Lund B C, Ernst E J, Klepser M E
College of Pharmacy, University of Iowa, Iowa City 52242-1112, USA.
Am J Health Syst Pharm. 1998 Oct 1;55(19):1987-94. doi: 10.1093/ajhp/55.19.1987.
The epidemiology, resistance mechanisms, susceptibility testing, treatment, prevention, and clinical importance of penicillin-resistant Streptococcus pneumoniae (PRSP) infection are discussed. PRSP is an established presence in the United States, with some geographic areas reporting decreased susceptibility in up to half of isolates. The mechanism of resistance to beta-lactam antibiotics in S. pneumoniae is genetic changes resulting in decreased binding of drug to the bacterial cell wall. Emerging PRSP strains have necessitated testing as a tool in selecting drugs for treating life-threatening infections. Opinions differ on how to treat these infections empirically. Non-life-threatening infections, such as otitis media, are still often treated successfully with amoxicillin, amoxicillin-clavulanate potassium, or a third-generation cephalosporin. Currently recommended initial treatment of pneumococcal pneumonia in otherwise healthy patients requiring hospitalization consists of cefuroxime, ceftriaxone, or cefotaxime; some authors continue to emphasize injectable penicillin. Once the mainstay of empirical treatment of pneumococcal meningitis, penicillin has largely been abandoned in favor of cefotaxime or ceftriaxone. Vaccination remains an underutilized strategy in atrisk populations. The clinical importance of penicillin resistance among pneumococci is still uncertain. Changing patterns in the susceptibility of S. pneumoniae to penicillin make selection of appropriate therapy increasingly difficult. Key considerations are the site of infection and the level of resistance.
本文讨论了耐青霉素肺炎链球菌（PRSP）感染的流行病学、耐药机制、药敏试验、治疗、预防及临床重要性。PRSP在美国已确有存在，一些地理区域报告称高达半数的分离株药敏性下降。肺炎链球菌对β-内酰胺类抗生素的耐药机制是基因改变导致药物与细菌细胞壁的结合减少。新出现的PRSP菌株使得药敏试验成为选择治疗危及生命感染药物的一项工具。对于如何经验性治疗这些感染，存在不同观点。非危及生命的感染，如中耳炎，通常仍可用阿莫西林、阿莫西林-克拉维酸钾或第三代头孢菌素成功治疗。目前，对于需要住院治疗的健康患者，推荐的肺炎球菌肺炎初始治疗药物包括头孢呋辛、头孢曲松或头孢噻肟；一些作者仍强调使用注射用青霉素。青霉素曾是肺炎球菌脑膜炎经验性治疗的主要药物，但现在大多已被头孢噻肟或头孢曲松取代。在高危人群中，疫苗接种仍是一种未得到充分利用的策略。肺炎球菌对青霉素耐药的临床重要性仍不确定。肺炎链球菌对青霉素药敏模式的变化使得选择合适的治疗方法越来越困难。关键考虑因素是感染部位和耐药水平。
