接种13价肺炎球菌结合疫苗对就诊儿童肺炎链球菌血清型和耐药性的影响

林婉靖; 邵雪君; 张钧; 陶云珍; 冯爽; 张优仪; 陈庆会; 田健美; 赵根明; 张涛

doi:10.16462/j.cnki.zhjbkz.2022.05.013

接种13价肺炎球菌结合疫苗对就诊儿童肺炎链球菌血清型和耐药性的影响

doi: 10.16462/j.cnki.zhjbkz.2022.05.013

林婉靖¹,
邵雪君³,
张钧⁴,
陶云珍³,
冯爽¹,
张优仪¹,
陈庆会²,
田健美^2, ,,
赵根明¹,
张涛^1, ,

1.
200032 上海，复旦大学公共卫生学院流行病学教研室，公共卫生安全教育部重点实验室
2.
215003 苏州，苏州大学附属儿童医院感染科
3.
215003 苏州，苏州大学附属儿童医院检验科
4.
215003苏州，苏州市疾病预防控制中心

基金项目:

辉瑞临床合作项目 W1232403

详细信息

通讯作者:
张涛，E-mail: tzhang@shmu.edu.cn

TIAN Jian-mei, E-mail: tianjianmei@suda.edu.cn

中图分类号: R725.6;R186
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出版历程
- 收稿日期: 2021-08-20
- 修回日期: 2022-01-13
- 网络出版日期: 2022-05-11
- 刊出日期: 2022-05-10

Effect of 13-valent pneumococcal conjugate vaccine on serotypes and antibiotic-resistance of streptococcus pneumoniae in children

1.
Department of Epidemiology, School of Public Health, Fudan University, Key Laboratory of Public Health Safety Ministry of Education, Shanghai 200032, China
2.
Infectious Disease Department, Soochow University Affiliated Children's Hospital, Suzhou 215003, China
3.
Department of Clinical Laboratory Soochow University Affiliated Children's Hospital, Suzhou 215003, China
4.
Suzhou Centers for Disease Control and Prevention, Suzhou 215003, China

Funds:

Pfizer Clinical Research Collaboration W1232403

More Information

Corresponding author: ZHANG Tao, E-mail: tzhang@shmu.edu.cn

摘要

摘要: 目的了解就诊儿童肺炎链球菌(Streptococcus pneumoniae, Spn)血清型分布和耐药特征，探索接种13价肺炎球菌结合疫苗(13-valent pneumococcal conjugate vaccine, PCV13)对Spn的影响。方法收集2017—2019年苏州大学附属儿童医院疫苗接种信息明确的就诊儿童的Spn菌株，根据疫苗接种情况进行分组，并采用荚膜肿胀法进行血清分型，E-test法检测菌株抗生素的耐药性，比较是否接种PCV13对Spn血清型和耐药性的差别。结果共收集692株Spn，其中20株分离自接种PCV13儿童。接种组中常见的血清型为19F、6B、19A、23F，对照组中常见的血清型为19F、6B、23F、19A、14，两组血清型分布差别无统计学意义(P=0.868)，PCV13血清型覆盖率分别为70.0% 和72.4%(P=0.491)。所有菌株对红霉素、四环素、克林霉素高度耐药，且多重耐药率达98.5%。接种组和对照组的Spn菌株对青霉素的不敏感率分别为5.0%和9.1%(P=0.804)。结论苏州大学附属儿童医院监测就诊儿童Spn血清型以PCV13覆盖的血清型为主，菌株对β-内酰胺类抗生素的耐药性有所下降，但对红霉素等其他常用抗菌药物的耐药性依旧严峻，并存在大量的多重耐药情况。尚未观察到接种PCV13对菌株血清型分布及降低抗生素耐药性的明显效果。
- 肺炎链球菌 /
- 13价肺炎球菌结合疫苗 /
- 血清型 /
- 抗生素耐药性 /
- 儿童
Abstract: Objective To investigate the serotype distribution and antibiotic-resistance of Streptococcus pneumoniae (S. pneumoniae) isolated from medical-visiting children, and to explore the effect of 13-valent pneumococcal conjugate vaccine (PCV13) on pneumococcal isolates. Methods The strains of S. pneumoniae isolated from children with confirmed vaccination information in Soochow University Affiliated Children's Hospital (SCH) from 2017 to 2019 were collected. The strains were grouped according to the vaccination status, used quellung reactions to serotype and employed E-test method to determine the antibiotic resistance of strains, and compared the differences in serotypes and antibiotic-resistance between with and without PCV13 vaccination. Results A total of 692 strains of S. pneumoniae were collected, 20 of which were isolated from children vaccinated with PCV13. Serotypes 19F, 6B, 19A and 23F were prevalent in vaccinated children, while serotypes 19F, 6B, 23F, 19A and 14 were common in unvaccinated children. There was no significant difference between the two groups in serotype distribution (P=0.868), and the PCV13 serotype coverage was 70.0% and 72.4%, respectively (P=0.491). All strains were highly resistant to erythromycin, tetracycline and clindamycin, and the multi-antibiotic resistance rate was 98.5%. The unsusceptible rates of penicillin were 5.0% and 9.1% in the vaccinated and unvaccinated groups, respectively (P=0.804). Conclusions Most S. pneumoniae strains from children in SCH were covered by PCV13 serotypes. The resistance of S. pneumoniae to lactams antibiotics was decreased, but the resistance to other commonly used antibiotics such as erythromycin remained severe, and the multi-antibiotic resistance rate was high. No apparent effect of PCV13 on serotype distribution and antibiotic resistance was observed.
- Streptococcus pneumoniae /
- 13-valent pneumococcal conjugate vaccine /
- Serotype /
- Antimicrobial resistance /
- Children

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图 1 接种组和对照组Spn菌株血清型分布

Figure 1. Serotype distribution of S.pneumoniae strains in the vaccinated group and the control group

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表 1 Spn临床分离株的基本情况[n(%)]

Table 1. Characteristics of S.pneumoniae isolates [n(%)]

基本信息	接种组	对照组	合计	基本信息	接种组	对照组	合计
菌株数(株)	20(100.0)	672(100.0)	692(100.0)	菌株收集年份(年)
性别				2017	1(5.0)	70(10.4)	71(10.3)
男性	10(50.0)	444(66.1)	454(65.6)	2018	2(10.0)	351(52.2)	353(51.0)
女性	10(50.0)	228(33.9)	238(34.4)	2019	17(85.0)	251(37.4)	268(38.7)
年龄(岁)				入院第一诊断
0~ < 1	11(55.0)	371(55.2)	382(55.2)	社区获得性肺炎	18(90.0)	596(88.7)	614(88.7)
1~ < 2	8(40.0)	261(38.8)	269(38.9)	急性中耳炎	0(0.0)	8(1.2)	8(1.2)
2~ < 3	1(5.0)	40(6.0)	41(5.9)	下呼吸道感染	0(0.0)	7(1.0)	7(1.0)
菌株来源				脑膜炎	0(0.0)	2(0.3)	2(0.3)
侵袭性	0(0.0)	3(0.4)	3(0.4)	上呼吸道感染	0(0.0)	1(0.1)	1(0.1)
非侵袭性	20(100.0)	669(99.6)	689(99.6)	其他	2(10.0)	58(8.7)	60(8.7)

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表 2 接种组和对照组分离菌株的药敏结果[n(%)]

Table 2. Drug sensitivity of S.pneumoniae strains in the vaccinated group and the control group [n(%)]

抗生素	接种组(n=20)			对照组(n=672)
抗生素	敏感	中介	耐药	敏感	中介	耐药
PEN	19(95.0)	1(5.0)		611(90.9)	57(8.5)	4(0.6)
AMX	12(60.0)	6(30.0)	1(5.0)	472(70.2)	167(24.9)	32(4.8)
CTX ^a	13(65.0)	6(30.0)	1(5.0)	506(75.3)	81(12.1)	85(12.6)
LEV	19(100.0)			671(99.9)	1(0.1)
MXF	20(100.0)			663(100.0)
VCM	20(100.0)			672(100.0)
C	20(100.0)			606(90.2)		66(9.8)
RD	19(100.0)			669(99.6)		3(0.4)
TEL	19(95.0)		1(5.0)	627(94.6)		36(5.4)
EM			20(100.0)	2(0.3)		670(99.7)
TC	1(5.0)		19(95.0)	52(7.7)		620(92.3)
CLT			19(100.0)	16(2.4)		656(97.6)
LZD	20(100.0)			672(100.0)
SXT	3(15.0)	1(5.0)	16(80.0)	66(9.8)	83(12.4)	523(77.8)
QD	2(10.5)		17(89.5)	200(29.8)		472(70.2)
注：PEN-青霉素G；AMX-阿莫西林；CTX-头孢噻肟；LEV-左氧氟沙星；MXF-莫西沙星；VCM-万古霉素；C-氯霉素；RD-利福平；TEL-泰利霉素；EM-红霉素；TC-四环素；CLT-克林霉素；LZD-利奈唑烷；SXT-复方新诺明；QD-喹奴普汀-达福普汀。其中对AMX、LEV、RD、CLT、QD均有1株分离株未进行相应的药敏检测，对MXF和TEL则有9株菌株未检测。^a χ²=6.164, P=0.046。

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表 3 接种组和对照组分离菌株对多种抗生素的耐药模式[n(%)]

Table 3. The resistance modes of S.pneumoniae strains to multiple antibiotics in the vaccinated group and the control group [n(%)]

多重耐药模式	接种组(n=20)	对照组(n=672)
EM+CLT+TC+SXT+QD	7(35.0)	195(29.0)
EM+CLT+TC+SXT+QD+β	6(30.0)	143(21.3)
EM+TC+SXT	1(5.0)	98(14.6)
EM+CLT+TC+SXT	1(5.0)	97(14.4)
EM+CLT+TC+SXT+β	1(5.0)	27(4.0)
EM+CLT+TC+QD	2(10.0)	25(3.7)
EM+CLT+TC+SXT+QD+C	0(0.0)	25(3.7)
EM+CLT+TC+SXT+C	0(0.0)	23(3.4)
EM+CLT+SXT+QD	1(5.0)	12(1.8)
EM+CLT+SXT	0(0.0)	11(1.6)
EM+CLT+TC	0(0.0)	8(1.2)
EM+TC+SXT+β	0(0.0)	6(0.9)
EM+CLT+SXT+QD+β	0(0.0)	6(0.9)
EM+CLT+QD	0(0.0)	5(0.7)
EM+CLT+QD+β	0(0.0)	2(0.3)
EM+CLT+QD+C	0(0.0)	2(0.3)
EM+CLT+SXT+QD+C	0(0.0)	2(0.3)
EM+CLT+TC+SXT+QD+β+C	0(0.0)	2(0.3)
EM+CLT+TC+β	0(0.0)	1(0.1)
EM+CLT+TC+C	0(0.0)	1(0.1)
EM+CLT+SXT+C	0(0.0)	1(0.1)
EM+TC+SXT+C	0(0.0)	1(0.1)
注：PEN-青霉素G；AMX-阿莫西林；CTX-头孢噻肟；LEV-左氧氟沙星；MXF-莫西沙星；VCM-万古霉素；C-氯霉素；RD-利福平；TEL-泰利霉素；EM-红霉素；TC-四环素；CLT-克林霉素；LZD-利奈唑烷；SXT-复方新诺明；QD-喹奴普汀-达福普汀。其中耐药模式包括中介和耐药。

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接种13价肺炎球菌结合疫苗对就诊儿童肺炎链球菌血清型和耐药性的影响

doi: 10.16462/j.cnki.zhjbkz.2022.05.013

通讯作者:
张涛，E-mail: tzhang@shmu.edu.cn

TIAN Jian-mei, E-mail: tianjianmei@suda.edu.cn

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Effect of 13-valent pneumococcal conjugate vaccine on serotypes and antibiotic-resistance of streptococcus pneumoniae in children

Corresponding author: ZHANG Tao, E-mail: tzhang@shmu.edu.cn

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接种13价肺炎球菌结合疫苗对就诊儿童肺炎链球菌血清型和耐药性的影响

doi: 10.16462/j.cnki.zhjbkz.2022.05.013

通讯作者: 张涛，E-mail: tzhang@shmu.edu.cn TIAN Jian-mei, E-mail: tianjianmei@suda.edu.cn

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出版历程

Effect of 13-valent pneumococcal conjugate vaccine on serotypes and antibiotic-resistance of streptococcus pneumoniae in children

Corresponding author: ZHANG Tao, E-mail: tzhang@shmu.edu.cn

计量

出版历程

目录

通讯作者:
张涛，E-mail: tzhang@shmu.edu.cn

TIAN Jian-mei, E-mail: tianjianmei@suda.edu.cn