Shimada Kaoru, Nakano Kunio, Igari Jun, Oguri Toyoko, Ikemoto Hideo, Mori Takeshi, Yokouchi Hiroshi, Yamamoto Makoto, Inoue Hiroshi, Nakadate Toshihide, Suwabe Akira, Okada Shinji, Ashino Yugo, Gejyo Fumitake, Okada Masahiko, Aoki Nobuki, Kitamura Nobuko, Suzuki Yasutoshi, Karasawa Yasuo, Nakata Kouichiro, Nakatani Tatsuo, Inagawa Hiroko, Kudo Kouichiro, Kobayashi Nobuyuki, Tanaka Tsukasa, Kobayashi Hiroyuki, Goto Hajime, Kawai Shin, Takeda Hidenori, Sumitomo Midori, Matsushima Toshiharu, Niki Yoshihito, Kohno Shigeru, Miyazaki Yoshitugu, Yanagihara Katsunori, Hirakata Yoichi, Matsuda Junichi, Nasu Masaru, Hiramatsu Kazufumi, Suga Moritaka, Tosaka Masakazu
Tokyo Senbai Hospital.
Jpn J Antibiot. 2004 Jun;57(3):213-45.
From October 2002 to September 2003, we collected the specimen from 476 patients with lower respiratory tract infections in 16 institutions in Japan, and investigated the susceptibilities of isolated bacteria to various antibacterial agents and patients' characteristics. Of 584 strains that were isolated from specimen (mainly from sputum) and assumed to be bacteria causing in inflammation, 578 strains were examined. The breakdown of the isolated bacteria were: Staphylococcus aureus 77, Streptococcus pneumoniae 103, Haemophilus influenzae 95, Pseudomonas aeruginosa (non-mucoid) 61, P. aeruginosa (mucoid) 23, Klebsiella pneumoniae 36, Moraxella subgenus Branhamella catarrhalis 29, etc. Of 77 S. aureus strains, those with 2 microg/ml or less of MIC of oxacillin (MPIPC) [methicillin-susceptible S. aureus: MSSA] was 34 strains (44.2%) and those with 4 microg/ml or more of MIC of oxacillin (methicillin-resistant S. aureus: MRSA) was 43 strains (55.8%). Against MSSA, imipenem (IPM) and minocycline (MINO) had the most potent antibacterial activity and inhibited the growth of all the strains at 0.25 microg/ml. Although clindamycin (CLDM) and aminoglycosides also had the potent activity, the resistant strains against those agents were detected. Cefotiam (CTM) inhibited the growth of all the strains at 1 microg/ml without the low sensitive strains. Against MRSA, vancomycin (VCM) showed the most potent activity and inhibited the growth of all the strains at 2 microg/ml. Arbekacin (ABK) also showed the relatively potent activity and inhibited the growth of all the strains at 4 microg/ml. Carbapenems showed the most potent activities against S. pneumoniae and inhibited the growth of all the strains at 0.25-0.5 microg/ml. Cefozopran (CZOP) also had a preferable activity (MIC90: 1 microg/ml) and inhibited the growth of all the strains at 2 microg/ml. In contrast, the resistant strains for cefaclor (CCL), erythromycin (EM), CLDM, and tetracycline (TC) were detected in 50.5%, 76.7%, 50.5%, and 80.6% of all the strains, respectively. Against H. influenzae, LVFX showed the most potent activity and inhibited the growth of 92 of all the strains (96.8%) at 0.063 microg/ml. Tobramycin (TOB) showed the most potent activity against P. aeruginosa (both mucoid and non-mucoid) and inhibited the growth of all the strains at 2 microg/ml. The antibacterial activity of CZOP was good and its MIC90 against mucoid and non-mucoid strains was 8 and 16 microg/ml, respectively. CZOP and cefpirome (CPR) were the most potent against K. pneumoniae with 0.125 microg/ml of MIC90. Also, all the agents generally showed potent activities against M. (B.) catarrhalis and the MIC90 of all drugs were 4 microg/ml or less. The approximately half the number (47.5%) of the patients with respiratory infection were aged 70 years or older. As for the incidence by the diseases, bacterial pneumonia and chronic bronchitis were the highest, being noted in 35.7 and 33.8% of all the patients, respectively. The bacteria frequently isolated from the patients with bacterial pneumonia were S. pneumoniae (22.6%). In contrast, S. aureus (16.6%) and P. aeruginosa (13.7%) were relatively frequently isolated from the patients with chronic bronchitis. Before the drug administration, the bacteria frequently isolated from all the patients were H. influenzae (24.5%) and S. pneumoniae (24.2%). In comparison of the isolated bacteria by pretreatment agents, P. aeruginosa was relatively frequently isolated from the patients pretreated with cephems or macrolides and H. influenzae was relatively frequently isolated from the patients pretreated with penicillins.
2002年10月至2003年9月，我们从日本16家机构的476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药物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584株菌株中，检测了578株。分离出的细菌分类如下：金黄色葡萄球菌77株、肺炎链球菌103株、流感嗜血杆菌95株、铜绿假单胞菌（非黏液型）61株、铜绿假单胞菌（黏液型）23株、肺炎克雷伯菌36株、莫拉菌属卡他莫拉菌29株等。在77株金黄色葡萄球菌中，苯唑西林（MPIPC）[甲氧西林敏感金黄色葡萄球菌：MSSA]最低抑菌浓度（MIC）为2μg/ml或更低的有34株（44.2%），苯唑西林MIC为4μg/ml或更高的（耐甲氧西林金黄色葡萄球菌：MRSA）有43株（55.8%）。对于MSSA，亚胺培南（IPM）和米诺环素（MINO）具有最强的抗菌活性，在0.25μg/ml时可抑制所有菌株的生长。虽然克林霉素（CLDM）和氨基糖苷类也具有较强活性，但检测到了对这些药物耐药的菌株。头孢替安（CTM）在1μg/ml时可抑制所有菌株的生长，且无低敏感菌株。对于MRSA，万古霉素（VCM）显示出最强的活性，在2μg/ml时可抑制所有菌株的生长。阿贝卡星（ABK）也显示出相对较强的活性，在4μg/ml时可抑制所有菌株的生长。碳青霉烯类对肺炎链球菌显示出最强的活性，在0.25 - 0.5μg/ml时可抑制所有菌株的生长。头孢唑兰（CZOP）也具有较好的活性（MIC90：1μg/ml），在2μg/ml时可抑制所有菌株的生长。相比之下，在所有菌株中，头孢克洛（CCL）、红霉素（EM）、CLDM和四环素（TC）的耐药菌株分别占50.5%、76.7%、50.5%和80.6%。对于流感嗜血杆菌，左氧氟沙星（LVFX）显示出最强的活性，在0.063μg/ml时可抑制92株（96.8%）所有菌株的生长。妥布霉素（TOB）对铜绿假单胞菌（黏液型和非黏液型）均显示出最强的活性，在2μg/ml时可抑制所有菌株的生长。CZOP的抗菌活性良好，其对黏液型和非黏液型菌株的MIC90分别为8μg/ml和16μg/ml。CZOP和头孢匹罗（CPR）对肺炎克雷伯菌的活性最强，MIC90为0.125μg/ml。此外，所有药物对卡他莫拉菌通常都显示出较强的活性，所有药物的MIC90均为4μg/ml或更低。约半数（47.5%）的呼吸道感染患者年龄在70岁及以上。就疾病发病率而言，细菌性肺炎和慢性支气管炎最高，分别占所有患者的35.7%和33.8%。从细菌性肺炎患者中频繁分离出的细菌是肺炎链球菌（22.6%）。相比之下，金黄色葡萄球菌（16.6%）和铜绿假单胞菌（13.7%）在慢性支气管炎患者中相对频繁分离出。在给药前，从所有患者中频繁分离出的细菌是流感嗜血杆菌（24.5%）和肺炎链球菌（24.2%）。比较经预处理药物后的分离细菌，铜绿假单胞菌在接受头孢菌素或大环内酯类预处理的患者中相对频繁分离出，流感嗜血杆菌在接受青霉素预处理的患者中相对频繁分离出。
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