Laboratory of Molecular Epidemiology for Infectious Agents, Kitasato Institute for Life Sciences, Kitasato University, 5-9-1 Shirokane, Minato-ku, Tokyo, 108-8641, Japan.
J Infect Chemother. 2013 Feb;19(1):34-41. doi: 10.1007/s10156-012-0448-x. Epub 2012 Jul 18.
In Japan, β-lactamase-nonproducing, ampicillin-resistant organisms have been evident among Haemophilus influenzae type b (Hib) isolates since 2000, when no appropriate vaccine had been approved. We therefore performed molecular analysis of agents causing H. influenzae meningitis nationwide over the following 10 years. Some 285 institutions have participated in surveillance since 2000. The capsular type and resistance genes of 1,353 isolates and 23 cerebrospinal fluid samples from pediatric patients with meningitis we had received from 2000 to 2011 were analyzed by polymerase chain reaction. Blood and spinal fluid test results obtained when patients were admitted were examined for correlation with outcomes. Hib was found in 98.9 % of isolates. We received more than 100 Hib isolates per year until vaccination began in December 2008, when these isolates decreased, especially since establishment of a special fund to promote vaccination in November 2010. Decreased incidence among infants 7 months to 2 years old has been particularly notable. However, the rate of ampicillin-resistant organisms has increased to more than 60 % of all isolates since 2009. We received 587 replies to a questionnaire concerning outcomes, indicating 2 % mortality and 17.7 % serious morbidity. Age of 6 months or younger and presence of disseminated intravascular coagulation at admission were related to an unfavorable outcome (p < 0.05), but ampicillin resistance was not. Combination therapy with third-generation cephem and carbapenem agents was used initially for 72 % of patients. Routine immunization can prevent Hib meningitis in children.
在日本，自 2000 年以来，由于没有批准合适的疫苗，乙型流感嗜血杆菌（Hib）分离株中已出现产β-内酰胺酶、氨苄青霉素耐药的病原体。因此，我们对 2000 年以来的 10 年间全国范围内引起流感嗜血杆菌脑膜炎的病原体进行了分子分析。自 2000 年以来，约有 285 家机构参与了监测。我们通过聚合酶链反应分析了 2000 年至 2011 年期间从儿科脑膜炎患者中收到的 1353 株分离株和 23 份脑脊液样本的荚膜型和耐药基因。检查了患者入院时的血液和脑脊液检测结果与结果的相关性。结果发现，98.9%的分离株为 Hib。在 2008 年 12 月开始接种疫苗之前，我们每年收到的 Hib 分离株超过 100 株，此后这些分离株数量减少，特别是自 2010 年 11 月设立促进接种特别基金以来。7 个月至 2 岁婴儿的发病率下降尤为显著。然而，自 2009 年以来，耐氨苄青霉素的病原体比例已增加到所有分离株的 60%以上。我们收到了 587 份有关结果的问卷回复，表明死亡率为 2%，严重发病率为 17.7%。入院时年龄在 6 个月或以下和弥散性血管内凝血的存在与不良结果相关（p < 0.05），但耐氨苄青霉素耐药性则无关。72%的患者最初接受了第三代头孢菌素和碳青霉烯类药物的联合治疗。常规免疫接种可预防儿童 Hib 脑膜炎。
