Antibiotic-resistant Streptococcus pneumoniae: clinical and epidemiologic aspects.
Antibiotic-resistant Streptococcus pneumoniae: clinical and epidemiologic aspects.
复制标题
抗生素耐药性肺炎链球菌：临床和流行病学方面。
DOI：
10.1093/clinids/3.2.254
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发表时间：
1981
期刊：
影响因子：
--
通讯作者：
J. Ward
中科院分区：
文献类型：
--
作者：
J. Ward
对抗生素耐药的肺炎链球菌，特别是青霉素耐药菌株，被发现的频率越来越高。青霉素中度耐药(IPR)肺炎球菌已从患者体内恢复了15年。这些菌株对青霉素的最小抑菌浓度(MIC)为0.1-1.0微克/毫升，是敏感菌株的10-100倍。然而，在过去的三年中，分离出了对青霉素的MIC为2-10微克/毫升的耐药菌株。IPR菌株引起的疾病对大剂量注射青霉素可能有反应，但由更多耐药菌株引起的疾病，特别是脑膜炎，需要用替代药物治疗。对四环素、磺胺类、红霉素、林可霉素、氯霉素、克林霉素、链霉素和利福平耐药的肺炎球菌也有报道。尤其不祥的是，南非出现了多重耐药肺炎球菌，它对上述所有药物，包括所有的β-内酰胺类抗菌剂都具有耐药性。本文综述了耐药肺炎球菌的定义和药敏试验方法，耐药株的地理分布，感染患者的流行病学特征，疾病的临床表现和治疗反应，血清型的分布和肺炎球菌疫苗的使用，以及(6)限制耐药株传播和预防疾病的方法。这些新问题可能会改变这样一种印象，即肺炎球菌疾病很容易得到治疗，不再是主要的公共卫生威胁。
Antibiotic-resistant Streptococcus pneumoniae, particularly penicillin-resistant strains, are being identified with increasing frequency. Pneumococci with intermediate penicillin resistance (IPR) have been recovered from patients for 15 years. These strains have minimal inhibitory concentrations (MICs) for penicillin of 0.1-1.0 microgram/ml, an MIC that is 10-100 times greater than that for susceptible strains. However, in the past three years, resistant strains have been isolated that have MICs for penicillin of 2-10 microgram/ml. Disease caused by IPR strains may respond to high-dosage parenteral penicillin, but disease caused by more resistant strains, especially meningitis, requires therapy with alternative agents. Pneumococci resistant to tetracycline, sulfonamides, erythromycin, lincomycin, chloramphenicol, clinadmycin streptomycin, and rifampin have also been reported. Particularly ominous has been the development in South Africa of multiply resistant pneumococci, resistant to all the above agents, including all beta-lactam antimicrobial agents. This paper reviews the following aspects of resistant pneumococci: (1) the definitions of resistance and methods of susceptibility testing, (2) the geographic distribution of resistant strains, (3) the epidemiologic characteristics of infected patients, (4) the clinical manifestations of disease and response to therapy, (5) the distribution of serotypes and implications for use of the pneumococcal vaccine, and (6) the methods used to limit spread of resistant strains and to prevent disease. These new issues may alter the impression that pneumococcal disease is readily treated and no longer a major public health threat.