佛山学龄前儿童肺炎链球菌的传播风险和耐药特征

邓文君; 李文宇; 陈敏琪; 王旭麟; 周俊立; 姚振江; 叶小华

doi:10.16835/j.cnki.1000-9817.2022.08.028

佛山学龄前儿童肺炎链球菌的传播风险和耐药特征

doi: 10.16835/j.cnki.1000-9817.2022.08.028

广东药科大学公共卫生学院流行病与卫生统计学系，广州 510310

基金项目:

国家自然科学基金 81973069

广东省基础与应用基础研究基金 2019A1515010915

详细信息

作者简介:
邓文君(1998-)，女，广东佛山人，在读硕士，主要研究方向为传染病流行病学

通讯作者:
叶小华，E-mail：smalltomato@163.com

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R181.3 R446 R183
计量
- 文章访问数: 289
- HTML全文浏览量: 138
- PDF下载量: 18
- 被引次数: 0
出版历程
- 收稿日期: 2022-03-21
- 修回日期: 2022-06-13
- 网络出版日期: 2022-08-24
- 刊出日期: 2022-08-25

Transmission risk and resistance characteristics of Streptococcus pneumoniae among preschool children in Foshan

Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou(510310), China

摘要

摘要: 目的了解健康学龄前儿童肺炎链球菌的同源性和耐药特征, 为阻断疾病传播和指导合理使用抗生素提供依据。方法采用分层整群随机抽样方法, 抽取佛山市顺德区6所幼儿园中1 829名健康儿童, 进行鼻拭子采样并分离鉴定肺炎链球菌; 采用多位点序列分型进行同源性分析; 采用χ²检验、随机森林算法进行耐药特征分析。结果儿童鼻腔肺炎链球菌携带率为22.5%(412名), 多重耐药肺炎链球菌(MDRSP)的携带率为21.3%(390名)。菌株序列型别的同源性分析显示, 6所幼儿园菌株的同源率分别为93.5%(87/93)、91.1%(72/79)、89.2%(58/65)、88.9%(64/72)、86.2%(50/58)、77.8%(35/45);班级内同源率最高达82.8%(48/58), 班级间同源率最高为93.1%(81/87)。肺炎链球菌主要对阿奇霉素(97.1%, 400/412)、红霉素(92.0%, 379/412)、四环素(91.5%, 377/412)耐药; MDRSP主要耐药谱为同时对阿奇霉素、红霉素、复方新诺明、四环素及克林霉素不敏感。随机森林分析提示, MDRSP相关的重要耐药表型变量为阿奇霉素耐药、复方新诺明耐药、四环素耐药、克林霉素耐药、红霉素耐药(平均不纯度减少值分别为8.94, 6.92, 5.80, 4.84, 2.58)。结论幼儿园儿童间肺炎链球菌的交叉传播风险较高, 且直接接触传播是最主要传播途径。幼儿园和相关卫生部门应采取有效措施, 有效预防和阻断肺炎链球菌的传播。
- 链球菌，肺炎 /
- 药物耐受性 /
- 基因 /
- 儿童，学龄前
Abstract: Objective To understand the homology and resistance characteristics of Streptococcus pneumoniae (S. pneumoniae) in healthy preschool children, so as to provide basis for disease transmission prevention and rational use of antibiotics. Methods Stratified cluster random sampling method was used to sample 1 829 healthy children from six kindergartens in Shunde District, Foshan City. Nasal swabs were taken and tested for S. pneumoniae. Multi-locus sequence typing was used for homology analysis. The Chi-squared test and random forest analysis were used to explore the resistance characteristics. Results The nasal carriage rate of S. pneumoniae and multidrug-resistant S. pneumoniae (MDRSP) in children were 22.5%(412/1 829) and 21.3%(390/1 829), respectively. Homology analysis in sequence types showed that the total homology rates of 6 kindergartens were 93.5%(87/93), 91.1%(72/79), 89.2%(58/65), 88.9%(64/72), 86.2%(50/58), 77.8%(35/45), respectively. It was found that the highest homology rate was 82.8% (48/58) within-class and 93.1% (81/87) between classes. S. pneumoniae was mainly resistant to azithromycin (97.1%, 400/412), erythromycin (92.0%, 379/412) and tetracycline (91.5%, 377/412). The dominant multidrug resistance pattern of MDRSP isolates was not sensitive to azithromycin, erythromycin, cotrimoxazole, tetracycline and clindamycin. Random forest analysis indicated that the important phenotypic markers associated with MDRSP were resistance to azithromycin, cotrimoxazole, tetracycline, clindamycin and erythromycin(MDG=8.94, 6.92, 5.80, 4.84, 2.58). Conclusion The risk of cross-transmission of S. pneumoniae among preschool children is high, and direct contact is the main way of transmission. Consequently, kindergartens and health departments should take effective measures to effectively prevent and block the spread of Streptococcus pneumoniae.
- Streptococcus pneumoniae /
- Drug tolerance /
- Genes /
- Child, preschool
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

HTML全文

表 1 MDRSP与non-MDRSP的耐药率比较

Table 1. Comparison of the antibiotic resistance rate between MDRSP and non-MDRSP isolates

菌株	株数	阿奇霉素^a	红霉素	四环素	克林霉素	复方新诺明	头孢噻肟	氯霉素	左氧氟沙星^a
肺炎链球菌	412	400(97.1)	379(92.0)	377(91.5)	357(86.7)	338(82.0)	35(8.5)	31(7.5)	3(0.7)
MDRSP	390	387(99.2)	368(94.4)	367(94.1)	349(89.5)	329(84.4)	35(9.0)	31(7.9)	3(0.8)
non-MDRSP	22	13(59.1)	11(50.0)	10(45.5)	8(36.4)	9(40.9)	0	0	0
χ²值			49.76	57.30	46.32	23.81	1.16	0.92
P值		< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	0.28	0.34	1.00
注： ()内数字为耐药率/%；a表示采用Fisher确切概率法；MDRSP为多重耐药肺炎链球菌，non-MDRSP为非多重耐药肺炎链球菌。

下载: 导出CSV

参考文献(23)

[1]	KARTASASMITA C B, REZEKI HADINEGORO S, KURNIATI N, et al. Epidemiology, nasopharyngeal carriage, serotype prevalence, and antibiotic resistance of streptococcus pneumoniae in Indonesia[J]. Infect Dis Ther, 2020, 9(4): 723-736. doi: 10.1007/s40121-020-00330-5
[2]	付盼, 何磊燕, 王传清, 等. 中国儿童细菌耐药监测组2019年儿童细菌耐药监测[J]. 中国循证儿科杂志, 2021, 16(1): 43-49. FU P, HE L Y, WANG C Q, et al. Antimicrobial resistance profile of clinical isolates in pediatric hospitals in China: report from the ISPED Surveillance Program in 2019[J]. Chin J Evidence-Based Pediatr, 2021, 16(1): 43-49.
[3]	WANG C Y, CHEN Y H, FANG C, et al. Antibiotic resistance profiles and multidrug resistance patterns of Streptococcus pneumoniae in pediatrics: a multicenter retrospective study in mainland China[J]. Medicine(Baltimore), 2019, 98(24): e15942.
[4]	ZHOU M, WANG Z, ZHANG L, et al. Serotype distribution, antimicrobial susceptibility, multilocus sequencing type and virulence of invasive streptococcus pneumoniae in China: a six-year multicenter study[J]. Front Microbiol, 2022, 12: 798750. doi: 10.3389/fmicb.2021.798750
[5]	Clinical and Laboratory Standards Institute. Performance standards forantimicrobial susceptibility testing; 27th ed[J]. Clin Laborat Stand Inst, 2018, 38(3): M100S.
[6]	DING Y, GENG Q, TAO Y, et al. Etiology and epidemiology of children with acute otitis media and spontaneous otorrhea in Suzhou, China[J]. Pediatr Infect Dis J, 2015, 34(5): 102-106. doi: 10.1097/INF.0000000000000617
[7]	DAYIE N T, ARHIN R E, NEWMAN M J, et al. Multidrug-resistant Streptococcus pneumoniae isolates from healthy Ghanaian preschool children[J]. Microb Drug Resist, 2015, 21(6): 636-642. doi: 10.1089/mdr.2014.0314
[8]	VOROBIEVA S J V, FURBERG A S, SLOTVED H C, et al. Epidemiological and molecular characterization of Streptococcus pneumoniae carriage strains in pre-school children in Arkhangelsk, Northern European Russia, prior to the introduction of conjugate pneumococcal vaccines[J]. BMC Infect Dis, 2020, 20(1): 279. doi: 10.1186/s12879-020-04998-5
[9]	KARAMI M, HOSSEINI S M, HASHEMI S H, et al. Prevalence of nasopharyngeal carriage of Streptococcus pneumoniae in children 7 to 14 years in 2016: a survey before pneumococcal conjugate vaccine introduction in Iran[J]. Hum Vaccin Immunother, 2019, 15(9): 2178-2182. doi: 10.1080/21645515.2018.1539601
[10]	PAN H, CUI B, HUANG Y, et al. Nasal carriage of common bacterial pathogens among healthy kindergarten children in Chaoshan region, southern China: a cross-sectional study[J]. BMC Pediatr, 2016, 16(1): 161. doi: 10.1186/s12887-016-0703-x
[11]	TODA H, SATOH K, KOMATSU M, et al. Laboratory surveillance of antimicrobial resistance and multidrug resistance among Streptococcus pneumoniae isolated in the Kinki region of Japan, 2001-2015[J]. J Infect Chemother, 2018, 24(3): 171-176. doi: 10.1016/j.jiac.2017.12.010
[12]	ABAYE G, FEKADU H, HAJI K, et al. Prevalence and risk factors of pneumococcal nasopharyngeal carriage in healthy children attending kindergarten, in district of Arsi Zone, South East, Ethiopia[J]. BMC Res Notes, 2019, 12(1): 253. doi: 10.1186/s13104-019-4283-3
[13]	LIANG Z, FU J, LI L, et al. Molecular epidemiology of Streptococcus pneumoniae isolated from pediatric community-acquired pneumonia in pre-conjugate vaccine era in Western China[J]. Ann Clin Microbiol Antimicrob, 2021, 20(1): 4.
[14]	YAN Z, CUI Y, HUANG X, et al. Molecular characterization based on whole-genome sequencing of Streptococcus pneumoniae in children living in southwest China during 2017-2019[J]. Front Cell Infect Microbiol, 2021, 11: 726740.
[15]	宋相泉, 赖剑秀, 徐菊芳, 等. 携带ermB耐药基因肺炎链球菌血清学分型及ST序列分析[J]. 九江学院学报(自然科学版), 2021, 36(2): 91-95, 124. SONG X Q, LAI J X, XU J F, et al. Analysis on serotypes and ST sequences of streptococcus pneumoniae carrying ermB drug resistance gene[J]. J Jiujiang Univ(Nat Sci Ed), 2021, 36(2): 91-95, 124.
[16]	BOWERS J R, DRIEBE E M, NIBECKER J L, et al. Dominance of multidrug resistant CC271 clones in macrolide-resistant streptococcus pneumoniae in arizona[J]. BMC Microbiol, 2012, 12: 12.
[17]	DELIC S, MIJAC V, GAJIC I, et al. A Laboratory-based surveillance study of invasive neisseria meningitidis, streptococcus pneumoniae, and haemophilus influenzae diseases in a serbian pediatric population-implications for vaccination[J]. Diagnostics(Basel), 2021, 11(6): 1059.
[18]	中华预防医学会, 中华预防医学会疫苗与免疫分会. 肺炎球菌性疾病免疫预防专家共识(2020版)[J]. 中国疫苗和免疫, 2021, 27(1): 1-47. Chinese Preventive Medicine Association, Vaccine and Immunology Branch of the Chinese Preventive Medicine Association. Expert consensus on immunoprophylaxis of pneumococcal disease(2020 version)[J]. Chin J Vaccines Immun, 2021, 27(1): 1-47.
[19]	赵宇燕, 吴居逸, 吴红娟, 等. 儿童呼吸科住院患儿鼻腔及口咽部肺炎链球菌定植状况和耐药性分析[J]. 中国消毒学杂志, 2021, 38(3): 195-197, 200. ZHAO Y Y, WU J Y, WU H J, et al. Analysis of colonization status and drug resistance of streptococcus pneumoniae in nasal cavity and oropharynx of hospitalized children in pediatric respiratory department[J]. Chin J Disinfect, 2021, 38(3): 195-197, 200.
[20]	KIM S H, CHUNG D R, SONG J H, et al. Changes in serotype distribution and antimicrobial resistance of Streptococcus pneumoniae isolates from adult patients in Asia: emergence of drug-resistant non-vaccine serotypes[J]. Vaccine, 2020, 38(38): 6065-6073.
[21]	李梅, 陈正立, 张文超, 等. 儿童急性中耳炎感染肺炎链球菌的药物敏感性及血清型分析[J]. 中国耳鼻咽喉头颈外科, 2020, 27(1): 4-7. LI M, CHEN Z L, ZHANG W C, et al. Antimicrobial susceptibility and serotype analysis of streptococcus pneumonia in children with acute otitis media[J]. Chin Arch Otolaryngol-Head Neck Surg, 2020, 27(1): 4-7.
[22]	XU S, GUO D, LIU X, et al. Ocular pathogens and antibiotic resistance in microbial keratitis over three years in Harbin, Northeast China[J]. Acta Ophthalmol, 2021, 99: 909-915.
[23]	GOLDEN A R, ROSENTHAL M, FULTZ B, et al. Characterization of MDR and XDR Streptococcus pneumoniae in Canada, 2007-13[J]. J Antimicrob Chemother, 2015, 70(8): 2199-2202.