Konno Masatoshi, Baba Shunkichi, Mikawa Haruki, Hara Kohei, Matsumoto Fumio, Kaga Kimitaka, Nishimura Tadao, Kobayashi Toshimitsu, Furuya Nobuhiko, Moriyama Hiroshi, Okamoto Yoshitaka, Furukawa Mituru, Yamanaka Noboru, Matsushima Toshiharu, Yoshizawa Yasuyuki, Kohno Shigeru, Kobayashi Kunihiko, Morikawa Akihiro, Koizumi Shoichi, Sunakawa Keisuke, Inoue Matsuhisa, Ubukata Kimiko
Teikyo University School of Medicine, Tokyo, Japan.
J Infect Chemother. 2006 Oct;12(5):287-304. doi: 10.1007/s10156-006-0468-5. Epub 2006 Nov 6.
In our first report, we investigated nasopharyngeal bacterial flora related to penicillin-resistant Streptococcus pneumoniae (PRSP) and beta-lactamase-negative ampicillin-resistant Haemophilus influenzae (BLNAR) and their relation to acute upper respiratory tract infection (AURTI). This report analyzes the results of a study of nasopharyngeal bacterial flora before the administration of antimicrobial agents in 172 AURTI patients aged 6 years or younger. In addition to Gram staining, microscopic observation, and culturing, a polymerase chain reaction (PCR) method was used to identify PRSP (gPRSP) and BLNAR (gBLNAR) drug-resistant genes. Of the patients analyzed, 90% had acute otitis media (AOM) and were aged 2 years or younger. The antimicrobial agents administered were amoxicillin (34%), clavulanic acid/amoxicillin (11%), cefditren pivoxil (CDTR-PI) (43%), and others (12%). This was particularly true for patients administered CDTR-PI, among whom there were many who had already suffered one or more episodes of AOM by the age of 1 year or younger, and many in which gPRSP were detected (P < 0.01). There was a significant relation between the degree of nasopharyngeal inflammation indicated by leukocyte infiltration images and the amount of S. pneumoniae and H. influenzae detected, which are the main pathogenic bacteria causing AOM (P < 0.01). In addition to leukocyte infiltration images, there were cases in which shedding of ciliated cells was observed and/or giant monocytic cells. Both nasopharyngeal leukocyte infiltration images and/or shed cell findings observed in infant AURTI cases are important indices for the prompt detection of gPRSP and/or gBLNAR and appropriate doses of antimicrobial agents.
在我们的首份报告中，我们研究了与耐青霉素肺炎链球菌（PRSP）及β-内酰胺酶阴性氨苄西林耐药流感嗜血杆菌（BLNAR）相关的鼻咽部细菌菌群，以及它们与急性上呼吸道感染（AURTI）的关系。本报告分析了172例6岁及以下AURTI患者在使用抗菌药物前的鼻咽部细菌菌群研究结果。除革兰氏染色、显微镜观察和培养外，还采用聚合酶链反应（PCR）方法鉴定PRSP（gPRSP）和BLNAR（gBLNAR）耐药基因。在分析的患者中，90%患有急性中耳炎（AOM）且年龄在2岁及以下。使用的抗菌药物有阿莫西林（34%）、克拉维酸/阿莫西林（11%）、头孢地尼酯匹酯（CDTR-PI）（43%）及其他（12%）。对于使用CDTR-PI的患者尤其如此，其中许多患者在1岁及以下时就已患过一次或多次AOM，且检测到许多gPRSP（P<0.01）。白细胞浸润图像所示的鼻咽部炎症程度与导致AOM的主要病原菌肺炎链球菌和流感嗜血杆菌的检出量之间存在显著关系（P<0.01）。除白细胞浸润图像外，还观察到有纤毛细胞脱落和/或巨单核细胞的病例。婴儿AURTI病例中观察到的鼻咽部白细胞浸润图像和/或脱落细胞结果均是及时检测gPRSP和/或gBLNAR以及确定合适抗菌药物剂量的重要指标。
