Hotomi M, Ubukata K, Konno M, Samukawa T, Shimada J, Suzumoto M, Yamanaka N
Department of Otorhinolaryngology, Wakayama Medical College.
Nihon Jibiinkoka Gakkai Kaiho. 1998 Jul;101(7):924-30. doi: 10.3950/jibiinkoka.101.7_924.
Streptococcus Pneumoniae is a leading cause of acute otitis media (AOM). For most AOM caused by S. pneumoniae, penicillin is the antibiotic of choice. However, there are some recent reports of clinical resistance to penicillin by S. pneumoniae. The sequences of penicillin binding protein, pbpla, pbp2b and pbp2x, genes of penicillin-resistant S. pneumoniae (PRSP) were more highly divergent than those of penicillin-succeptible S. pneumoniae (PSSP). The polymerase chain reaction (PCR) can easily determine whether an S. pheumoniae isolate is susceptible or resistant to penicillin by amplifying the target gene by using a combination of primers. In this study, clinical isolates (n = 12) were obtained from the nasopharynx of patients with AOM. PCR was used to confirm the identification of an isolate as S. pneumoniae by amplifying the autolysin gene and to detect three PBP genes by amplifying parts of pbp1a, pbp2x and pbp2b. The resistance of S. pneumoniae to penicillin and other beta-lactams has been shown to be associated with mosaic mutations in the pbp1a, pbp2b and pbp2x genes. These findings suggest that rapid identification of PSSP and PISP/PRSP by PCR is possible and very useful for proper treatment of acute otitis media.
肺炎链球菌是急性中耳炎（AOM）的主要病因。对于大多数由肺炎链球菌引起的AOM，青霉素是首选抗生素。然而，最近有一些关于肺炎链球菌对青霉素产生临床耐药性的报道。耐青霉素肺炎链球菌（PRSP）的青霉素结合蛋白pbp1a、pbp2b和pbp2x基因序列比敏感肺炎链球菌（PSSP）的差异更大。聚合酶链反应（PCR）通过使用引物组合扩增靶基因，能够轻松确定肺炎链球菌分离株对青霉素敏感还是耐药。在本研究中，从AOM患者的鼻咽部获取临床分离株（n = 12）。PCR用于通过扩增自溶素基因来确认分离株为肺炎链球菌，并通过扩增pbp1a、pbp2x和pbp2b的部分片段来检测三个PBP基因。肺炎链球菌对青霉素和其他β-内酰胺类抗生素的耐药性已被证明与pbp1a、pbp2b和pbp2x基因中的镶嵌突变有关。这些发现表明，通过PCR快速鉴定PSSP和PISP/PRSP是可行的，并且对于急性中耳炎的恰当治疗非常有用。
