Sakata Hiroshi
Department of Pediatrics, Asahikawa Kosei Hospital, 1-24 Asahikawa, Hokkaido, 078-8211, Japan.
J Infect Chemother. 2006 Oct;12(5):338-42. doi: 10.1007/s10156-006-0467-6. Epub 2006 Nov 6.
A total of 16 isolates of Streptococcus pneumoniae and 18 isolates of Haemophilus influenzae were obtained from the blood of children admitted to the pediatric wards of hospitals in Hokkaido Kamikawa subprefecture between January 2003 and December 2005. The ages of the patients with S. pneumoniae or H. influenzae infection ranged from 2 months to 9 years and from 1 month to 4 years, respectively. The diagnoses of S. pneumoniae infection were as follows: pneumonia in 8 patients, occult bacteremia in 5 patients, and meningitis in 3 patients. The diagnoses of H. influenzae were: meningitis in 6 patients, pneumonia in 4 patients, occult bacteremia in 4 patients, epiglotitis in 2 patients, and facial cellulitis in 2 patients. Out of 16 S. pneumoniae isolates, penicillin-resistant strains with a mutation of 3 genes were observed in 7 children, and penicillin intermediate-resistant strains with a mutation of 1 or 2 genes were observed in 8 children. Out of 18 H. influenzae isolates, the beta-lactamase-negative ampicillin-resistant strain with a substitution of 2 points in the ftsI gene was revealed in 2 children, the beta-lactamase-negative ampicillin-resistant strain with a substitution of 1 point in the ftsI gene was observed in 4 children, the beta-lactamase-positive amoxicillin/clavulanic acid-resistant strain with blaTEM-1 and ftsI with 2 substitutions in the ftsI gene was observed in 3 children, and the beta-lactamase-positive ampicillin-resistant strain with blaTEM-1was not observed. The MBC90s of ampicillin, ceftriaxone, cefotaxime, meropenem, panipenem, and vancomycin against S. pneumoniae were 8 microg/ml, 1 microg/ml, 1 microg/ml 1 microg/ml, 0.25 microg/ml, and 0.5 microg/ml, respectively. Those of ampicillin, piperacillin, ceftriaxone, cefotaxime, meropenem, and panipenem against H. influenzae were >128 microg/ml, >128 microg/ml, 0.25 microg/mL, 1 microg/ml, 0.12 microg/ml, and 0.5 g/ml, respectively. It is suggest that the minimum bactricidal concentration (MBC) was dissociated from the minimum inhibitory concentration (MIC) in S. pneumoniae and H. influenzae with abnormal pbp genes.
2003年1月至2005年12月期间，从北海道上川郡医院儿科病房收治儿童的血液中，共分离出16株肺炎链球菌和18株流感嗜血杆菌。肺炎链球菌感染患者的年龄范围为2个月至9岁，流感嗜血杆菌感染患者的年龄范围为1个月至4岁。肺炎链球菌感染的诊断如下：8例肺炎，5例隐匿性菌血症，3例脑膜炎。流感嗜血杆菌的诊断为：6例脑膜炎，4例肺炎，4例隐匿性菌血症，2例会厌炎，2例面部蜂窝织炎。在16株肺炎链球菌分离株中，7名儿童中观察到3个基因突变的耐青霉素菌株，8名儿童中观察到1个或2个基因突变的青霉素中介耐药菌株。在18株流感嗜血杆菌分离株中，2名儿童中发现ftsI基因有2个位点替代的β-内酰胺酶阴性氨苄西林耐药菌株，4名儿童中观察到ftsI基因有1个位点替代的β-内酰胺酶阴性氨苄西林耐药菌株，3名儿童中观察到携带blaTEM-1和ftsI基因有2个替代位点的β-内酰胺酶阳性阿莫西林/克拉维酸耐药菌株，未观察到携带blaTEM-1的β-内酰胺酶阳性氨苄西林耐药菌株。氨苄西林、头孢曲松、头孢噻肟、美罗培南、帕尼培南和万古霉素对肺炎链球菌的MBC90分别为8μg/ml-1μg/ml、1μg/ml、1μg/ml、1μg/ml、0.25μg/ml和0.5μg/ml。氨苄西林、哌拉西林、头孢曲松、头孢噻肟、美罗培南和帕尼培南对流感嗜血杆菌的MBC90分别>128μg/ml、>128μg/ml、0.25μg/mL、1μg/ml、0.12μg/ml和0.5μg/ml。提示肺炎链球菌和流感嗜血杆菌中具有异常pbp基因时，最低杀菌浓度（MBC）与最低抑菌浓度（MIC）分离。
