Shimada K, Nakano K, Ohno I, Okada S, Hayashi K, Yokouchi H, Arakawa M, Gejyo F, Igarashi K, Ikemoto H, Mori T, Okada M, Ozaki K, Igari J, Aoki N, Oguri T, Kitamura N, Terai T, Suzuki Y, Inoue H, Nakadate T, Karasawa Y, Ito C, Yoshida T, Nakata K, Nakatani T, Inagawa H, Ando M, Suga M, Sato K, Kudo K, Kobayashi N, Tosaka M, Hasegawa M, Kohno S, Tomono K, Miyazaki Y, Kobayashi H, Kawai S, Takayasu S, Hirakata Y, Matsuda J, Mochida C, Ito A, Sumitomo M, Nasu M, Nagai H, Matsushima T, Niki Y, Hiramatsu K, Nakano T
Tokyo Senbai Hospital.
Jpn J Antibiot. 2001 Jul;54(7):331-64.
From October 1999 to September 2000, we collected the specimen from 430 patients with lower respiratory tract infections in 17 institutions in Japan, and investigated the susceptibilities of isolated bacteria to various antibacterial agents and antibiotics and patients' characteristics. Of 515 strains that were isolated from specimen (mainly from sputum) and assumed to be bacteria causing in inflammation, 506 strains were investigated. The breakdown of the isolated bacteria were: Staphylococcus aureus 78, Streptococcus pneumoniae 101, Haemophilus influenzae 104, Pseudomonas aeruginosa (non-mucoid) 58, P. aeruginosa (mucoid) 11, Moraxella subgenus Branhamella catarrhalis 41, Klebsiella pneumoniae 18, etc. Of 78 S. aureus strains, those with 4 micrograms/ml or above of MIC of oxacillin (methicillin-resistant S. aureus: MRSA) occupied 57.7%. Vancomycin and arbekacin showed the most potent activities against MRSA without detection of ABK-resistant strain (MIC: 64 micrograms/ml) and decrease of VCM-sensitive strains those were found in 1998. The frequency of S. pneumoniae exhibiting low sensitivity to penicillin (penicillin-intermediate S. pneumoniae: PISP + penicillin-resistant S. pneumoniae: PRSP) decreased to 34.7% from 46.0% in 1998. The frequency of PRSP was 3.0%, being the least number after 1991. Carbapenems showed strong activities against S. pneumoniae. Especially, panipenem inhibited the growth of all 101 strains with MIC of 0.063 microgram/ml. Generally, all drugs showed strong activities against H. influenzae with MIC80s of 4 micrograms/ml or below. MICs of ofloxacin ranged between 0.063 microgram/ml and 4 micrograms/ml in 1998, however, those were 0.125 microgram/ml or below in all H. influenzae in 1999 showing the strongest activity. Tobramycin and ciprofloxacin showed strong activities against P. aeruginosa (both mucoid and non-mucoid) with MIC80s of 1 microgram/ml. Number of isolated P. aeruginosa (mucoid) was little as 11, however, the susceptibilities to all drugs were better than P. aeruginosa (non-mucoid). K. pneumoniae showed good susceptibilities to all drugs except for ampicillin with decreasing of low-sensitive strains compared to those detected in 1998. Also, all drugs generally showed strong activities against M. (B.) catarrhalis. MIC80s of all drugs were 2 micrograms/ml or below. The drug which showed the strongest activity was imipenem inhibiting all 41 strains with MIC of 0.063 microgram/ml. On the patients' characteristics, the number of patients aged 80 years or older who had been increased was decreased in 1999 in the distribution by age. The percentage of the elderly patients aged 70 years or older was 47.0%, which occupied almost a half number of the total patients as in the last year. As for the incidence by disease, bacterial pneumonia and chronic bronchitis were the highest. They were noted in 37.9% and 30.5% of the patients, respectively. In 1999, bronchial asthma was frequently observed as compared in recent years. It was noted in about 10% of the patients which is the same % as in bronchiectasis. We examined the number of strains from these patients with infections before and after administration of antibiotics. In patients with bacterial pneumonia, the number of isolated strains was almost the same between those before and after administration. However, in patients with chronic bronchitis, the number of strains remarkably decreased to less than the half of the total after administration of antibiotics in the last year, but it decreased to 2/3 of the total in 1999. On the administration of antibiotics and isolated bacteria by the day of administration, the bacteria which were isolated more before administration were H. influenzae in 28.4%, S. pneumoniae in 25.7%, M. (B.) catarrhalis in 12.0% and S. aureus in 10.6%. The frequency of S. aureus after administration over 15 days was almost the same as that before administration, but the frequency of P. aeruginosa (both mucoid and non-mucoid) was 36.8% which was higher than that before administration. The frequency of isolated S. pneumoniae was decreased after administration and none of them was isolated after completion of administration. However, that of H. influenzae was decreased to 7.1% after administration within 3 days, and many H. influenzae were isolated after completion of administration as 21.4%.
1999年10月至2000年9月,我们从日本17家机构的430例下呼吸道感染患者中采集标本,调查分离出的细菌对各种抗菌剂和抗生素的敏感性以及患者的特征。从标本(主要是痰液)中分离出并假定为引起炎症的细菌的515株菌株中,对506株进行了调查。分离出的细菌分类如下:金黄色葡萄球菌78株、肺炎链球菌101株、流感嗜血杆菌104株、铜绿假单胞菌(非黏液型)58株、铜绿假单胞菌(黏液型)11株、莫拉菌属卡他布兰汉菌41株、肺炎克雷伯菌18株等。在78株金黄色葡萄球菌中,苯唑西林MIC为4μg/ml及以上的菌株(耐甲氧西林金黄色葡萄球菌:MRSA)占57.7%。万古霉素和阿贝卡星对MRSA显示出最强的活性,未检测到阿贝卡星耐药菌株(MIC:64μg/ml),且1998年发现的万古霉素敏感菌株数量有所减少。对青霉素表现出低敏感性的肺炎链球菌(青霉素中介肺炎链球菌:PISP + 耐青霉素肺炎链球菌:PRSP)的频率从1998年的46.0%降至34.7%。PRSP的频率为3.0%,是1991年以来最少的。碳青霉烯类对肺炎链球菌显示出强大的活性。特别是,帕尼培南抑制了所有101株菌株的生长,MIC为0.063μg/ml。一般来说,所有药物对流感嗜血杆菌都显示出强大的活性,MIC80s为4μg/ml或更低。1998年氧氟沙星的MIC范围在0.063μg/ml至4μg/ml之间,然而,1999年所有流感嗜血杆菌的MIC均为0.125μg/ml或更低,显示出最强的活性。妥布霉素和环丙沙星对铜绿假单胞菌(黏液型和非黏液型)均显示出强大的活性,MIC80s为1μg/ml。分离出的铜绿假单胞菌(黏液型)数量很少,仅11株,但其对所有药物的敏感性均优于铜绿假单胞菌(非黏液型)。肺炎克雷伯菌对除氨苄西林外的所有药物均显示出良好的敏感性,与1998年检测到的低敏感菌株相比有所减少。此外,所有药物一般对卡他布兰汉菌都显示出强大的活性。所有药物的MIC80s均为2μg/ml或更低。显示出最强活性的药物是亚胺培南,抑制了所有41株菌株的生长,MIC为0.063μg/ml。关于患者特征,按年龄分布,1999年80岁及以上患者数量增加的情况有所减少。70岁及以上老年患者的百分比为47.0%,几乎占总患者数的一半,与去年相同。就疾病发病率而言,细菌性肺炎和慢性支气管炎最高。分别在37.9%和30.5%的患者中发现。1999年,支气管哮喘的发病率较近年来有所增加。在约10%的患者中发现,与支气管扩张的发病率相同。我们检查了这些感染患者在使用抗生素前后的菌株数量。在细菌性肺炎患者中,使用前后分离出的菌株数量几乎相同。然而,在慢性支气管炎患者中,使用抗生素后菌株数量显著减少,降至去年总数的一半以下,但在1999年降至总数的2/3。关于按给药日的抗生素使用情况和分离出的细菌,给药前分离较多的细菌为流感嗜血杆菌(28.4%)、肺炎链球菌(25.7%)、卡他布兰汉菌(12.0%)和金黄色葡萄球菌(10.6%)。给药15天后金黄色葡萄球菌的频率与给药前几乎相同,但铜绿假单胞菌(黏液型和非黏液型)的频率为36.8%,高于给药前。给药后肺炎链球菌的分离频率降低,给药结束后未分离到。然而,流感嗜血杆菌在给药后3天内降至7.1%,给药结束后有许多流感嗜血杆菌被分离到,为21.4%。