急性鼻及鼻竇炎之細菌抗藥性

Antimicrobial Resistance in Acute Rhinosinusitis

蘇俊賓(Chun-Pin Su) ； 黃威雄(Wei-Hsiung Huang) ； 張文源(Wen-Yuan Chang) ； 洪培凱(Pei-Kai Hung) ； 賴美珠(Mei-Chu Lai)

《台灣醫學》 9卷5期 (2005/09) Pp. 577-583

https://doi.org/10.6320/FJM.2005.9(5).02

摘要

在台灣，臨床上急性鼻及鼻竇炎的診斷十分常見，抗生素經常被過度使用，歷年來抗藥性菌種不斷地產生，導致抗生素防線逐一失守。本研究採前瞻性方式，從2000年10月至2004年3月收集秋冬兩季（每年10月至隔年3月），至嘉義基督教醫院耳鼻喉科門診之急性鼻及鼻竇炎病患，經同一位主治醫師確定診斷後，採集中鼻道之膿性分泌物檢體，進行好氧細菌培養，進而分析其種類、抗藥性及分佈比例，作為台灣本土有關急性鼻及鼻竇炎細菌分佈特性之參考。四年來，共收集620人，培養之總菌株數為589株，其中Streptococcus pneumoniae佔30.2%，Haemophilius influenzae佔26.8%，Moraxella catarrhalis佔22.9%。S.pneumoniae對抗生素的敏感性百分比分別為Penicillin: 20.2%，trimethoprim-sulfamethoxazole (TMP-SMX):36.5%，erythromycin:5.1%，cefotaxime:100.0%，ofloxacin:98.3%。H.influenzae對抗生素的敏感性百分比分別為ampicillin:34.8%，TMP-SMX:40.5%，cefaclor:71.5%，cefuroxime:97.5%，amoxicillin-clavulanate:97.5%，ofloxacin:100.0%。M.catarrhalis對抗生素的敏感性百分比分別為ampicillin:20.0%，TMP-SMX:65.2%，cefaclor:67.4%，cefuroxime:93.3%，amoxicillin-clavulanate:100.0%，ofloxacin:96.3%。正確合理地使用抗生素已是衛生單位推行多年的施政重點，但是綜觀本研究發現部分第一線抗生素抗藥性並無明顯改善，少數甚至還有升高的趨勢，並且H.influenzae對amoxicillin-clavulanate及S.pneumoniae和M.catarrhalis對ofloxacin的抗藥性已陸續出現，這是我們必須謹慎處理的課題，以免陷入無藥可用的地步。

關鍵字

鼻及鼻竇炎 ； 抗藥性 ； 台灣 ； 細菌學

並列摘要

In Taiwan, antibiotics were excessively used. Bacterial resistance has continued to increase in recent years. We performed a prospective study from October through the following March of four consecutive years (from October 2000 to March 2004). Mucopurulent specimen from middle meatus of outpatients who were diagnosed with acute rhinosinusitis by the same attending physician in the Department of Otolaryngology, Chiayi Christian Hospital were subjected to aerobic culture and antibiotic susceptibility test. The aim was to determine the bacterial distribution and antibiotic resistance pattern of acute rhinosinusitis in Taiwan. A total of 620 cases with 589 bacterial isolates were collected. Thirty point two percent of the isolates were identified as Streptococcus pneumoniae, 26.8% as Haemophilius influenzae and 22.9% as Moraxella catarrhalis. The percentages of antibiotics susceptibility of S.pneumoniae were 20.2% for penicillin, 36.5% for trimethoprim-sulfamethoxazole (TMP-SMX), 5.1% for erythromycin, 100.0% for cefotaxime and 98.3% for ofloxacin. The percentages of antibiotics susceptibility of H. influenzae were 34.8% for ampicillin, 40.5% for TMP-SMX, 71.5% for cefaclor, 97.5% for cefuroxime, 97.5% for amoxicillin-clavulanate and 100.0% for ofloxacin. The percentages of antibiotics susceptibility of M. catarrhalis were 20.0% for ampicillin, 65.2% for TMP-SMX, 67.4% for cefaclor, 93.3% for cefuroxime, 100.0% for amoxicillin-clavulanate, 96.3% for ofloxacin. Though the health administration stressed rational use of antibiotics, we found this policy did not reduce the prevalence of resistance to the first-line antibiotics. In addition, the resistance of H. influenzae to amoxicillin-clavulanate and S.pneumoniae and M. catarrhalis to ofloxacin is another rising clinical challenge.

並列關鍵字

rhinosinusitis ； antimicrobial resistance ； Taiwan ； bacteriology