感受性からみた年代別の眼科領域抗菌薬選択2008

Recommended antibiotics for each age group based on sensitivity of microorganism from the eye in 2008

要約　目的：眼科領域での細菌の抗菌薬に対する感受性の報告と，年齢層別の適応。対象と方法：2008年4月までの1年間に198人の結膜炎患者から得られた眼脂を培養同定した。患者の年齢を1歳未満，1～15歳，16～64歳，65歳以上の4群に分けて評価した。結果：総計417株が分離された。コアグラーゼ非産生性ブドウ球菌が30％を占め，バンコマイシン（VCM），セフメノキシム（CMX），モキシフロキサシン（MFLX）に感受性があった。コリネバクテリウムは23％でVCM，CMX，テトラサイクリン（TC）に感受性があった。インフルエンザ菌は7％でエリスロマイシン（EM）とVCM以外のすべての抗生物質に感受性があり，α溶血性連鎖球菌は6％でジベカシン，EM，TC以外のすべてに感受性があった。黄色ブドウ球菌は6％でEM以外のすべてに感受性があった。MRSAは4％を占め，VCM，TC，クロラムフェニコール（CP）のみに感受性があった。結論：TCの眼軟膏が耐性菌の多い高齢者では最も効果があった。VCMとオフロキサシンへの感受性は相互補完的である。点眼の第一選択はCMX，ガチフロキサシン，MFLXである。MRSAにはVCMとCPが有効である。

Abstract.　Purpose：To report the incidence of microorganisms from the eye as related to sensitivity to antibiotics in four age groups. Cases and Method：This study was made on 198 patients with conjunctivitis seen during one year through April 2008. Scrapings from the eye were cultured and identified. Findings were evaluated in 4 age-related groups：under one year,between 1 and 15 years,between 16 and 64 years,and 65 years and over. Results：A total of 417 strains were isolated. Coagulase-negative Staphylococcus was present in 30％ and was sensitive to vancomycin（VCM）,cefmenoxime（CMX）and moxifloxacin（MFLX）. Corynebacterium sp. was present in 24％ and was sensitive to VCM,CMX and tetracycline（TC）. H. influenzae was present in 7％ and was sensitive to all drugs except erythromycin（EM）and VCM. Alpha-hemolytic Streptococcus was present in 6％ and was sensitive to drugs except EM,TC and dibekacin. Staphylococcus aureus was present in 6％ and was sensitive to all except EM. Methicillin-resistant Staphylococcus aureus（MRSA）was present in 5％ and was sensitive to VCM,TC and chloramphenicol（CP）only. Conclusion：TM ointment is most effective for conjunctivitis in elderly persons. Ofloxacin and VCM may be used together as their effect is complementary. CMX,gatifloxacin or MFLX may be used as the first choice for conjunctivitis. VCM or CP is recommended for MRSA.