小児急性中耳炎症例における薬剤耐性菌の現況 [in Japanese] Current status of drug resistant bacteria in pediatric patients with acute otitis media [in Japanese]
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I investigated 146 <I>S. pneumoniae</I> strains and 257 <I>H. influenzae</I> strains isolated from the epipharynx of 319 pediatric patients with severe acute otitis media from January 2006 to August 2007, and the detection frequency of drug resistant bacteria, the patients' age and use of day care facilities were analysed. And also the annual change in the detection frequency of drug resistant bacteria in these patients with that reported in 2004 was compared.<BR>1. The risk factors for infection with drug resistant bacteria in these patients included their age, use of day care facilities, administration of antibiotics within the previous month and recurrent otitis media. In this study, the patients received antibiotics within a month before visiting our clinic and those who developed 5 or more recurrent acute otitis media in the preceding 6 months were excluded.<BR>2. The relation between the detection frequency of drug resistant bacteria and their age showed that the drug resistant <I>S. pneumoniae</I> (DRSP) was detected in significantly higher rate in the patients under 3 years of age compared to the patients aged 3 or older, while the detection frequency of ampicillin (ABPC)-resistant <I>H. influenzae</I> showed no differences between these two age groups.<BR>3. The relation between the detection frequency of drug-resistant bacteria and the use of day care facilities in the patients under 3 years of age showed that DRSP and ABPC-resistant <I>H. influenzae</I> were detected with significantly higher frequency in the patients attending a day care facility than in those who did not.<BR>4. Among the patients with infections with drug-resistant bacteria, a special attension should be paid to those with <I>S. pneumoniae</I> infection under 3 years and attending to a day care facility. Amoxicillin/clavulanic acid (AMPC/CVA)(14: 1) was apparently effective in these patients. However, AMPC/CVA (14: 1) was ineffective in some patients under 3 and ABPC-resistant <I>H influenzae</I> was isolated from the majority of them. As the sensitivity of cefditoren (CDTR) to ABPC-resistant <I>H influenzae</I> was favorable, high dose CDTR proved effective in patients with ABPC-resistant H influenzae infections refractory to AMPC/CVA (14: 1).<BR>5. The detection frequency of DRSP was approximately 40% in 2001, 2003 and 2006-2007. Moreover, it was maintained low throughout the country. On the other hand, the detection frequency of ABPC-resistant <I>H influenzae</I> significantly increased in 2006-2007 compared with that in 2001.<BR>These findings indicated that the detection frequency of DRSP could be maintained low by adopting a penicillin-based strategy for the treatment of upper respiratory tract infections in the pediatric patients, while there might be an increase in the detection frequency of ABPC-resistant <I>H influenzae</I>.
- Ear Research Japan
Ear Research Japan 17(5), 627-637, 2007-12-25
THE JAPAN OTOLOGICAL SOCIETY