小児急性中耳炎の薬剤耐性肺炎球菌と臨床像

抄録

The incidence of acute otitis media caused by drug-resistant strains of Streptococcus pneumonie has increased among the children in Japan.
Sixty-four pneumococcal isolates from the middle ear, otorrhea, or the nasopharynx of 56 children with acute otitis media from February 2001 to January 2003 was evaluated by polymerase chain reaction (PCR) for mutation of penicillin-binding protein (PBP) and other genes. The results showed mutation of all three PBP genes, pbp 1a, pbp 2b, and pbp 2x, in 64.1% of the isolates, while 96.9% were found to possess various PBP gene mutations. The mutation of mef E and erm AM, which contribute the resistance to macrolide, were detected in 56.3% and 31.3%, respectively.
Seventy-nine percent of the 56 children were between 6 to 23 months old. Seventy-six percent were attending day-care centers. Myringotomy was performed in 66.1% of all children. Twenty-nine of the 56 children were hospitalized, and 26 were treated with PAPM/BP. There was no clinical improvement noted after treatment with PAPM/BP in 3 cases. However, they were cured by injecting CTX together with PAPM/BP.
The ratio of penicillin and macrolide-resistant strain in Streptococcus pneumonie were higher than those reported in previous studies. Clinicians who treat children with acute otitis media in hospitals should be alert to the possibility of resistance to multiple antibiotics.