Abstract：Objective To investigate the antimicrobial resistance of invasive and non-invasive Streptococcus pneumoniae (SP) strains in children and to provide a basis for proper use of antimicrobial drugs in the treatment of SP infection. Methods Seventy children who were diagnosed with invasive pneumococcal diseases (IPD) between January 2009 and December 2013 were enrolled, and 164 children with lower respiratory tract infection caused by SP were randomly selected as the control group. The samples from sterile sites (blood, cerebrospinal fluid, etc) of children with IPD, as well as the sputum samples of children in the control group, were collected for bacterial culture, and the drug susceptibility tests for isolated SP strains were conducted. Results A total of 82 invasive strains of SP were isolated from sterile sites of 70 children with IPD; 49 strains (60%) were isolated from blood, and 19 strains (23%) from cerebrospinal fluid. The detection rate of invasive SP strains decreased from 2009 to 2013 (P<0.01). The total detection rates of penicillin-nonsusceptible SP from the invasive and non-invasive strains were 27% and 17% respectively (P>0.05). Among invasive strains, the penicillin-nonsusceptible SP strains had significantly higher rates of insusceptibility to cefotaxime, ceftriaxone, and cefepime than the penicillin-susceptible SP (P<0.01). There were significant differences in the rates of insusceptibility to cefotaxime, ceftriaxone, and meropenem between the sensitive and non-sensitive SP strains (P<0.05). The multidrug resistance rates of the invasive and non-invasive SP strains were 89% and 93% respectively (P>0.05). Conclusions Invasive SP can easily invade the blood in children, but the total detection rate has decreased year by year. The results of drug sensitivity tests have guiding significance for proper use of antimicrobial drugs for different SP infections.
DAI Li-Hong,DONG Lin,LI Hai-Yan et al. Control study on antimicrobial resistance of invasive and non-invasive Streptococcus pneumoniae in children[J]. CJCP, 2015, 17(4): 303-307.
Lin TY, Shah NK, Brooks D, et al. Summary of invasive pneumococcal disease burden among children in the Asia- Pacific region[J]. Vaccine, 2010, 28(48): 7589-7605.
[3]
Jaiswal N, Singh M, Thumburu KK, et al. Burden of invasive pneumococcal disease in children aged 1 month to 12 years living in South Asia: a systematic review[J]. PLoS One, 2014, 9(5): e96282.
[4]
Paulke-Korinek M, Kollaritsch H, Kundi M. Characteristics of invasive pneumococcal disease in hospitalized children in Austria[J]. Eur J Pediatr, 2014, 173(4): 469-476.
[5]
Rudan L, Chan KY, Zhang JS, et al. Causes of deaths in children younger than 5 years in China in 2008[J]. Lancet, 2010, 375(9720): 1083-1089.
[6]
Gaschignard J, Levy C, Chrabieh M, et al. Invasive pneumococcal disease in children can reveal a primary immunodeficiency[J]. Clin Infect Dis, 2014, 59(2): 244-251.
[7]
Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing, Eighteenth informational supplement. CLSI document M100-S18[S]. Wayne, Pennsylvania: 2008: 1-181.
[8]
Richter SS, Heilmann KP, Dohrn CL, et al. Pneumococcal serotypes before and after introduction of conjugate vaccines, United States, 1999-2011[J]. Emerg Infect Dis, 2013, 19(7): 1074-1083.
[9]
Hsu HE, Shutt KA, Moore MR, et al. Effect of pneumococcal conjugate vaccine on pneumococcal meningitis[J]. N Engl J Med, 2009, 360(3): 244-256.
[10]
Kuster SP, Rudnick W, Shigayeva A, et al. Previous antibiotic exposure and antimicrobial resistance in invasive pneumococcal disease: results from prospective surveillance[J]. Clin Infect Dis, 2014, 59(7): 944-952.
Su LH, Wu TL, Kuo AJ, et al. Antimicrobial susceptibility of Streptococcus pneumoniae at a university hospital in Taiwan, 2000-07: impact of modified non-meningeal penicillin breakpoints in CLSI M100-S18[J]. J Antimicrob Chemother, 2009, 64(2): 336-342.
[13]
Imohl M, Reinert RR, der Linden M. New penicillin susceptibility breakpoints for Streptococcus pneumoniae and their effects on susceptibility categorisation in Germany (1992- 2008) [J]. Int J Antimicrob Agents, 2009, 34(3): 271-273.
[14]
Dogan O, Gulmez D, Hascelik G. Effect of new breakpoints proposed by Clinical and Laboratory Standards Institute in 2008 for evaluating penicillin resistance of Streptococcus pneumoniae in a Turkish University Hospital[J]. Microb Drug Resist, 2010, 16(1): 39-41.
Choi SH, Chung JW, Sung H, et al. Impact of penicillin nonsusceptibility on clinical outcomes of patients with nonmeningeal Streptococcus pneumoniae bacteremia in the era of the 2008 clinical and laboratory standards institute penicillin breakpoints[J]. Antimicrob Agents Chemother, 2012, 56(9): 4650-4655.
[21]
Liu C, Xiong X, Xu W, et al. Serotypes and patterns of antibiotic resistance in strains causing invasive pneumococcal disease in children less than 5 years of age[J]. PLoS ONE, 2013, 8(1): e54254.
