肺炎链球菌对β-内酰胺类抗生素的耐药机制及疫苗免疫预防的研究进展

Progress on the mechanism of resistance of Streptococcus pneumoniae toβ-lactam antibiotics and vaccine immunoprophylaxis

肺炎链球菌(streptococcus pneumoniae,SP)是儿童呼吸道感染的常见病原体之一,严重感染时可发展为重症肺炎和坏死性肺炎。β-内酰胺类抗生素是治疗SP的临床一线用药,SP对β-内酰胺类抗生素的耐药机制主要是PBPs基因突变,其次是与非PBPs基因如MurM、CpoA、TEM、CiaH/CiaR-TCSS和StkP-PhpP信号耦联相关的基因突变。抗生素的选择压力与疫苗诱导的血清型替换可对SP的耐药性产生影响。19F、19A血清型对β-内酰胺类抗生素具有较高的耐药性,推广13价肺炎链球菌结合疫苗(13-valent pneumococcal conjugate vaccine,PCV13)在预防儿童SP感染方面可能比其他SP疫苗获益更大。

Streptococcus pneumoniae(SP)is one of the common pathogens of respiratory tract infection in children,which can evolve into severe pneumonia and necrotizing pneumonia in case of severe infection.β-lactam antibiotics are the first-line treatment for SP.The resistance mechanism of SP toβ-lactam antibiotics is mainly PBPs gene mutation,followed by mutations related to non-PBPs genes such as MurM,CpoA,TEM,CiaH/CiaR-TCSS and StkP-PhpP signal conjugations.Antibiotic selection pressure and vaccine-induced serotype substitution may influence SP resistance.Serotypes 19F and 19A have high resistance toβ-lactam antibiotics,and promotion of PCV13 may be more beneficial than other SP vaccines in preventing SP infection in children.