PENICILLIN-RESISTANT STREPTOCOCCUS-PNEUMONIAE IN ACUTE OTITIS-MEDIA - RISK-FACTORS, SUSCEPTIBILITY PATTERNS AND ANTIMICROBIAL MANAGEMENT
PENICILLIN-RESISTANT STREPTOCOCCUS-PNEUMONIAE IN ACUTE OTITIS-MEDIA - RISK-FACTORS, SUSCEPTIBILITY PATTERNS AND ANTIMICROBIAL MANAGEMENT
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DOI：
10.1097/00006454-199509000-00005
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发表时间：
1995-09-01
影响因子：
3.6
通讯作者：
CHARTRAND, SA
中科院分区：
文献类型：
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作者：
BLOCK, SL;HARRISON, CJ;CHARTRAND, SA
1992年1月至1994年1月，肯塔基州农村地区246名流动患者的急性中耳炎（AOM）或复发性AOM的283株分离株中，青霉素耐药（最低抑制浓度（MIC）>0.06μg/ml）肺炎链球菌（PRSP）分离株占48株（17%），通过微量肉汤稀释，对青霉素相对耐药使用 1994 年国家临床实验室标准委员会肺炎球菌断点（无口服数据），在 157 株中耳肺炎球菌分离株中，分别检测到 25 株（16%）和 23 株（15%）对青霉素（MIG >0.06 至 1.0 μg/ml）和高度青霉素耐药（MIG 大于或等于 2.0 μg/ml）菌株。除头孢呋辛外的头孢菌素），高 PRSP 菌株几乎一致对克林霉素和万古霉素敏感，相反，高 PRSP 菌株对大多数用于 AOM 的口服抗菌药物具有耐药性，其中三分之一的菌株对头孢曲松高度耐药（MIG 大于或等于 2.0 μg/ml）。血清型 6B、19F 和 23F 占高度 PRSP 菌株的 95%，血清型 9V 占相对 PRSP 菌株的 48%，通过多变量分析，耳炎倾向 (P = 0.0008) 和培养前抗生素疗程数 (P < 0.0001) 是 PRSP 的独立预测因素，高度 PRSP 分离株更常见于最近在 3 天内接受治疗的患者中(30%) 对比提前 3 天完成治疗的患者 (2%) (P < 0.0001)，PRSP 菌株患者的成功治疗结果率为：阿莫西林/克拉维酸治疗组为 76%（17 例中的 13 例），阿莫西林（60 至 80 mg/kg/天）为 63%（8 例中的 5 例），口服治疗为 70%（10 例中的 7 例）克林霉素治疗10至14天；肠外头孢曲松（25 或 50 mg/kg/天）每天一次，持续 3 至 8 天，率为 78%（18 中的 14）。这是美国第一个大规模前瞻性鉴定的 AOM 分离株，记录了 PRSP 作为这种常见儿科疾病的常见病原体的出现。
From January, 1992, to January, 1994, penicillin-resistant (minimal inhibition concentration (MIC) > 0.06 mu g/ml) Streptococcus pneumoniae (PRSP) isolates accounted for 48 (17%) of 283 isolates from acute otitis media (AOM) or recurrent AOM in 246 ambulatory patients in rural Kentucky, By broth microdilution, relatively penicillin-resistant (MIG >0.06 to 1.0 mu g/ml) and highly penicillin-resistant (MIG greater than or equal to 2.0 mu g/ml) strains were detected in 25 (16%) and 23 (15%), respectively, of 157 pneumococcal middle ear isolates, Using 1994 National Committee for Clinical Laboratory Standards breakpoints for pneumococci (unavailable for oral cephalosporins except cefuroxime), highly PRSP strains were almost uniformly susceptible to clindamycin and vancomycin, In contrast highly PRSP strains were resistant to most oral antimicrobials customarily used for AOM with one-third of strains highly resistant (MIG greater than or equal to 2.0 mu g/ml) to ceftriaxone. Serotypes 6B, 19F and 23F accounted for 95% of highly PRSP strains and serotype 9V for 48% of relatively PRSP strains, By multivariate analysis, otitis-prone condition (P = 0.0008) and number of antibiotic courses before day of culture (P < 0.0001) were independently predictive of PRSP, Highly PRSP isolates were more commonly isolated from patients recently treated within 3 days (30%) vs, those who completed therapy more than 3 days earlier (2%) (P < 0.0001), Rates of successful treatment outcome for patients with PRSP strains were: 76% (13 of 17) for amoxicillin/clavulanate, 63% (5 of 8) for amoxicillin (60 to 80 mg/kg/day) and 70% (7 of 10) for oral clindamycin for 10 to 14 days of therapy; and 78% (14 of 18) for parenteral ceftriaxone (25 or 50 mg/kg/day) once daily for 3 to 8 days, This is the first large series of prospectively identified AOM isolates in the United States to document the emergence of PRSP as a frequent pathogen of this common pediatric disease.