Tomiyama Michio
Department of Otolaryngology, Tomiyama Clinic, Niigata.
Nihon Jibiinkoka Gakkai Kaiho. 2004 Feb;107(2):156-68. doi: 10.3950/jibiinkoka.107.156.
In recent years, Streptococcus pneumoniae and Haemophilus influenzae have acquired resistance to some drugs; as such, a therapeutic strategy in which penicillins (PCs) are primarily used is currently recommended for the treatment of pediatric upper respiratory tract infections. In 2000, we changed the primary drug used for such infections in patients visiting our hospital from cephems (CEPs) to PCs. We examined the effect of this change on the detection rates of drug-resistant S. pneumoniae (DRSP) and ampicillin (ABPC)-resistant H. influenzae. 1. The subjects consisted of patients who had visited our hospital and received bacteriological examinations during 1999, 2001 or 2003. At the time of the examination, we questioned each patient regarding the medical institutions where they had received oral antibiotic therapy during the past year, how many antibiotic therapies they had received, and which antibiotics they had received. The number of patients who had only received antibiotics from our hospital was 37 out of 52 (71%) patients in 1999, 80 out of 110 (73%) patients in 2001, and 50 out of 71 (70%) patients in 2003. The number of therapies in which only PCs were used was significantly higher in 2001 and 2003 than in 1999. The number of therapies in which only CEPs were used was lower in 2001 and 2003 than in 1999. We believe that this trend reflects our therapeutic strategy. Furthermore, the antibiotic therapies that patients received at other hospitals were thought to have only a small influence on the detection rates of DRSP and ABPC-resistant H. influenzae. 2. The detection rate for DRSP was 30% in 1995 and 60% in 1999. However, the detection rate for DRSP was 37% in 2001 and 39% in 2003, representing a significant decrease from the detection rate in 1999. The detection rate for ABPC-resistant H. influenzae was 26% in 1995 and increased slightly to 36% in 1999. However, the detection rate for ABPC-resistant H. influenzae increased significantly from 36% in 1999 to 59% in 2001 and to 71% in 2003. The reason for this trend is that PCs are considered to be less effective than CEPs against H. influenzae, even though they are more effective than CEPs against S. pneumoniae. 3. We received the patients at our hospital who required hospitalization for the treatment of bacterial infections. In 1999, DRSP was detected in 2 of the 11 (18%) patients who required hospitalization, but no ABPC-resistant H. influenzae strains were detected. ABPC-resistant H. influenzae was detected in 3 of the 12 (25%) patients hospitalized in 2001 and in 4 of the 10 (40%) patients hospitalized in 2003. Thus, the detection rate for ABPC-resistant H. influenzae appears to be increasing. 4. Our findings suggest that the number of DRSP isolates may increase when treatment policies focused on CEPs are employed, while the number of ABPC-resistant H. influenzae isolates may increase when treatment policies are focused on PCs. 5. At present, guidelines focusing on the use of PCs for the treatment of pediatric upper respiratory tract infection are recommended, but standardizing the choice of antibiotics may cause the number of resistant bacteria to increase. When such guidelines are employed at medical institutions, attention should be constantly paid to trends in drug susceptibility. If an increase in one type of resistant bacteria is observed, flexible measures should be taken, without strict adherence to the guideline.
近年来，肺炎链球菌和流感嗜血杆菌已对某些药物产生耐药性；因此，目前推荐主要使用青霉素（PCs）的治疗策略来治疗小儿上呼吸道感染。2000年，我们将我院就诊患者此类感染的主要用药从头孢菌素（CEPs）改为PCs。我们研究了这一改变对耐药肺炎链球菌（DRSP）和耐氨苄西林（ABPC）流感嗜血杆菌检出率的影响。1. 研究对象为1999年、2001年或2003年到我院就诊并接受细菌学检查的患者。检查时，我们询问每位患者过去一年接受口服抗生素治疗的医疗机构、接受抗生素治疗的次数以及所接受的抗生素种类。1999年，仅在我院接受抗生素治疗的患者有52例中的37例（71%），2001年为110例中的80例（73%），2003年为71例中的50例（70%）。2001年和2003年仅使用PCs治疗的次数显著高于1999年。2001年和2003年仅使用CEPs治疗的次数低于1999年。我们认为这一趋势反映了我们的治疗策略。此外，患者在其他医院接受的抗生素治疗被认为对DRSP和耐ABPC流感嗜血杆菌的检出率影响较小。2. 1995年DRSP的检出率为30%，1999年为60%。然而，2001年DRSP的检出率为37%，2003年为39%，与1999年的检出率相比显著下降。1995年耐ABPC流感嗜血杆菌的检出率为26%，1999年略有上升至36%。然而，耐ABPC流感嗜血杆菌的检出率从1999年的36%显著上升至2001年的59%，2003年升至71%。这种趋势的原因是，尽管PCs对肺炎链球菌比CEPs更有效，但对流感嗜血杆菌而言，PCs被认为不如CEPs有效。3. 我们接收我院因细菌感染需要住院治疗的患者。1999年，11例（18%）需要住院治疗的患者中有2例检测出DRSP，但未检测到耐ABPC流感嗜血杆菌菌株。2001年住院的12例（25%）患者中有3例检测出耐ABPC流感嗜血杆菌，2003年住院的10例（40%）患者中有4例检测出耐ABPC流感嗜血杆菌。因此，耐ABPC流感嗜血杆菌的检出率似乎在上升。4. 我们的研究结果表明，采用以CEPs为主的治疗策略时，DRSP分离株数量可能增加，而采用以PCs为主的治疗策略时，耐ABPC流感嗜血杆菌分离株数量可能增加。5. 目前，推荐以使用PCs治疗小儿上呼吸道感染为重点的指南，但规范抗生素的选择可能会导致耐药菌数量增加。医疗机构采用此类指南时，应持续关注药敏趋势。如果观察到某类耐药菌数量增加，应采取灵活措施，而不是严格遵循指南。
