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下気道由来検体から分離されたβ -lactamase non-producing ampicillin resistant Haemophilus influenzae(BLNAR)の分離頻度と薬剤感受性


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Title: 下気道由来検体から分離されたβ -lactamase non-producing ampicillin resistant Haemophilus influenzae(BLNAR)の分離頻度と薬剤感受性
Other Titles: The prevalence of β -lactamase non-producing ampicillin-resistant Haemophilus influenzae (BLNAR) isolated from respiratory samples and investigation of the susceptibility trends in Nagasaki University Hospital from 2000 to 2006
Authors: 中村, 茂樹 / 栁原, 克紀 / 森永, 芳智 / 木谷, 貴嘉 / 松田, 淳一 / 泉川, 公一 / 関, 雅文 / 掛屋, 弘 / 山本, 善裕 / 田代, 隆良 / 上平, 憲 / 河野, 茂
Authors (alternative): Nakamura, Shigeki / Yanagihara, Katsunori / Morinaga, Yoshitomo / Kiya, Takayoshi / Matsuda, Junichi / Izumikawa, Koichi / Seki, Masafumi / Kakeya, Hiroshi / Yamamoto, Yoshihiro / Tashiro, Takayoshi / Kamihira, Simeru / Kohno, Shigeru
Issue Date: Jan-2009
Publisher: 日本化学療法学会 / Japan Society of Chemotherapy
Citation: 日本化学療法学会雑誌, 57(1), pp.32-36; 2009
Abstract: 2000 年から2006 年までに当院で喀痰など下気道呼吸器検体より分離されたβ -lactamase nonproducing ampicillin(AMP)-resistant Haemophilus influenzae(BLNAR)のretrospective な検討を行った。また保存された下気道呼吸器検体由来BLNAR 43 株を対象に薬剤感受性試験を行い,有効抗菌薬の検討を行った。β ―ラクタム系抗菌薬耐性の判定はCLSI (Clinical Laboratory and Standards Institute)のAMP 耐性基準を参考に感受性菌(AMP MIC≦1 μ g mL),中間耐性菌(AMP MIC=2 μ g mL),耐性菌(AMP MIC≧4 μ g mL)に分類した1)。β ―ラクタマーゼ産生株は減少傾向を示していたが,BLNARは徐々に増加傾向を示し,2006 年度には中間耐性株と耐性株を合わせると50% 超に達していた。薬剤感受性試験ではペニシリン系抗菌薬,セフェム系抗菌薬ではpiperacillin(PIPC),ceftazidime(CAZ),ceftriaxone(CTRX)は良好な感受性を有していたが,cefotiam(CTM),cefotaxime(CTM),cefepime(CFPM)の感受性は低下していた。またカルバぺネム系抗菌薬ではmeropenem(MEPM)とdoripenem(DRPM)は良好な感受性を有していたがimipenem(IPM),biapenem(BIPM)の感受性は低下していた。マクロライド系抗菌薬ではazithromycin(AZM)が最も優れていた。フルオロキノロン系抗菌薬(levofloxacin;LVFX,gatifloxacin;GFLX,moxifloxacin;MFLX)はすべて良好な感受性を有していたが,1 株のみLVFX 感受性が1 μ g mL と低下した株を認めた。小児科領域だけでなく呼吸器内科領域でもBLNAR は急速に増加しており,今後,市中肺炎や慢性気道感染症などの治療に難渋する症例が増えることが懸念される。また同系統抗菌薬間でもBLNAR に対する抗菌活性に差を認めることから,H. influenzae 感染症治療の際には抗菌薬選択に注意が必要である。 / The prevalence of strains with ampicillin(AMP) resistance among Haemophilus influenzae (H. influenzae) isolated from the lower respiratory tract has been increasing significantly during the 7 years from 2000, when it was 0%, to 2005, when it reached 29.7%. From 2006, the ratio of β -lactam resistant strains, which is β -lactamase non-producing AMP-resistant H. influenzae(BLNAR) strains with a minimum inhibitory concentration(MIC) of AMP of over 4 μ g mL and intermediate strains (MIC of AMP; 2 μ g mL), exceeded 50%. The prevalence of beta-lactamase positive strain has been decreasing from levels reported in previous studies to 1.8% in 2006. We measured the drug susceptibility test of BLNAR isolated from 2000―2006 to several currently approved antimicrobial agents. Piperacillin, ceftazidime, ceftriaxone had good potency, but the susceptibility of cefotiam, cefotaxime, cefepime were decreased. Meropenem and doripenem had good susceptibility, but imipenem and biapenem revealed low susceptibility. Azithromycin is the most effective drug in macrolides. All fluoroquinolones (levofloxacin, gatifloxacin, moxifloxacin) had good potency against H. influenzae, but one strain was levofloxacin low-susceptible (MIC=1.0 μ g mL). BLNAR has been increasing rapidly not only in pediatric but also respiratory tract medicine. It is important to realize the trends of drug resistant pathogens and effective antimicrobial agents, especially against BLNAR because there is difference of the drug susceptibility during the same groups.
Keywords: adult community acquired pneumonia / Haemophilus influenzae / β-lactamase non-producing ampicillin resistant Haemophilus influenzae / drug resistance
URI: http://hdl.handle.net/10069/24484
ISSN: 13407007
Rights: © 日本化学療法学会 2009
Type: Journal Article
Text Version: publisher
Appears in Collections:Articles in academic journal

Citable URI : http://hdl.handle.net/10069/24484

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