- 期刊
急性鼻及鼻竇炎細菌抗藥性之三年分析
A Three-years Analysis of Bacterial Resistance in Acute Rhinosinusitis
摘要
背景：台灣細菌的抗藥性在世異名列前矛，近年來更成為衛生一與全國民眾關注的焦點。2001年7月健保對一般急性上呼吸道炎限制使用抗生素，11月將erythromycin從第一線抗生素中除名，同時衛生署也大力宣導合理使用抗生素，希望能隆低細菌之抗藥性，其效果如何相當令人感興趣。急性鼻及鼻竇炨是耳鼻喉科門診病人最常見的細菌性感染，本研究持續3年針對秋冬兩季門診之急性鼻及鼻竇炎患者，進行中鼻道之細菌培養，藉以了解細菌種類與分布比例，並對抗藥性進行追蹤。 方法：本研究收集近連續3年度秋冬季節（每年10月至隔年3月），本院耳鼻喉診之急性鼻及鼻竇炎病人，採集其中鼻道膿性分泌物進行好氧細菌之培養，並測試其對抗生素之敏感性。 結果：病例人數為（第一年／第二年／第三年）133/184/146，培養菌株數目為102/166/149株，其中Streptococcus pneumoniae佔25.4/34.9/28.9％，Haemophilus influenzae佔37.3/26.5/26.2％，erythromycin: 6.9/0/4.7，baktar: 3.4/45.5/46.2％，ofloxacin：100/100/100％。M. catarrhalis對抗生素的敏感性百分比為ampicillin: 41.7/23.8/11.1％，augmentin: 100/100/100％，cefaclor: 83.3/78.6/41.7％，cefuroxime: 100/95.2/86.1％，baktar: 83.3/71.4/58.3％，ofloxacin: 100/100/94.4％。 結論：雖然衛生單位大力推動合理使用抗生素，但是到目前為止，顯然效果不彰，甚至部分第線抗生素的抗藥性還持續升高。S. pneumoniae對erythromycin的抗藥性竟然接近百分之百，相當驚人。正確合理地使用抗生素，確實是我必須嚴肅面對的課題。
並列摘要
BACKGROUND: Taiwan is near the top of the list of countries where antibiotic resistance is highly prevalent. Both the health administrations and the public have paid a great deal of attention to this situation is recent years. The National Health Insurance has cancelled its coverage of antibiotics for use in cases of the common cold since July, 2001. Furthermore, erythromycin was removed from the list of first-line antibiotics in November, 2001. In order to reduce antibiotic resistance, the Department of Health has devoted much effort to the promotion of rational use of antibiotics. It is interesting to know whether bacterial resistance has been reduced by this action. Acute rhinosinusitis is the most common bacterial infection in Otolaryngological clinics. Our study involved the collection of middle meatus discharge for bacterial culture during the respiratory disease seasons of three consecutive years. The aim was to identify changes in the bacteriology and antibiotic susceptibility of organisms causing acute rhinosinusitis. MATERIALS AND METHODS: This study was performed during the respiratory disease season from October in one year to March in the next year for three consecutive years. The middle meatus discharge was collected from out-patients who were diagnosed with acute rhinosinusitis at our Otolaryngological Department clinics. These specimens were sent for aerobic culture and antibiotic susceptibility test. RESULTS: The case numbers were 133/184/146 for each successive season. The numbers of bacterial isolates were 102/166/149 and organisms present were 25.4/34.9/28.9% for Streptococcus pneumoniae, 37.3/26.5/26.2% for Haemophilus influenzae and 11.8/25.3/24.2% for Moraxella catarrhalis for each successive season. The percentages of susceptible isolates of S. pneumoniae were 27.6/17.2/18.6% for penicillin, 6.9/0/4.7% for erythromycin, 24.1/36.2/44.2% for baktar and 100/98.3/100% for ofloxacin. The percentages of susceptible isolates of H. influenzae were 39.5/38.6/30.8% for ampicillin, 97.4/100/92.3% for augmentin, 68.4/75/64.1% for cefaclor, 97.4/100/92.3% for cefuroxime, 34.2/45.5/46.2% for baktar, 100/100/100% for ofloxacin. The percentages of susceptible isolates of M. catarrhalis were 41.7/23.8/11.1% for ampicillin, 100/100/100% for augmentin, 83.3/78.6/41.7% for cefaclor, 100/95.2/86.1% for cefuroxime, 83.3/71.4/58.3% for baktar, and 100/100/94.4% for ofloxacin. CONCLUSION: Even though the health administration has devoted much effort to the promotion of the rational use of antibiotics, the prevalence of antibiotic resistance does not seem to have improved as yet. On the contrary, some bacteria have become more resistant to antibiotics over the study period. Most surprisingly, almost all of the S. pneumoniae isolates were resistant to erythromycin. Close monitoring of antibiotic susceptibility and careful control of antibiotic use are most important and still needed to halt any further worsening of this situation.