保育施設園児における鼻咽腔インフルエンザ菌と肺炎球菌の検討 Survey of Nasopharyngeal Carriage of Haemophilus Influenzae and Streptococcus Pneumoniae in Infants at Day Care Centers

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著者

    • 橋田 光一 HASHIDA Koichi
    • 産業医科大学医学部耳鼻咽喉科 Department of Otorhinolaryngology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu
    • 塩盛 輝夫 SHIOMORI Teruo
    • 産業医科大学医学部耳鼻咽喉科 Department of Otorhinolaryngology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu
    • 北村 拓朗 KITAMURA Takuro
    • 産業医科大学医学部耳鼻咽喉科 Department of Otorhinolaryngology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu
    • 宇高 毅 UDAKA Tsuyoshi
    • 産業医科大学医学部耳鼻咽喉科 Department of Otorhinolaryngology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu
    • 鈴木 秀明 SUZUKI Hideaki
    • 産業医科大学医学部耳鼻咽喉科 Department of Otorhinolaryngology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu

抄録

近年乳幼児における難治性,反復性中耳炎の増加が問題となっており,その要因として薬剤耐性菌の増加,集団保育などが指摘されている.今回我々は夏期•冬期に2集団保育施設園児を対象に,耳鼻咽喉科疾患既往•罹患状況,インフルエンザ菌,肺炎球菌の鼻咽腔検出率,薬剤感受性を検討した.既往歴は中耳炎が最多で,検診結果では鼻•副鼻腔炎が最多であった.インフルエンザ菌検出率は冬期に上昇し,耐性菌比率は冬期に減少した.肺炎球菌検出率は,夏期•冬期ともに40%台で,耐性菌比率は冬期に減少した.耐性菌比率を保育園別にみるとインフルエンザ菌21.6~69.7%,肺炎球菌5.1~48.9%とばらつきがあった.鼻咽腔における保菌の有無,母乳栄養の有無で各疾患の既往に有意差は認められなかったが,冬期の診察所見で,保菌ありの群の鼻•副鼻腔炎の有所見率が有意に高かった.通園期間と保菌率との関係は通園期間3ヵ月以内での保菌率は50.0%で,12ヵ月以降では75~80%であり,ほぼ一定であった.<br>以上より,乳幼児は集団保育施設に入園後,速やかにインフルエンザ菌,肺炎球菌の暴露を受け,入園中は菌の定着が維持されるが,耐性菌比率は時期,対象施設によって大きく異なっていた.今後さらに集団保育児の上気道からの細菌サーベイランスを行い,これらの菌の保菌状態,流行性,耐性率を評価する必要があると考えられた.

Infants at day care centers tend to contract repetitive upper respiratory infections and prolonged otitis media. The increase in antimicrobial-resistant bacteria, particularly in infants, has given rise to a stubborn therapeutic problem. We studied the nasopharyngeal carriage and drug resistance to <i>Haemophilus influenzae</i> (<i>H. influenzae</i>) and <i>Streptococcus pneumoniae</i> (<i>S. pneumoniae</i>), the most common pathogens of upper respiratory infections, in infants at day care centers.<br>Nasopharyngeal cultures of infants between the ages of 0 and 6 years were conducted at two day care centers in July 2004 ("summer"; n=183), and in February 2005 ("winter"; n=182). Isolated <i>H. influenzae</i> and <i>S. pneumoniae</i> were subjected to antibiotic susceptibility tests by broth microdilution. We also conducted an otolaryngological examination and a survey on past and life histories.<br><i>H. influenzae</i> in summer (38.3%) increased significantly in winter (57.7%). β-lactamase-negative and positive ampicillin-resistant <i>H. influenzae</i> (BLNAR+BLPAR) in summer decreased significantly in winter. <i>S. pneumoniae</i> did not differ in summer (42.1%) or in winter (43.4%). Penicillin-resistant and intermediate <i>S. pneumoniae</i> (PRSP+PISP) was 41.3% in summer and decreased significantly to 19.0% in winter. BLNAR+BLPAR and PRSP+PISP differed with the day care center. In otolaryngological examination, rhinosinusitis was commonest (28.4% in summer and 30.8% in winter), followed by allergic rhinitis (8.7% in summer and 6.0% in winter) and otitis media (8.2% in summer and 6.0% in winter). Tonsillitis was minor (0.5% in both seasons). Rhinosinusitis in winter was significantly higher in carriers of <i>H. influenzae</i> and/or <i>S. pneumoniae</i> than in non carriers (36.4% versus 16.0%). Breast-fed infants tended to have less otitis media than bottle-fed infants (38.2% versus 52.9%). <i>H. influenzae</i> and/or <i>S. pneumoniae</i> plateaued (75-80%) after 12 months in day care centers.<br>These results suggest that infants attending day care centers are immediately colonized by <i>H. influenzae</i> and <i>S. pneumoniae</i> in the nasopharynx after entering the centers. Nasopharyngeal drug-resistant <i>H. influenzae</i> and <i>S. pneumoniae</i> varied during the seasons and between day care centers. Further prospective studies are needed to determine upper respiratory tract infection in infants at day care centers and to evaluate carriage, epidemiology, and the drug-resistance rates of these pathogens.

収録刊行物

  • 日本耳鼻咽喉科學會會報  

    日本耳鼻咽喉科學會會報 109(12), 821-829, 2006-12-20 

    The Oto-Rhino-Laryngological Society of Japan, Inc.

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各種コード

  • NII論文ID(NAID)
    10018561516
  • NII書誌ID(NCID)
    AN00191551
  • 本文言語コード
    JPN
  • 資料種別
    ART
  • ISSN
    00306622
  • NDL 記事登録ID
    8634429
  • NDL 雑誌分類
    ZS43(科学技術--医学--耳鼻咽喉科学)
  • NDL 請求記号
    Z19-250
  • データ提供元
    CJP書誌  CJP引用  NDL  J-STAGE 
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