Yamamoto Akira, Konishi Ichiro, Kumata Masahiro
Health Care Facilities for the Aged, Minoh Life Plaza.
Nihon Ronen Igakkai Zasshi. 2007 May;44(3):359-66. doi: 10.3143/geriatrics.44.359.
Elderly patients living in nursing homes can easily find themselves unable to carry out their daily activities, once they become ill, even with infectious diseases of a slight to mild degree, and rapid treatment is required to cure them of their malaise. However, treatment is often difficult due to the presence of drug-resistant bacteria. This study was designed to evaluate the efficacy of the selective use of antimicrobial agents based on a sensitivity test of isolated bacteria.
Possible pathogenic bacteria were isolated from cultures of pharyngeal swabs or urine obtained from patients with chronic febrile conditions or urinary tract infections, resistant to antimicrobial treatment. The efficacy of the treatment was evaluated based on release from febrile conditions and improvement of activities of daily living (ADL) accompanied by the disappearance of possible pathogenic bacteria following the use of selective antimicrobial agents.
The outcome of 14 cases with sustaining febrile conditions and 3 cases with urinary tract infections was reviewed. Most of them showed a good response to treatment with remarkable improvement in ADL. In some cases, patients were switched from one antimicrobial agent to another each time new pathogenic bacteria were detected in the culture. A combination of rifampicin and sulfamethoxazole/trimethoprim (RFP/ST) was found to be the most convenient and effective treatment in patients with MRSA or drug-resistant Streptococcus pneumoniae. Levofloxacin (LVFX)-resistant Escherichia coli were detected together with MRSA in our 3 patients with urinary tract infections, corresponding to the frequent use of LVFX in our community.
Identification of possible pathogenic bacteria and the use of proper antibiotic agents based on a sensitivity test are very effective in the treatment of elderly patients with chronic febrile conditions arising from the presence of drug-resistant bacteria. Careful use of fluoroquinolones is required in patients in whom MRSA is or had once been detected. This is beneficial not only for the elderly patients themselves but is also useful in preventing the spread of drug-resistant bacteria.
生活在养老院的老年患者一旦生病，即使是轻度至中度的传染病，也很容易发现自己无法进行日常活动，需要迅速治疗以消除不适。然而，由于耐药菌的存在，治疗往往很困难。本研究旨在评估基于分离细菌药敏试验选择性使用抗菌药物的疗效。
从慢性发热患者或对抗菌治疗耐药的尿路感染患者的咽拭子或尿液培养物中分离可能的病原菌。根据使用选择性抗菌药物后发热症状的缓解以及伴随可能病原菌消失的日常生活活动能力（ADL）的改善来评估治疗效果。
回顾了14例持续发热病例和3例尿路感染病例的治疗结果。大多数患者对治疗反应良好，ADL有显著改善。在某些情况下，每次在培养物中检测到新的病原菌时，患者就从一种抗菌药物换用另一种抗菌药物。发现利福平与磺胺甲恶唑/甲氧苄啶联合使用（RFP/ST）是治疗耐甲氧西林金黄色葡萄球菌（MRSA）或耐药肺炎链球菌患者最方便有效的治疗方法。在我们3例尿路感染患者中，发现耐左氧氟沙星（LVFX）的大肠杆菌与MRSA同时存在，这与我们社区频繁使用LVFX相对应。
识别可能的病原菌并根据药敏试验使用合适的抗生素药物，对于治疗因耐药菌引起的慢性发热老年患者非常有效。对于已检测到或曾经检测到MRSA的患者，需要谨慎使用氟喹诺酮类药物。这不仅对老年患者本身有益，而且有助于防止耐药菌的传播。
