Kei Mori

経気管吸引法 (TTA) による嫌気性菌呼吸器感染症の臨床的検討

We evaluated the clinical and bacteriologic features in the patients with bronchopulmonary infections isolated anaerobes from transtracheal aspirates between April 1990 and March 1998. Some anaerobe was isolated in 42 (10.9%) in 387 patients whom we performed transtracheal aspiration (TTA), in 42 (15.7%) of 268 in whom some organism was isolated from TTA, or in 42 (16.3%) of 257 patients in whom some bacterium excluding acid-fast bacteria, fungi or mycoplasma from TTA. The isolation rate of anaerobic bacteria was 93.3% in the patients with lung abscess, 22.7% in the patients with nosocomial pneumonia, 19.4% in the patients with community-acquired pneumonia, 26.7% in the patients with acute exacerbation of chronic lower respiratory tract infection (CLRTI), 1.6% in the patients with persistent infection of CLRTI, and 3.0% in the patients with acute bronchitis, respectively. The major anaerobes, isolated from TTA, were Peptostreptococcus micros and Prevotella melaninogenica. The aerobic bacteria were isolated with anaerobic bacteria in 32 of 42 patients at the same time. The quantitive grade of colonial growth of anaerobes was equal to or more than aerobes in the patients with lung abscess and pneumonia. We mostly administrated 3rd generation cephems or carbapenems with or without clindamycin for the treatment of anaerobic infections. Forty-one of 42 patients were cured only by the therapy of antimicrobial agents, but pneumonia patient with lung cancer died in spite of adequate antimicrobial therapy. These results suggest that the anaerobic infections are important in the bronchopulmonary infections.

経気管吸引法 (TTA) にてムコイド型緑膿菌を検出した呼吸器感染症の臨床的検討

We performed a clinical study of 20 cases (33 episodes) of respiratory infections due to mucoid Pseudomonas aeruginosa by transtracheal aspiration (TTA) in the recent 10 years. There was only one pneumonia without underlying chronic lower respiratory infection (CLRTI) case positive for mucoid P. aeruginosa and others were all CLRTI among 33 TTA trials. In contrast, nonmucoid P. aeruginosa was recovered from 9 cases of respiratory infections without underlying CLRTI among 46 TTA trials. Monomicrobial infection of mucoid P. aeruginosa was 69.7%, and polymicrobial infection containing mucoid P. aeruginosa was 30.3%, and Haemophilus influenzae was the most frequent microorganism recovered with mucoid P. aeruginosa. The recovery rate of mucoid P. aeruginosa among P. aeruginosa-colonized cases was 56.3% in diffuse panbronchiolitis, and that was 42.9% and 40.0% in bronchiectasis and chronic bronchitis, respectively. Mortality due to pneumonia with nonmucoid P. aeruginosa was 46.1%, but there was no fatal pneumonia case with mucoid P. aeruginosa. In CLRTI, laboratory data were not remarkably different between mucoid and non-mocoid P. aeruginosa-colonized cases. Thus, these results suggest that mucoid P. aeruginosa is a more important organism in persistent infections in the lower respiratory tract compared with nonmucoid P. aeruginosa, and further investigations is required on the mechanism and clinical role of this infection.

MRSA及びPRSP(PISPも含む)の検出状況と緑膿菌の薬剤感受性に関する2004年近畿地区アンケート報告

序 文 様々な市中感染症・院内感染症を来す原因菌の中で も,メチリシン耐性ブドウ球菌(MRSA)やペニシリ ン耐性肺炎球菌(PISP,PRSP),そして薬剤耐性緑 膿菌はその分離頻度の高さや患者予後に与える影響の 大きさなどから非常に大きな問題になっている.近畿 感染症研究会は 1995 年に近畿地区における感染症に 関する研究を行うための会として発足し,世話人を中 心に,会の趣旨に賛同された医師,薬剤師,臨床検査 技師等によって年 1回の学術集会を基本的な活動の場 として運営されている.また,発足時より近畿地区に おける細菌の耐性化を疫学調査するためにアンケート 調査を毎年実施してきている.今回,2004 年度の調 査結果がまとまったので報告する. 対象と方法 調査期間は 2004 年 10 月 1 日~12 月 31 日までの 3 カ月間とした.対象医療機関は近畿地区(大阪,奈良, 和歌山,兵庫,京都)の 31 の医療施設(病床数 108~ 1,064 床)で,1995 年より用いているアンケート用紙 (1997 年に一部改変)を用いてアンケート調査を依頼 し,回答のあった施設の結果を解析した.アンケート の内容は,(1)各施設のベッド数,(2)薬剤感受性試 験の方法(寒天平板希釈法,微量液体希釈法(自動機 器,手法,ディスク法),(3)期間中に検出された入 院・外来別の黄色ブドウ球菌の株数とそのうち MRSAの株数,(4)期間中に検出された入院・外来 別の肺炎球菌の株数とそのうち PISP と PRSP をあわ せた株数,(5)期間中に検出された入院・外来別の緑 膿菌の株数とその各種抗菌薬の感受性,についてであ る. 成 績 1.調査施設の概要と細菌感受性試験の方法 調査施設は院内に細菌検査室をもつ近畿地区の病院 全 31 医療施設である.病床数と施設数の関係は,病 床数が 0~200 床の施設が 4施設,201~400 床が 10 施設,401~600 床が 4施設,601~800 床が 8施設, 801~1,000 床が 2施設,1,000 床以上が 3施設である. また,細菌感受性の方法としては,寒天平板希釈法を 用いている施設はなく,微量液体希釈法(自動機器測 定)が 28 施設(マイクロスキャン 22 施設,バイテッ ク 2 4 施設,MIC2000 1 施設,セプター 1施設),微 量液体希釈法(手法測定)が 5施設,ディスク法が 15 施設(センシディスク 9施設,KBディスク 5施設, センシ・KBディスク 1施設,SN・KBディスク 1施 設)であった(重複回答可). 2.MRSAの分離頻度について 調査期間中に分離された黄色ブドウ球菌は 7,298 株 であり,そのうち 4,167 株(57.1%)がMRSAであっ た.その内訳を入院と外来別にみると,入院では 4,764 株中 3,378 株(70.9%)がMRSAで,外来でも 2,534 株中 791 株(31.2%)がMRSAであった. 3.PRSP の分離頻度について 肺炎球菌の分離総数は 1,133 株であり,そのうち PRSP(PISP を含む)は 707 株(62.4%)であった. 入院と外来別では,入院 461 株中 284 株(61.5%), 短 報

Idiopathic esophageal ulcer which was related with the diagnosis of HIV infection.

わが国ではhuman immunodeficiency virus (HIV) 感染者の増加が指摘されている. その診断契機は, acquired immunodeficiency syndrome (AIDS) 指標疾患以外にもさまざまである. 我々は, 食道潰瘍がHIV感染症の診断契機となり, 生検所見と治療経過から特発性食道潰瘍と診断した症例を経験したので報告する. HIV感染症は, 多彩な合併症を認めるので, 病態を総合的に判断して診断機会を逃さないようにする必要があると考える.

慢性下気道感染症患者における血清中IL-6, TNFαと病態との関連性の検討

In the present study, we assessed the serum level of IL-6 and TNF-alpha by ELISA in patients with chronic lower respiratory tract infection. The serum levels of IL-6 and TNF-alpha of patients in acute exacerbation phase are higher than that of in stable phase. We also classified patients in acute exacerbation phase into two groups according to the microorganism of persistent infection. The serum level of IL-6 and TNF-alpha in the patients with persistent infection with Pseudomonas aeruginosa were higher than that with Haemophilus influenzae. Moreover, the serum level of IL-6 and TNF-alpha were found to be related with malnutrition which assessed by clinical indices such as the serum level of albumin and cholinesterase. The present result suggests that IL-6 and TNF-alpha may have relationship with not only inflammation in airway but also indices of nutrition in patients with chronic lower respiratory tract infection.

Determination of the Neutrophil Function in the Respiratory Infection by Chemiluminescence (CL)

We measured the chemiluminescent activity (CL-index) in both the whole blood and isolated neutrophils from 12 patients with acute respiratory infection (7 cases; pneumonia, 4 cases; in the exacerbated phase, chronic lower tract infection, and one; acute bronchitis) two times per each case: before and after chemotherapy. Before the initiation of chemotherapy, neutrophil and whole blood CL was high but whole blood CL was higher. After the completion of chemotherapy, whole blood CL was decreased more significantly than neutrophil CL. There was no correlation between neutrophil CL and whole blood CL. However the neutrophil CL-index.N (neutrophil numbers x neutrophil CL-index) was correlated with the whole blood CL. Thus, we think the number of neutrophils is a critical factor for phagocytic function of neutrophils as determined by CL.