Goto Hajime, Kumagai Shigeru
Jpn J Antibiot. 2015 Feb;68(1):37-54.
From October 2009 to September 2010, we collected the specimen from 432 patients with lower respiratory tract infections in 16 institutions in Japan, and investigated the susceptibilities of isolated bacteria to various antibacterial agents and patients' characteristics. All of 479 strains that were isolated from specimen (mainly from sputum) and assumed to be bacteria causing in infection, were examined. The isolated bacteria were: Staphylococcus aureus 90, Streptococcus pneumoniae 74, Haemophilus influenzae 82, Pseudomonas aeruginosa (non-mucoid) 60, P. aeruginosa (mucoid) 31, Klebsiella pneumoniae 41, and Moraxella catarrhalis 34. Of 90 S. aureus strains, those with 2 μg/mL or less of MIC of oxacillin (methicillin-susceptible S. aureus: MSSA) and those with 4 μg/mL or more of MIC of oxacillin (methicillin-resistant S. aureus: MRSA) were 43 (47.8%) and 47 (52.2%) strains, respectively. Against MSSA, imipenem had the most potent antibacterial activity and inhibited the growth of all strains at 0.063 μg/mL or less. Against MRSA, vancomycin and arbekacin showed the potent activity and inhibited the growth of all the strains at 2 and 4 μg/mL, respectively. Linezolid also showed the great activity and inhibited the growth of all the strains at 2 μg/mL. Carbapenems and penems showed the most potent activities against S. pneumoniae and panipenem inhibited the growth of all the strains at 0.125 μg/mL. Imipenem and faropenem also had a preferable activity and inhibited the growth of all the strains at 0.25 and 0.5 μg/mL, respectively. In contrast, there were high-resistant strains (MIC: > 128 μg/mL) for erythromycin (51.4%) and clindamycin (35.1%). Against H. influenzae, levofloxacin showed the most potent activity and its MIC90 was 0.063 μg/mL or less. Meropenem showed the most potent activity against P. aeruginosa (mucoid) and its MIC90 was 1 μg/mL. Against the non-mucoid type of P. aeruginosa, tobramycin had the most potent activity and its MIC90 was 2 μg/mL. Against K. pneumoniae, cefozopran had the most potent activity and inhibited the growth of all the strains at 0.125 μg/mL or less. All the antibacterial agents except ampicillin generally showed a potent activity against M. catarrhalis and the MIC90 of them were 2 μg/mL or less. The majority number (60.0%) of the patients with respiratory infection was aged 70 years or older. Bacterial pneumonia and chronic bronchitis accounted for 48.8% and 31.7% of all the respiratory infection, respectively. The bacteria frequently isolated from the patients with bacterial pneumonia were S. aureus (21.5%), S. pneumoniae (20.2%), and H. influenzae (16.7%). S. aureus (21.9%) and P. aeruginosa (20.0%) also were frequently isolated from the patients with chronic bronchitis. The bacteria frequently isolated from the patients were S. pneumoniae (21.5%) and H. influenzae (20.5%) before administration of the antibacterial agents. The bacteria frequently isolated from the patients previously treated with cephems and macrolides were P. aeruginosa, and the isolation frequencies were 28.6% and 47.2%, respectively.
2009年10月至2010年9月,我们从日本16家机构的432例下呼吸道感染患者中采集标本,调查分离细菌对各种抗菌药物的敏感性及患者特征。对从标本(主要是痰液)中分离出的、被认为是引起感染的479株细菌进行了检测。分离出的细菌有:金黄色葡萄球菌90株、肺炎链球菌74株、流感嗜血杆菌82株、铜绿假单胞菌(非黏液型)60株、铜绿假单胞菌(黏液型)31株、肺炎克雷伯菌41株、卡他莫拉菌34株。在90株金黄色葡萄球菌中,苯唑西林最低抑菌浓度(MIC)为2μg/mL及以下的菌株(甲氧西林敏感金黄色葡萄球菌:MSSA)和苯唑西林MIC为4μg/mL及以上的菌株(甲氧西林耐药金黄色葡萄球菌:MRSA)分别为43株(47.8%)和47株(52.2%)。对于MSSA,亚胺培南具有最强的抗菌活性,在0.063μg/mL及以下浓度可抑制所有菌株生长。对于MRSA,万古霉素和阿贝卡星活性最强,分别在2μg/mL和4μg/mL浓度可抑制所有菌株生长。利奈唑胺活性也很强,在2μg/mL浓度可抑制所有菌株生长。碳青霉烯类和青霉烯类对肺炎链球菌活性最强,帕尼培南在0.125μg/mL浓度可抑制所有菌株生长。亚胺培南和法罗培南也有较好活性,分别在0.25μg/mL和0.5μg/mL浓度可抑制所有菌株生长。相比之下,红霉素(51.4%)和克林霉素(35.1%)存在高耐药菌株(MIC:>128μg/mL)。对于流感嗜血杆菌,左氧氟沙星活性最强,其MIC90为0.063μg/mL及以下。美罗培南对铜绿假单胞菌(黏液型)活性最强,其MIC90为1μg/mL。对于非黏液型铜绿假单胞菌,妥布霉素活性最强,其MIC90为2μg/mL。对于肺炎克雷伯菌,头孢唑肟活性最强,在0.125μg/mL及以下浓度可抑制所有菌株生长。除氨苄西林外,所有抗菌药物对卡他莫拉菌一般都有较强活性,其MIC90为2μg/mL及以下。呼吸道感染患者中大多数(60.0%)年龄在70岁及以上。细菌性肺炎和慢性支气管炎分别占所有呼吸道感染的48.8%和31.7%。细菌性肺炎患者中常见分离菌为金黄色葡萄球菌(21.5%)、肺炎链球菌(20.2%)和流感嗜血杆菌(16.7%)。金黄色葡萄球菌(21.9%)和铜绿假单胞菌(20.0%)也常见于慢性支气管炎患者。抗菌药物使用前患者中常见分离菌为肺炎链球菌(21.5%)和流感嗜血杆菌(20.5%)。先前接受头孢菌素类和大环内酯类治疗的患者中常见分离菌为铜绿假单胞菌,分离率分别为28.6%和47.2%。