Kaplan S L, Mason E O, Barson W J, Wald E R, Arditi M, Tan T Q, Schutze G E, Bradley J S, Givner L B, Kim K S, Yogev R
Pediatric Infectious Disease Section, Baylor College of Medicine, Houston, TX 77030, USA.
Pediatrics. 1998 Sep;102(3 Pt 1):538-45. doi: 10.1542/peds.102.3.538.
To track antibiotic susceptibility of Streptococcus pneumoniae isolates obtained from children with systemic infections and determine outcome of treatment.
A 3-year (September 1993 through August 1996) prospective surveillance study of all invasive pneumococcal infections in children.
Infants and children cared for at eight children's hospitals in the United States with culture-proven systemic pneumococcal infection.
One thousand two hundred ninety-one episodes of systemic pneumococcal infection were identified in 1255 children. An underlying illness was present in the children for 27% of the episodes. The proportion of isolates that were nonsusceptible to penicillin or ceftriaxone increased annually and nearly doubled throughout the 3-year period; for the last year the percentages of isolates nonsusceptible to penicillin and ceftriaxone were 21% and 9.3%, respectively. There was no difference in mortality between patients with penicillin-susceptible or nonsusceptible isolates. Only 1 of 742 patients with bacteremia had a repeat blood culture that was positive > 1 day after therapy was started. All 24 normal children with bacteremia attributable to isolates resistant to penicillin had resolution of their infection; the most common treatment regimen was a single dose of ceftriaxone followed by an oral antibiotic.
The percentage of pneumococcal isolates nonsusceptible to penicillin and ceftriaxone increased yearly among strains recovered from children with systemic infection. Because empiric antibiotic therapy already has changed for suspected pneumococcal infections, antibiotic resistance has not been associated with increased mortality. Careful monitoring of antibiotic susceptibility and outcome of therapy is necessary to continually reassess current recommendations for treatment.
追踪从患有全身感染的儿童中分离出的肺炎链球菌菌株的抗生素敏感性，并确定治疗结果。
一项为期3年（1993年9月至1996年8月）的对儿童所有侵袭性肺炎球菌感染的前瞻性监测研究。
在美国八家儿童医院接受治疗的经培养证实患有全身肺炎球菌感染的婴儿和儿童。
在1255名儿童中确定了1291例全身肺炎球菌感染病例。27%的病例中儿童存在基础疾病。对青霉素或头孢曲松不敏感的分离株比例逐年增加，在整个3年期间几乎翻倍；在最后一年，对青霉素和头孢曲松不敏感的分离株百分比分别为21%和9.3%。青霉素敏感或不敏感分离株的患者之间死亡率无差异。742例菌血症患者中只有1例在开始治疗>1天后重复血培养仍为阳性。所有24例因对青霉素耐药的分离株导致菌血症的正常儿童感染均得到缓解；最常见的治疗方案是单剂量头孢曲松，随后口服抗生素。
从患有全身感染的儿童中分离出的肺炎球菌菌株对青霉素和头孢曲松不敏感的百分比逐年增加。由于针对疑似肺炎球菌感染的经验性抗生素治疗已经改变，抗生素耐药性与死亡率增加无关。必须仔细监测抗生素敏感性和治疗结果，以便不断重新评估当前的治疗建议。
