Tolerance to vancomycin in pneumococci: detection with a molecular marker and assessment of clinical impact.
Tolerance to vancomycin in pneumococci: detection with a molecular marker and assessment of clinical impact.
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肺炎球菌对万古霉素的耐受性：分子标记检测和临床影响评估。
DOI：
10.1086/424467
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发表时间：
2004
期刊：
影响因子：
--
通讯作者：
Tuomanen,ElaineI
中科院分区：
文献类型：
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作者：
Rodriguez,CarinaA;Atkinson,Robyn;Bitar,Wally;Whitney,CynthiaG;Edwards,KathrynM;Mitchell,Lauren;Li,Juan;Sublett,Jack;Li,Chin-Shang;Liu,Tiebin;Chesney,PJoan;Tuomanen,ElaineI
背景：治疗肺炎链球菌引起的脑膜炎时，常加用万古霉素。没有经典耐药性的耐受性细菌可以逃脱多种抗生素的杀戮，这是零星的报道。方法：对215株鼻咽部分离株和113株脑膜炎分离株的档案标本进行万古霉素杀灭效果检测。耐药菌株在转运蛋白基因座上发现了特定的DNA序列变化。结果：在档案分离株中，3.7%的NP和10.6%的侵袭性分离株对万古霉素耐药。由耐药菌株引起的脑膜炎患者的估计30天存活率比由不耐药菌株引起的脑膜炎患者差(49%比86%；P=.048)；62.5%的耐药档案NP菌株含有Pep27和Vex2的特定序列变化(P=.021)。对517株携带菌的前瞻性分析表明，8.1%的菌株对万古霉素耐药，82.1%的耐药株携带特定的标记基因序列(P=.001)。结论：肺炎球菌群体中存在对万古霉素的耐药。耐受性分离株与死亡率增加的脑膜炎有关，这些分离株可以通过2个基因中的特定标记序列进行跟踪。
Background.Vancomycin is often added to therapy for meningitis caused byStreptococcus pneumoniae. Tolerant bacteria without classic resistance that escape killing by multiple antibiotics have been reported sporadically. We determined the prevalence of tolerance to vancomycin in pneumococci and its effect on the outcome of meningitis.Methods.Archival samples of 215 nasopharyngeal (NP) and 113 meningitis isolates were tested for the killing efficacy of vancomycin. Specific DNA sequence changes in a transporter locus were identified for tolerant isolates. Similar tests were conducted prospectively on 517 NP isolates from healthy children.Results.In archival isolates, tolerance to vancomycin was detected in 3.7% of NP and 10.6% of invasive isolates. Patients with meningitis caused by tolerant isolates had a worse estimated 30-day survival than did patients with meningitis caused by nontolerant isolates (49% vs. 86%;P= .048); 62.5% of tolerant archival NP isolates harbored a specific sequence change forpep27andvex2(P= .021). Prospective analysis of 517 carriage isolates indicated that 8.1% were tolerant to vancomycin and that 82.1% of tolerant isolates harbored the specified marker gene sequences (P= .001).Conclusions.Tolerance to vancomycin exists in the population of pneumococci. Tolerant isolates are associated with meningitis of increased mortality, and these isolates can be tracked by specific marker sequences in 2 genes.