慢性副鼻腔炎の細菌学的検討

Bacteriological Study on Chronic Sinusitis

　はじめに

　慢性副鼻腔炎の成因については，細菌感染がすべてではないが大きな要因として存在する。当科では，慢性副鼻腔炎患者に対する内視鏡下鼻内副鼻腔手術時に細菌検査を行ってきた。従来の報告では，検体を上顎洞粘膜や中鼻道分泌物としたものがほとんどであり^1-3），節骨洞粘膜を検体とした報告は多くない^4）。今回われわれは，内視鏡下手術時に部位を確認しつつ採取した節骨洞粘膜を主な検体として細菌学的検討を行った。また術後の経過観察時に感染を起こした例についても細菌検査を行っているのであわせて報告する。

Microbial examination of specimens collected during functional endoscopic sinus surgery for chronic sinusitis (128 patients, 200 sinuses) was performed. Two hundred forty nine strains of bacteria were obtained from 143 sinuses and the microbial detection rate was 71.5% (143 of 200 sinuses), and mixed infection was observed in 50.3% (72 of 143 sinuses). Gram-positive aerobes were found most frequently in both the ethmoid and maxillary sinuses. In the ethmoid sinus, anerobes and Gram-negative aerobes were found more frequently than in the maxillary sinus. Preoperative oral administration of antibiotics resulted in significant decrease of the microbial detection rate. Anaerobes were found more fre-quently after administration of oral antibiotics. The microbial detection rate was not different between the cases previously operated on and the cases not operated, but the rate of mixed infec-tion was significantly higher in the previously operated group. One hundred eighteen strains were isolated from 33 patients during the follow-up periods. Alfa-streptococcus, Staphylococcus aureus, Neisseria, and Pseudomonas aeruginosa were found more frequently compared with the strains detected during the surgery. Xanthomonas maltophilia, MRSA, Streptococcus pneumoniae, and Branhamella catarrhalis were only found in the follow-up course.