Mihajlović-Ukropina M, Milutinović M
Institu za zastitu zdravlja, Medicinski fakultet, Novi Sad.
Med Pregl. 1998 Mar-Apr;51(3-4):169-73.
Streptococcus pneumoniae is the leading cause of community acquired pneumonia and a frequent cause of otitis media, sinusitis and meningitis. Although most pneumococci remain susceptible to penicillin, relatively less susceptible and resistant strains have been recognized with increasing frequency throughout the world (1). The aim of this study was to determine whether and to what degree pneumococci isolated in our laboratory were resistant to penicillin and other frequently used antimicrobial agents.
During the period from 1991 to 1995 1139 Streptococcus pneumoniae strains isolated from patients with different pneumococcal infections were tested for their susceptibility to antimicrobial agents at the Department of Bacteriology and Parasitology of the Institute of Public Health in Novi Sad. Antimicrobial agents tested included: penicillin, ampicillin, cephalexin, erythromycin, sulfamethoxazole-trimethoprim and clindamycin. Susceptibility test was performed by using Kirby-Bauer disc diffusion technique on Mueller-Hinton agar supplemented with 5% defibrinated bovine blood (5).
Susceptibility of Streptococcus pneumoniae to seven antimicrobial agents used in the study is shown in Table 2. There was a resistance to all antimicrobial agents tested. It was the lowest to erythromycin (1.6%) and the highest to sulfamethoxazole+ trimethoprim (67.3%). The rate of resistance of penicillin was 3.3%. In Table 3 and 4 we can also see that the lowest resistance was to erythromycin, and the highest to sulfamethoxazole+trimethoprim, both for isolates from nose and other sources. Strains of Streptococcus pneumoniae isolated from nasal swabs were more susceptible to penicillin than those isolated from blood, sputum and cerebrospinal fluid.
For many years penicillin has been the mainstay of therapy for pneumococcal diseases. Clinical resistance to penicillin was first reported in 1960's. Since this early reported, penicillin resistance has been encountered with increasing frequency in strains of Streptococcus pneumoniae from around the world. In our study resistance to penicillin was low (3.3%). This is in accordance with the authors from Italy, Great Britain, USA and Germany (7, 8, 9, 10). Much higher prevalence of resistant pneumococci we found in the reports from Spain, France and Hungary (13, 14, 15, 17). Many of these strains have been resistant to multiple drugs and have been isolated from patients with invasive infections (meningitis, pneumonia, bacteremia). Percentage of penicillin resistant pneumococci isolated from blood, sputum and cerebrospinal fluid in our study was relatively low (7.7%), but it was higher than the percentage of resistant isolates from nasal swabs (2.0%). These findings are in accordance with other reports (20, 21).
The increasing number of Streptococcus pneumoniae isolates resistant to penicillin and other antimicrobial agents indicates the need to perform susceptibility testing for every isolated strain in order to avoid possible therapeutic failure.
肺炎链球菌是社区获得性肺炎的主要病因，也是中耳炎、鼻窦炎和脑膜炎的常见病因。尽管大多数肺炎球菌对青霉素仍敏感，但在全球范围内，相对不敏感和耐药的菌株出现频率日益增加（1）。本研究的目的是确定我们实验室分离出的肺炎球菌对青霉素及其他常用抗菌药物的耐药情况及耐药程度。
1991年至1995年期间，在诺维萨德公共卫生研究所细菌学和寄生虫学系，对从不同肺炎球菌感染患者中分离出的1139株肺炎链球菌进行了抗菌药物敏感性检测。检测的抗菌药物包括：青霉素、氨苄西林、头孢氨苄、红霉素、磺胺甲恶唑-甲氧苄啶和克林霉素。采用 Kirby-Bauer 纸片扩散法，在补充有5%去纤维蛋白牛血的 Mueller-Hinton 琼脂上进行敏感性试验（5）。
表2显示了肺炎链球菌对本研究中使用的七种抗菌药物的敏感性。对所有检测的抗菌药物均存在耐药情况。对红霉素的耐药率最低（1.6%），对磺胺甲恶唑+甲氧苄啶的耐药率最高（67.3%）。青霉素的耐药率为3.3%。在表3和表4中我们还可以看到，无论是从鼻腔及其他来源分离的菌株，对红霉素的耐药率最低，对磺胺甲恶唑+甲氧苄啶的耐药率最高。从鼻拭子中分离出的肺炎链球菌菌株比从血液、痰液和脑脊液中分离出的菌株对青霉素更敏感。
多年来，青霉素一直是肺炎球菌疾病治疗的主要药物。1960年代首次报道了对青霉素的临床耐药情况。自该早期报道以来，世界各地肺炎链球菌菌株中青霉素耐药情况日益常见。在我们的研究中，对青霉素的耐药率较低（3.3%）。这与意大利、英国、美国和德国的作者报道一致（7、8、9、10）。我们发现西班牙、法国和匈牙利的报道中耐药肺炎球菌的患病率要高得多（13、14、15、17）。其中许多菌株对多种药物耐药，且是从侵袭性感染（脑膜炎、肺炎、菌血症）患者中分离出来的。在我们的研究中，从血液、痰液和脑脊液中分离出的青霉素耐药肺炎球菌百分比相对较低（7.7%），但高于从鼻拭子中分离出的耐药菌株百分比（2.0%）。这些发现与其他报道一致（20、21）。
对青霉素和其他抗菌药物耐药的肺炎链球菌分离株数量不断增加，这表明需要对每一株分离菌株进行敏感性检测，以避免可能的治疗失败。
