Study of nasopharyngeal bacterial flora. Second report. Variations in nasopharyngeal bacterial flora in children aged 6 years or younger when administered antimicrobial agents. Part 1.
In our first report, we investigated nasopharyngeal bacterial flora related to penicillin-resistant Streptococcus pneumoniae (PRSP) and beta-lactamase-negative ampicillin-resistant Haemophilus influenzae (BLNAR) and their relation to acute upper respiratory tract infection (AURTI). This report analyzes the results of a study of nasopharyngeal bacterial flora before the administration of antimicrobial agents in 172 AURTI patients aged 6 years or younger. In addition to Gram staining, microscopic observation, and culturing, a polymerase chain reaction (PCR) method was used to identify PRSP (gPRSP) and BLNAR (gBLNAR) drug-resistant genes. Of the patients analyzed, 90% had acute otitis media (AOM) and were aged 2 years or younger. The antimicrobial agents administered were amoxicillin (34%), clavulanic acid/amoxicillin (11%), cefditren pivoxil (CDTR-PI) (43%), and others (12%). This was particularly true for patients administered CDTR-PI, among whom there were many who had already suffered one or more episodes of AOM by the age of 1 year or younger, and many in which gPRSP were detected (P < 0.01). There was a significant relation between the degree of nasopharyngeal inflammation indicated by leukocyte infiltration images and the amount of S. pneumoniae and H. influenzae detected, which are the main pathogenic bacteria causing AOM (P < 0.01). In addition to leukocyte infiltration images, there were cases in which shedding of ciliated cells was observed and/or giant monocytic cells. Both nasopharyngeal leukocyte infiltration images and/or shed cell findings observed in infant AURTI cases are important indices for the prompt detection of gPRSP and/or gBLNAR and appropriate doses of antimicrobial agents.
Konno
Masatoshi
M
Teikyo University School of Medicine, Tokyo, Japan. mrsa@interlink.or.jp
Baba
Shunkichi
S
Mikawa
Haruki
H
Hara
Kohei
K
Matsumoto
Fumio
F
Kaga
Kimitaka
K
Nishimura
Tadao
T
Kobayashi
Toshimitsu
T
Furuya
Nobuhiko
N
Moriyama
Hiroshi
H
Okamoto
Yoshitaka
Y
Furukawa
Mituru
M
Yamanaka
Noboru
N
Matsushima
Toshiharu
T
Yoshizawa
Yasuyuki
Y
Kohno
Shigeru
S
Kobayashi
Kunihiko
K
Morikawa
Akihiro
A
Koizumi
Shoichi
S
Sunakawa
Keisuke
K
Inoue
Matsuhisa
M
Ubukata
Kimiko
K
D000367:Age Factors; D000668:Ampicillin Resistance; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006192:Haemophilus Infections / Q000188:drug therapy / Q000382:microbiology; D006193:Haemophilus influenzae / Q000201:enzymology / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D007223:Infant; D008297:Male; D009305:Nasopharynx / Q000187:drug effects / Q000382:microbiology*; D010033:Otitis Media / Q000188:drug therapy / Q000382:microbiology; D011008:Pneumococcal Infections / Q000188:drug therapy / Q000382:microbiology; D016133:Polymerase Chain Reaction / Q000379:methods; D012141:Respiratory Tract Infections / Q000188:drug therapy / Q000382:microbiology; D013296:Streptococcus pneumoniae / Q000235:genetics / Q000302:isolation & purification*; D001618:beta-Lactamases / Q000378:metabolism
D000890:Anti-Infective Agents; D001618:beta-Lactamases