Himi K, Miyamoto S, Ohshimi H, Kuroki H, Ishikawa N, Yamazaki T, Namba M, Suzuki H, Uehara S, Niimi H
Department of Pediatrics, Chiba University School of Medicine.
Kansenshogaku Zasshi. 1990 Jun;64(6):725-33. doi: 10.11150/kansenshogakuzasshi1970.64.725.
Recently, isolation of penicillin-resistant S. pneumoniae has been increasing. The first Japanese case of penicillin-resistant pneumococcal meningitis was reported in 1988. We experienced a case of a one-year-old boy with penicillin-resistant pneumococcal meningitis who dead on arrival on his third day of illness. Minimal inhibitory concentration (MIC) of penicillin G or S. pneumoniae isolated from cerebrospinal fluid and blood was 0.6 micrograms/ml. We evaluated the antibiotic susceptibility of 163 strains of S. pneumoniae isolated from children from 1985 to 1988. Penicillin G (PCG), ampicillin (ABPC), cefotaxime (CTX), imipenem (IPM), and vancomycin (VCM) had good susceptibilities to S. pneumoniae. Twelve of the 163 isolates (7.3%) were penicillin-resistant strains whose MIC of PCG were more than 0.1 microgram/ml, and all of them were intermediately resistant. The annual penicillin-resistant rates were 12.5% in 1985, 1.3% in 1986, 0% in 1986, and 19.0% in 1988. We also evaluated the MIC distribution and MIC90 of antibiotics available for meningitis against penicillin-sensitive and -resistant S. pneumoniae. MIC90 of PCG and ABPC against penicillin-resistant strains was 1.56 micrograms/ml, and it might be dangerous to use PCG or ABPC for central nervous system pneumococcal infections. MIC90 of IPM against penicillin-resistant strains was 0.1 microgram/ml, and that of VCM was 0.4 micrograms/ml. There was little fall of susceptibilities of resistant strains in IPM and VCM. We evaluated the MIC distribution and MIC70 of antibiotics for oral usage against penicillin-sensitive and -resistant S. pneumoniae. Although there were falls of susceptibilities of resistant strains in PCG and ABPC, these two antibiotics had the best susceptibilities among the oral antibiotics.
最近，耐青霉素肺炎链球菌的分离率一直在上升。1988年报道了日本首例耐青霉素肺炎球菌性脑膜炎病例。我们遇到一例1岁男孩患耐青霉素肺炎球菌性脑膜炎，在患病第3天到达时已死亡。从脑脊液和血液中分离出的肺炎链球菌对青霉素G的最低抑菌浓度（MIC）为0.6微克/毫升。我们评估了1985年至1988年从儿童中分离出的163株肺炎链球菌的抗生素敏感性。青霉素G（PCG）、氨苄西林（ABPC）、头孢噻肟（CTX）、亚胺培南（IPM）和万古霉素（VCM）对肺炎链球菌有良好的敏感性。163株分离株中有12株（7.3%）是耐青霉素菌株，其PCG的MIC大于0.1微克/毫升，且均为中度耐药。1985年的年度耐青霉素率为12.5%，1986年为1.3%，1987年为0%，1988年为19.0%。我们还评估了可用于治疗脑膜炎的抗生素对青霉素敏感和耐药肺炎链球菌的MIC分布及MIC90。PCG和ABPC对耐青霉素菌株的MIC90为1.56微克/毫升，使用PCG或ABPC治疗中枢神经系统肺炎球菌感染可能有危险。IPM对耐青霉素菌株的MIC90为0.1微克/毫升，VCM的为0.4微克/毫升。耐青霉素菌株对IPM和VCM的敏感性几乎没有下降。我们评估了口服抗生素对青霉素敏感和耐药肺炎链球菌的MIC分布及MIC70。尽管耐青霉素菌株对PCG和ABPC的敏感性有所下降，但这两种抗生素在口服抗生素中敏感性最佳。
