呼吸器感染症患者分離菌の薬剤感受性について(1997年)  [in Japanese] SUSCEPTIBILITIES OF BACTERIA ISOLATED FROM PATIENTS WITH LOWER RESPIRATORY INFECTIOUS DISEASES TO ANTIBIOTICS(1997)  [in Japanese]

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Abstract

1997年10月~1998年9月の問に全国17施設において, 下気道感染症患者440例から採取された検体を対象とし, 分離菌の各種抗菌薬に対する感受性及び患者背景などを検討した。これらの検体 (主として喀痰) から分離され, 起炎菌と推定された細菌512株のうち503株について感受性を測定した。分離菌の内訳は<I>Staphylococcus aureus</I> 100株, <I>Streptococcus pneumoniae</I>81株, <I>Haemophilus influenzae</I>85株, <I>Pseudomonas aeruginosa</I> (non-mucoid株) 71株, <I>Pseudomonas aeruginosa</I> (mucoid株) 27株, <I>Moraxella</I> subgenus <I>Branhamnella catarrhalis</I>33株, <I>Klebsiella pneumoniae</I>17株などであった。<I>S. aureus</I> 100株のうちOxacillinのMICが4μg/ml以上の株 (Methicillin-resistant <I>S. aureus</I>: MRSA) は55.0%検出され, 1996年の67.3%に比べ10%以上減少した。ArbekacinとVancomycinはMRSAに対して強い抗菌力を示し, 本年度もABK耐性株やVCM低感受性株は検出されなかった。<I>S. pneumoniae</I>に対する抗菌力はカルバペネム系薬剤が強くPanipenem, ImipenemのMIC80は0.063μg/mlであった。またペニシリンに低感受性を示す株 (Penicillin-intermediate <I>S. pneumoniae</I>: PISP+Penicillin-resistant <I>S. pneumoniae</I>: PRSP) の分離頻度は1995年の40.3%から緩やかに減少し本年度は30.9%であった。<I>H. influenzae</I>と<I>M.(B.) catarrhalis</I>の各薬剤に対する感受性はいずれも良好であったが, 1995・1996年に比べ両菌種ともCeftazidimeに対して感受性の低下が認められた。<I>P. aeruginosa</I>は多くの薬剤に耐性化を示す傾向にあるが, ムコイド産性株にはMeropenem, Imipenem, Tobramycinの抗菌力が強く, ムコイド非産性株にはTobramycinとCiprofloxacinの抗菌力が比較的強かった。<I>K. pneumoniae</I>はAmpicillinを除く薬剤に対して良好な感受性を示し1996年の成績と比較しても良かった。<BR>患者背景については, 年齢別の分布で70歳以上の高齢者が年々増加しており, 本年度は45.5%を占めた。疾患別の頻度ではあまり変化はなく, 細菌性肺炎が33.6%, 慢性気管支炎が29.1%と多かった。これら感染症からの抗菌薬投与前後における分離菌株数は, 慢性気管支炎では抗菌薬投与後に比べ未投与の症例からの分離株数が多いが, 細菌性肺炎では1995年以降で投与後での分離株数が投与前より多くなっており, 薬剤投与後における<I>S. aureus</I>と<I>P. aeruginosa</I>の分離頻度の増加は, これらの菌の薬剤感受性低下傾向を示唆すると思われる。抗菌薬の投与の有無投与日数ごとの分離菌及び投与薬剤種類別の分離菌についてみると, 投与前に多く分離された菌は<I>S. pneumoniae</I>24.5%, <I>H. influenzae</I>21.4%, <I>S. aureus</I> 18.4%, <I>P. aeruginosa</I> 12.2%などであった。<I>S. aureus</I>は投与15日以上で減少したが, <I>P. aeruginosa</I>は薬剤投与により減少することはなく15日以上では47.8%分離された。投与された薬剤の種類ではペニシリン系及びセフェム系薬剤の投与症例からの分離菌は <I>S. aureus</I>が最も多く31.7~58.3%を占めた。またマクロライド系薬剤投与例では<I>P. aeruginosa</I>の分離頻度が高く50%近くを占めた。

The bacteria isolated from the patients with lower respiratory tract infections were collected by institutions located throughout Japan, since 1981. IKEMOTO et al. have been investigating susceptibilities of these isolates to various antibacterial agents and antibiotics, and analyzed some characteristics of the patients and isolates from them each year. Results obtained from these investigations are discussed.<BR>In these 17 institutions around the entire Japan, 512 strains of presumably etiological bacteria were isolated mainly from the sputa of 440 patients with lower respiratory tract infections during the period from October in 1997 to September in 1998. MICs of various antibacterial agents and antibiotics were determined against 100 strains of <I>Staphylococcus aureus</I>, 81 strains of <I>Streptococcus pneumoniae</I>, 85 strains of <I>Haemophilus influenzae</I>, 71 strains of <I>Pseudomonas aeruginosa</I> (non-mucoid strains), 27 strains of <I>Pseudomonas aeruginosa</I> (mucoid strains), 33 strains of <I>Moraxella</I> subgenus <I>Branhamella catarrhalis</I>, 17 strains of <I>Klebsiella pneumoniae etc</I>., and the susceptibilities of these strains were assessed except for those strains that died during transportation.<BR><I>S. aureus</I> strains for which MICs of oxacillin (MPIPC) were higher than 4 μg/ml (methicillin-resistant <I>S. aureus</I>: MRSA) accounted for 55.0%. The frequency of the drug resistant bacteria decreased comparing to the previous year's 67.3%. Arbekacin (ABK) and vancomycin (VCM) showed the most potent activities against MRSA. Imipenem (IPM) and panipenem (PAPM) of carbapenems showed the most potent activities with MIC80s of 0.063 μg/ml against <I>S. pneumoniae</I>. The frequency of penicillin (PC)-intermediate <I>S. pneumoniae</I> (PISP) + PCresistant <I>S. pneumoniae</I> (PRSP) had decreased gradually, that is, in 1995 the frequency of it was 40.3%, but that was 30.9% in 1997. Against <I>H. influenzae</I> and M.(B.) catarrhalis, all the drugs showed good activities. But the sensitive strains of them against ceftazidime (CAZ) had decreased in 1997, compared those in 1995 and 1996. Meropenem (MEPM), IPM and tobramycin (TOB) showed the most potent activity against <I>P. aeruginosa</I> (mucoid strains). And TOB and ciprofloxacin (CPFX) showed the most potent activities against P aeruginosa (non-mucoid strains). All drugs except ampicillin (ABPC) were more active against <I>K. pneumoniae</I> in 1997 than that in 1996.<BR>Also, we investigated year to year changes in the characteristics of patients, their respiratory infectious diseases, and the etiology. The examination of age distribution indicated that the proportion of patients with ages over 70 years was 45.5% of all the patients showing a slight increase year by year. About the proportion of diagnosed diseases, not so particular changes were recognized as follows: Bacterial pneumonia and chronic bronchitis were the most frequent with 33.6% and 29.1%, respectively. Number of strains isolated from patients before administration of antibiotics were more than those after administration of them in chronic bronchitis, but these had reversed in bacterial pneumonia. The tendency in bacterial pneumonia had been acknowledged since 1995. The increase of <I>S. aureus</I> and <I>P. aeruginosa</I> (both mucoid and non-mucoid strains) isolated after administration of antibiotics, has suggested the decrease of the susceptibility of these strains against antibiotics. Administration of antibiotics has changed the results of the frequency of isolation of bacterial species. Bacterial isolations before administration of antibiotics were as follows: <I>S. pneumoniae</I> 24.5%, <I>H. influenzae</I> 21.4%, <I>S. aureus</I> 18.4% and P aeruginosa 12.2%. The frequencies of <I>S. aureus</I> decreased after antibiotics administration over 15 days, but the frequencies of <I>P. aeruginosa</I> was not affected.

Journal

  • The Japanese Journal of Antibiotics

    The Japanese Journal of Antibiotics 52(5), 353-397, 1999-05-25

    Japan Antibiotics Research Association

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