山間地域医療圏における小児急性鼻副鼻腔炎よりの鼻汁検出菌の検討

DOI Web Site 参考文献2件
  • 藤 さやか
    岡山済生会総合病院耳鼻咽喉科 庄原赤十字病院耳鼻咽喉科
  • 竹野 幸夫
    広島大学大学院医歯薬学総合研究科耳鼻咽喉科・頭頸部外科 庄原赤十字病院耳鼻咽喉科

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  • Clinical Consideration of Isolated Bacteria in Nasal Discharge Associated with Acute Rhinosinusitis in Children at the Intermountain Medical Region
  • 臨床 山間地域医療圏における小児急性鼻副鼻腔炎よりの鼻汁検出菌の検討
  • リンショウ サンカン チイキ イリョウケン ニ オケル ショウニ キュウセイ ビ フクビコウエン ヨリ ノ ハナシル ケンシュツキン ノ ケントウ

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To reveal the clinical characteristics of pediatric acute rhinosinusitis in the intermountain region, we performed nasal culture bacteriological tests and examined the background factors and the efficacy of treatments.<br>We collected retrospectively the bacteriological test results, patient background factors, and histories of antibiotic use for 106 pediatric outpatients with acute rhinosinusitis who had undergone nasal culture tests at the Shobara Red Cross Hospital between April 2011 and January 2012. We analyzed the relationship among these factors, the risk of emergence of resistant bacteria, and the therapeutic outcome (cure group/resistant group).<br>There were 67 males and 39 females and the median age was 33.5 months. There were 23 mild cases, 77 moderate cases, and 6 severe cases. We obtained 55 Moraxella catarrhalis strains, 54 Haemophilus influenzae strains, and 29 Streptococcus pneumoniae strains in all 157 strains. These three bacterial species accounted for 88% of all. There were 21 strains of β-lactamase non-producing ampicillin resistant (BLNAR) and 13 strains of penicillin intermediate S. pneumoniae (PISP). Earlier age (5 years and under) was a significant risk factor for the emergence of resistant bacteria unlike in the case of group nursing. The therapeutic outcomes of each severity level were 21/2 (mild), 51/26 (moderate), and 2/4 (severe), respectively. The moderate and severe cases were significantly more resistant to treatment than mild cases. With regard to the moderate cases, both the group of administration of penicillin antibiotic by mouth and non-administration antibiotic group were significantly more resistant to treatment than the group of administration of cephem antibiotic by mouth. Earlier age, group nursing, and presence or absence of resistant bacteria did not affect the severity level and therapeutic outcome unlike in the case of administration of antibiotics.<br>It is important for antimicrobial treatment of pediatric acute rhinosinusitis to use antimicrobials properly according to the scoring system along with an understanding of the clinical background.

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