入院加療を要した急性中耳炎難治症例の検討

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  • Changing Trends of Hospitalized Children Due to Intractable Acute Otitis Media: 2007–2014
  • 入院加療を要した急性中耳炎難治症例の検討 : 2007年から2014年
  • ニュウイン カリョウ オ ヨウシタ キュウセイ チュウジエン ナンチ ショウレイ ノ ケントウ : 2007ネン カラ 2014ネン
  • ―2007年から2014年―

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<p>We previously reported that the number of hospitalized children with intractable acute otitis media had increased from 1990 to 2000 because of increasing penicillin-resistant Streptococcal pnuemoniae, and it has gradually declined through to 2006.</p><p>In this study, we performed clinical investigations for 17 patients affected with intractable acute otitis media between 2007 and 2014. The subjects were 8 boys and 9 girls of the age from 7 months to 18 months (median 14 months). Twelve patients (70.6%) were in daycare centers. The average number of patients per year in the period from 2007 to 2014 was 2.1, which is apparently decreased compared to that in 2000 of 24.</p><p>The isolated bacteria from ear discharges were Streptococcus pnuemoniae in 5 patients and Haemophilus influenzae in 5 patients. Bacteria were not detected from ear discharge in 7 of 17 patients. Among 5 isolated Streptococcus pnuemoniae, 1 was penicillin sensitive Streptococcus pneumonia (PSSP), 2 were penicillin intermediate resistant Streptococcus pneumonia (PISP) and another 2 were penicillin resistant Streptococcus pneumonia (PRSP). Haemophilus influenzae, β-lactamase negative ampicillin sensitive (BLNAS) were detected in 2 patients, and β-lactamase negative ampicillin intermediate resistant (BLNAI), β-lactamase negative ampicillin resistant (BLNAR) and β-lactamase positive AMPC-CVA resistant (BLPACR) were detected in 1 patient each. Seven patients were hospitalized with antibiotics side effects. Fourteen patients were tested for immunological immaturity, 4 patients showed low levels of IgG2 (<80 mg/dl).</p><p>Declines in hospitalizations for intractable acute otitis media were sustained through 2014. It has been considered that factors of declining acute otitis media due to antibiotic resistant bacteria were the introduction of pneumococcal vaccine, the issue of clinical practice guidelines for the diagnosis and management of acute otitis media in children in Japan, and the changing indication of some new antibiotics for children. To sustain current situation, we have to continue monitoring the appropriate usage of antibiotics and the change/emergence of drug-resistant strains.</p>

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