外来尿路感染症患者における尿路分離菌および薬剤感受性の年次推移について

Abstract

1977年から8年間の外来尿路感染症患者について検討した.1)外来患者総数に対する割合は1977年の31.8%から年々減少し1984年には22.0%となった.減少は主として急性膀胱炎の減少により, 本症は1984年には12.3%であった.2)急性型ではE. coilが毎年70%以上と最も多く, ついでS. epidermidisが10%前後分離された.その他に毎年分離された菌種はCitrobacter spp. Klebsiella spp. P. mirabilis, S. aureusであった.慢性型ではE. coliの分離頻度は17～37%であったが, 1981年と1982年を除いて最も多く分離される菌であった.S. aureusは8年間を通じて2～4%であった.E. faecalisの分離頻度は11～14%の間を変動し, 1981年と1982年を除いてE. coliについで多い菌種であった.急性型, 慢性型とも1981年と1982年を除いてグラム陰性桿菌の増加傾向を認めた.3)急性型ではE. coliおよびP. mirabilisのABPC, SBPCに対する感性の低下を認めた.慢性型ではE. coliのABPC, SBPC, NAに対する感受性が回復する傾向がみられたが, P. aeruginosaのDKBに対する感性率は低下した.E. faecalisではGM, CEZ, MINO, FOMに対してディスク(+)まで含めた感受性は良好であったが, 他菌種と異なり, ディスク感受性(+)を示す菌株が多く認められた

Changes of bacterial isolates from urine specimens of outpatients with urinary tract infections (UTI) from 1977 through 1984 were studied. Organisms which were isolated from patients with bacteriuria of over 10(3) bacteria per ml of urine regardless of grade of pyuria were studied. The incidence of UTI, especially that of acute cystitis was decreased during the recent 8 years. E. coli was the most predominant isolate in acute UTI with an isolation frequency of over 70% every year, followed by S. epidermidis nearly every year. Citrobacter spp., Klebsiella spp., P. mirabilis and S. aureus were also isolated steadily every year. Bacterial isolates in acute UTI were generally composed of these six species of bacteria. Although many kinds of bacteria were isolated in chronic UTI, E. coli was the most frequent species with an isolation frequency of 17-37%, followed by E. faecalis except in 1981 and 1982. The tendency of gram-negative rods to increase in acute and chronic UTI was observed except in 1981 and 1982. A slight decrease in sensitivity of E. coli and P. mirabilis against ampicillin (ABPC) and sulbenicillin (SBPC) was observed in acute UTI. In chronic UTI, the tendency of the sensitivity of E. coli against ABPC, SBPC and nalidixic acid to recover and the tendency of the sensitivity of P. aeruginosa against dibekacin to decrease were observed. E. faecalis was estimated to be sensitive to gentamicin, cefazolin, minocycline and fosfomycin. However, unlike those species mentioned above, many strains of E. faecalis showed a positive disc sensitivity to these drugs.