美國(guó)科學(xué)家近日研究發(fā)現(xiàn)一種能夠造成兒童耳部感染的肺炎鏈球菌菌株,，該菌株不在肺炎球菌7價(jià)共軛疫苗的預(yù)防范圍內(nèi)，并且對(duì)所有美國(guó)食品與藥物管理局（FDA）批準(zhǔn)的治療耳部感染的抗生素均具有抗藥性,，相關(guān)論文10月15日發(fā)表在《美國(guó)醫(yī)學(xué)協(xié)會(huì)期刊》（JAMA）上。
細(xì)菌性呼吸道感染的最常見(jiàn)原因,，就是對(duì)肺炎球菌抗生素產(chǎn)生抗藥性,，這也一直是兒科醫(yī)學(xué)的一個(gè)研究重點(diǎn)。
此次研究由美國(guó)紐約羅切斯特大學(xué)的兒科學(xué)醫(yī)學(xué)博士Michael E. Pichichero和Janet R. Casey領(lǐng)導(dǎo)完成,。他們表示，2000年在美國(guó)推出的肺炎球菌7價(jià)共軛疫苗（PCV7）在遏制兒童肺炎球菌感染方面提供了相當(dāng)樂(lè)觀的前景,，尤其是對(duì)耐青霉素和多種藥物的菌株產(chǎn)生了有利的影響,。
最新研究檢測(cè)了在推出造成急性中耳炎的肺炎鏈球菌菌株P(guān)CV7之后造成耳部感染的細(xì)菌變化狀況，尤其注重某些肺炎球菌血清型和抗生素易感性,。他們發(fā)現(xiàn)了2003年9月至2006年6月期間造成已接受PCV7的兒童患急性中耳炎的肺炎鏈球菌菌株,。
此次研究的所有兒童均來(lái)自紐約州羅徹斯特市小兒科，在被診斷患有急性中耳炎的1,816名兒童中,，212名兒童接受了鼓膜穿刺術(shù)（用針穿刺鼓膜,，讓液體從中耳流出），這導(dǎo)致了59例肺炎鏈球菌感染,。研究人員發(fā)現(xiàn),，一種屬于19A血清型的肺炎鏈球菌菌株是一種新的基因型，對(duì)美國(guó)食品與藥物管理局（FDA）批準(zhǔn)用于急性中耳炎兒童患者的所有抗生素均具有抗藥性,。一共有九例感染這種菌株,，兩例在2003-2004年，兩例在2004-2005年,，另外有五例在2005-2006年,。
（《美國(guó)醫(yī)學(xué)協(xié)會(huì)期刊》（JAMA）2007年第298(15)期，Michael E. Pichichero,，Janet R. Casey）
原始出處:
JAMA
Vol. 298 No. 15, October 17, 2007
Emergence of a Multiresistant Serotype 19A Pneumococcal Strain Not Included in the 7-Valent Conjugate Vaccine as an Otopathogen in Children
Michael E. Pichichero, MD; Janet R. Casey, MD
JAMA. 2007;298:1772-1778.
Context Concern has been raised about the possible emergence of a bacterial strain that is untreatable by US Food and Drug Administration (FDA)–approved antibiotics and that causes acute otitis media (AOM) in children.
Objective To monitor continuing shifts in the strains of Streptococcus pneumoniae that cause AOM, with particular attention to capsular serotypes and antibiotic susceptibility, following the introduction of a pneumococcal 7-valent conjugate vaccine (PCV7).
Design, Setting, and Patients Prospective cohort study using tympanocentesis to identify S pneumoniae strains that caused AOM in children receiving PCV7 between September 2003 and June 2006. All children were from a Rochester, New York, pediatric practice.
Main Outcome Measure Determination of serotypes and antibiotic susceptibility of S pneumoniae causing AOM.
Results Among 1816 children in whom AOM was diagnosed, tympanocentesis was performed in 212, yielding 59 cases of S pneumoniae infection. One strain of S pneumoniae belonging to serotype 19A was a new genotype and was resistant to all antibiotics approved by the FDA for use in children with AOM. This strain was identified in 9 cases (2 in 2003-2004, 2 in 2004-2005, and 5 in 2005-2006). Four children infected with this strain had been unsuccessfully treated with 2 or more antibiotics, including high-dose amoxicillin or amoxicillin-clavulanate and 3 injections of ceftriaxone; 3 had recurrent AOM; and for 2 others, the infection was their first in life. The first 4 cases required tympanostomy tube insertion after additional unsuccessful antibiotic therapies. Levofloxacin was used in the subsequent 5 cases, with resolution of infection without surgery.
Conclusion In the years following introduction of PCV7, a strain of S pneumoniae has emerged in the United States as an otopathogen that is resistant to all FDA-approved antibiotics for treatment of AOM in children.
Author Affiliations: University of Rochester and Legacy Pediatrics, Rochester, New York.
