the patient is allergic to penicillin and for prophylaxis, the usual recommendation is macrolide antibiotics or clindamycin. The majority of non-enterococcal groups of streptococci remain sensitive to erthromycin and clindamycin, but the antibiotic susceptibility pattern is unpredictable without testing the isolates, so empirical therapy or prophylaxis may fail.
对从血液中分离出的278株链球菌（包括66株肺炎链球菌）进行了青霉素G、庆大霉素、利福平、克林霉素、红霉素、万古霉素和替考拉宁的最低抑菌浓度（MIC）测试，以确定丹麦哥本哈根一家大学医院从血液中分离出的链球菌的耐药现状，从而评估对感染耐青霉素链球菌菌株或对青霉素过敏患者的替代治疗方法。使用了丹麦血液敏感性琼脂和Etest。总体而言，缓症链球菌菌株对青霉素的耐药率为44.4%（37%为中度敏感，7.4%为耐药）。由于缓症链球菌中的青霉素耐药可能是其他链球菌物种中出现青霉素耐药的早期迹象，这一发现令人担忧。除了这一观察结果外，青霉素仍然是治疗链球菌感染的最佳且安全的选择。对于患者对青霉素过敏时的替代治疗和预防，通常的建议是使用大环内酯类抗生素或克林霉素。大多数非肠球菌属链球菌组对红霉素和克林霉素仍敏感，但如果不测试分离株，抗生素敏感性模式是不可预测的，因此经验性治疗或预防可能会失败。
