Antimicrobial resistance in four major respiratory bacterial pathogens, Streptococcus pyogenes, Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis

목차 (Table of Contents)

• CONTENTS
• ABSTRACT = 11
• LIST OF PUBLICATIONS = 13
• ABBREVIATIONS = 14
• 1. INTRODUCTION = 15
• 2. ACUTE PHARYNGITIS AND ACUTE OTITIS MEDIA = 16
• 3. BACTERIA CAUSING ACUTE PHARYNGITIS AND ACUTE OTITIS MEDIA = 17
• 3.1 Bacteria causing acute pharyngitis = 17
• 3.2 Bacteria causing acute otitis media = 18
• 3.3 Carriage of Streptococcus pyogenes, Streptococcus pneumoniae, Haemophilus influenzae and Morexella catarrhalis in the healthy upper respiratory tract = 19
• 4. ACQUIRED ANTIMICROBIAL RESISTANCE IN STREPTOCOCCUS PYOGENES, STREPTOCOCCUS PNEUMONIAE, HAEMOPHILUS INFLUENZAE AND MORAXELLA CATARRHALIS = 21
• 4.1 Mechanisms of resistance = 21
• 4.1.1 Resisitance to penicillins and cephalosporins = 21
• 4.1.1.1 β-lactamase-mediated resistance = 22
• 4.1.1.2 Resistance mediated by altered penicillin-binding proteins = 25
• 4.1.2. Resistance to erythromycin and clindamycin = 27
• 4.1.3. Resistance to trimethoprim and sulfonamides = 29
• 4.1.4. Resistance to other antimicrobial agents = 31
• 4.2 The clonal nature of antimicrobial resistance = 32
• 4.3 The prevalence of antimicrobial resistance = 32
• 4.3 The prevalence of antimicrobial resistance in Streptococcus pyogenes, Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis = 34
• 4.3.1 Resistance in Streptococcus pyogenes = 34
• 4.3.2 Resistance in Streptococcus pneumoniae = 34
• 4.3.3 Resistance in Haemophilus influenzae = 36
• 4.3.4 Resistance in Moraxella catarrhalis = 37
• 5. METHODS FOR DETECTION OF ANTIMCROBIAL RESISTANCE = 38
• 5.1 Disk diffusion method = 38
• 5.2 Methods for testing the MIC = 39
• 5.3 Detection of β-lactamases = 41
• 6. AIMS OF THE STUDY = 42
• 7. MATERIAL AND METHODS = 42
• 7.1 Bacterial strains (Table 1) = 42
• 7.1.1 Streptococcus pyogenes strains(Ⅰ,Ⅳ) = 42
• 7.1.2 Streptococcus pneumoniae, Haemophilus influenaze, and Moraxella catarrhalis strains (Ⅱ,Ⅲ,Ⅴ) = 43
• 7.1.2.1 Strains obtained from patients with acute otitis media (otitis strains) = 43
• 7.1.2.2 Strains obtained from healthy children (healthy strains) = 43
• 7.1.2.3 Strains isolated from blood or cerebrospinal fluid (systemic strains) = 45
• 7.2 Identification and typing of bacterial isolates = 45
• 7.2.1 Identification methods (Ⅰ-Ⅴ) = 45
• 7.2.2 Typing methods (Ⅱ,Ⅲ) = 45
• 7.3 Susceptibility testing methods = 46
• 7.3.1 MIC testing (Ⅰ-Ⅴ) = 46
• 7.3.2 Screening method (Ⅰ,Ⅳ) = 47
• 7.3.3 Disk diffusion method (Ⅳ) = 49
• 7.3.4 Methods for detection of β-lactamase activity (Ⅲ,Ⅴ) = 50
• 7.4 Other methods = 50
• 7.4.1 Histogram analysis (Ⅳ) = 50
• 7.4.2 Statistical analysis (Ⅰ-Ⅴ) = 50
• 8. RESULTS AND DISCUSSION = 51
• 8.1 The prevalence of erythromycin resistance in Streptococcus pyogenes (Ⅰ) = 51
• 8.2 The prevalence of resistance in Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis to antimicrobial agents used in treatment of acute otitis media inchildren (Ⅱ,Ⅲ,Ⅴ, unpublished data) = 54
• 8.2.1 Resistance in Stretococcus pneumoniae (Ⅲ, unpublished data0 = 54
• 8.2.2 Resistance in Haemophilus influenzae (Ⅱ) = 57
• 8.2.3 Resistance in Moraxella catarrhalis (Ⅴ, unpublished data) = 59
• 8.2.4 Penicillin resistance in primary acute otitis media of children in Fanland - a conclusion = 60
• 8.3 Detection of antimicrobial resistance in Streptococcus pyogenes, Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis = 61
• 8.3.1 Detection of erythromycin resistance in Streptococcus pyogenes (Ⅳ) = 61
• 8.3.2 Detection of penicillin resistance in Streptococcus pneumoniae (unpublished data) = 62
• 8.3.3 Detection of cefaclor resistance in Haemophilus influenzae9Ⅱ, unpublished data) = 63
• 8.3.4 Detection of resistance to trimethoprim and sulfonamides in Streptococcus pneumoniae and Haemophilus influenzae = 64
• 9. CONCLUSIONS = 65
• ACKNOWLEDGEMENTS = 66
• REFERENCES = 68