マクロライド長期療法中に肺炎球菌により急性憎悪をきたした慢性下気道感染症例の検討  [in Japanese] Acute Exacerbations due to Streptococcus pneumoniae in Chronic Lower Respiratory Tract Infections during Lng-term Macrolide Therapy  [in Japanese]

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Abstract

マクロライド長期療法中に肺炎球菌により急性増悪をきたした慢性下気道感染症例16例18エピソードについて検討した.急性増悪の病態としては気管支炎が多く肺炎は比較的少なく, 重篤な例はみられなかった. 検出された肺炎球菌18株の薬剤感受性で中等度以上の耐性を示したものはエリスロマイシン (EM) が18株 (100%), クリンダマイシ (CLDM) とミノサイクリ (MINO) とが12株 (67%), アンピシリンが2株 (11%), セファゾリンとイミペネムとが0株 (0%) であり, EMと同時にCLDMとMINOにも耐性の株が半数にみられた. 治療はβラクタム系薬またはキノロン系薬を用い, 全例有効であった. 慢性下気道感染症の標準治療であるマクロライド長期療法中での肺炎球菌による急性増悪に対し, 現在のところこれらの治療で問題なく対処可能と考えられるが, 耐性化の動向には今後も注意が必要である.

In Japan, long-term 14-membered macrolide administration is chosen as a first line therapy against chronic lower respiratory tract infections (CLRTIs) such as diffuse panbronchiolitis, bronchiectasis and chronic bronchitis. However, sometimes acute exacerbations occur in these cases, even if therapy is effective. We investigated 18 episodes of CLRTIs exacerbations that were caused by <I>Streptococcus pneumoniae</I> during long-term macrolides therapy from 1991 to 1999 to clarify the clinical features and prevalence of antimicrobial resistance in <I>S. pneumoniae</I>. Exacerbations did not occur only in winter season, but also in other seasons. Among 18 episodes of exacerbation, only 7 episodes (39%) revealed infiltration in chest roentogenogram and few episodes revealed marked elevations of inflammation markers in laboratory data. Intermediate resistance or resistance rates of <I>S. pneumoniae</I> isolated from sputum or transtracheal aspiration were 100% to erythromycin, 67% to clindamycin or minocycline, 11% to ampicillin, and 0% to cephazoline or imipenem. Coresistance to erythromycin, clindamycin and minocycline was seen in a half of the episodes. Resistance was not correlated with the duration of macrolides administration. All episodes were mainly treated with beta-lactam agents or fluoroquinolones and cured successfully. These findings suggest that acute exacerbations in CLRTIs caused by <I>S. pneumoniae</I> during long-term macrolides therapy do not reveal severe clinical aspects and can be treated successfully at present, but attention should be paid to the trend of antibiotic susceptibility in <I>S. pneumoniae</I>.

Journal

  • Kansenshogaku Zasshi

    Kansenshogaku Zasshi 75(10), 846-850, 2001-10-20

    The Japanese Association for Infectious Diseases

References:  14

Cited by:  1

Codes

  • NII Article ID (NAID)
    10008703880
  • NII NACSIS-CAT ID (NCID)
    AN00047715
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    03875911
  • NDL Article ID
    5950401
  • NDL Source Classification
    ZS9(科学技術--医学--病理学・微生物学・寄生虫学・感染・免疫学・血清学・アレルギー)
  • NDL Call No.
    Z19-193
  • Data Source
    CJP  CJPref  NDL  J-STAGE 
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