Hoshino Tadashi, Ishiwada Naruhiko, Abe Katsuaki A, Ogita Junko, Fukasawa Chie, Sudo Fusayo, Inami Yukiko, Hishiki Haruka, Aizawa Jiro, Ishikawa Nobuyasu, Kurosaki Tomomichi, Nakamura Akira, Kohno Yoichi
Department of Pediatrics, Chiba University Graduate School of Medicine.
Kansenshogaku Zasshi. 2007 Jan;81(1):51-8. doi: 10.11150/kansenshogakuzasshi1970.81.51.
We summarize 41 cases of bacterial meningitis in the last 11 years caused by Haemophilus influenzae. All isolates were serotype b strain (Hib). Initial chemotherapy was started with ceftriaxone (CTRX) in 22 cases, ampicillin plus cefotaxime (CTX) in 9, CTRX plus panipenem/betamipron in 5, and CTX in 2. Some 31 cases were treated mainly with CTRX. Although therapeutic antibiotics showed good susceptibility for isolates, 8 complicated cases (19.5%) occurred. Sequalae were observed in 7 (17.1%) but none were fatal. Five strains with elevated MIC of CTX (0.12 to 1 microg/mL) recovered after 2001, and 3 of 5 strains also showed elevated MIC of CTRX (0.12 to 0.5 microg/mL), but all were cured completely with CTRX. At present, no treatment failures due to antibiotic resistance have been observed, and CTRX remains suitable as initial therapy for Hib meningitis. A decline in susceptibility for third-generation cephalosporin against beta-lactamase-nonproducing ampicillin-resistant H. influenzae is emerging, however, so it will be necessary to consider combination therapy with CTRX given the foreseeable trend in MICs.
我们总结了过去11年中由流感嗜血杆菌引起的41例细菌性脑膜炎病例。所有分离株均为b型菌株(Hib)。22例患者初始化疗采用头孢曲松(CTRX),9例采用氨苄西林加头孢噻肟(CTX),5例采用CTRX加帕尼培南/倍他米隆,2例采用CTX。约31例主要采用CTRX治疗。尽管治疗用抗生素对分离株显示出良好的敏感性,但仍发生了8例复杂病例(19.5%)。7例(17.1%)出现了后遗症,但均无死亡。2001年后分离出5株CTX最低抑菌浓度(MIC)升高(0.12至1微克/毫升)的菌株,其中5株中有3株CTRX的MIC也升高(0.12至0.5微克/毫升),但所有菌株均用CTRX完全治愈。目前,尚未观察到因抗生素耐药导致的治疗失败,CTRX仍然适合作为Hib脑膜炎的初始治疗药物。然而,第三代头孢菌素对不产β-内酰胺酶的氨苄西林耐药流感嗜血杆菌的敏感性正在下降,因此鉴于可预见的MIC趋势,有必要考虑CTRX联合治疗。