Серотипы пневмококков при назофарингеальном носительстве и менингитах, их чувствительность к антибиотикам у детей
DOI:
https://doi.org/10.15574/SP.2016.78.68Ключевые слова:
пневмококки, серотипы, носительство, менингиты, дети, антибиотикиАннотация
Цель — сравнить распределение серотипов пневмококков при назофарингеальном носительстве и менингитах у детей до пяти лет, изучить их чувствительность к антибиотикам.
Пациенты и методы. Обследовано 900 здоровых детей до пяти лет — жителей Киева и Киевской области. Ликвор получен от 89 детей с пневмококковым менингитом из семи дозорных регионов Украины. Использовались классические бактериологические методы и ПЦР. Исследование чувствительности проводилось к 13 антимикробным препаратам.
Результаты. Из 297 штаммов пневмококков, выделенных при назофарингеальном носительстве, 264 (88,9%) штамма принадлежали к капсульным, а 33 (11,1%) — к безкапсульным пневмококкам. Доминирующие серотипы — 19F (25%), 6 (16,1%), 14 (9,8%), 23F (5,3%), 18 (3,0%). Изоляты с серотипами, которые покрываются ПКВ13, составляют 65,5%, (92,6% у детей из домов ребенка). Возбудителем 93,2% пневмококковых менингитов у детей до 5 лет были те же серотипы пневмококков, которые колонизируют носоглотку здоровых детей. Наиболее частым серотипом был 6 (25,8%). Нетипированные штаммы при менингитах определялись в 28% случаев. Серотипы 19F, 14, 23F, 18 были причиной гнойного менингита в 5,6%, 7,9%, 11,2% и 5,6% случаев соответственно. Умеренная резистентность отмечена к защищенным амоксициллинам. Высокой антипневмококковой активностью отличались цефалоспорины III поколения.
Выводы. Возбудителем пневмококковых менингитов у детей в 93,2% случаев являются те же серотипы пневмококков, которые определяются при здоровом носительстве. Данные по антибиотикочувствительности пневмококков у детей при назофарингеальном носительстве можно учитывать при выборе антибиотиков для эмпирической терапии пневмококковых заболеваний. Целесообразно введение пневмококковой конъюгированной вакцины начинать детям из домов ребенка.
Ключевые слова: пневмококки, серотипы, носительство, менингиты, дети, антибиотики.
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