The annual multicenter studies on isolated bacteria from infections in general surgery and their antimicrobial susceptibility have been conducted in Japan since July 1982. In this paper, the results obtained in the academic year 1999 (from April 1999 to March 2000) have been summarized. Two hundred seven cases were investigated, and 411 strains were isolated from 169 cases (81.6%). Of those strains, 184 and 227 strains were from primary infections and postoperative infections, respectively. In primary infections, the isolation rates of anaerobes, Streptococcus spp., and Escherichia coli were higher than in postoperative infections, while in postoperative infections, those of Gram-positive aerobes were higher than in primary infections. Staphylococcus aureus were most frequently isolated among Gram-positive aerobes, Peptostreptococcus prevotii among Gram-positive anaerobes, E. coli among Gram-negative aerobes, and Bacteroides fragilis among Gram-negative anaerobes. In primary infections, the percentage of Gram-negative aerobes, which gradually increased by the year 1998, decreased in the year 1999. The percentage of Gram-negative anaerobes increased, while that of Gram-negative bacteria was equivalent to that in the last year. In postoperative infections, the percentage of Gram-negative anaerobes, which continuously increased after the year 1990, decreased, while that of Gram-positive aerobes, which decreased in the last year, increased. Methicillin-resistant S. aureus accounted for 70.7% of S. aureus (41 strains). Either the number of strain or the percentage of MRSA decreased. The susceptibilities of E. coli and Klebsiella pneumoniae decreased against third and forth generation cephems, oxacephems, and monobactams. The susceptibilities of P. aeruginosa to carbapenems tend to decrease after the year 1997. S. aureus showed good susceptibilities to the tested drugs including arbekacin, vancomycin, and teicoplanin.

Shinagawa, Nagao; Mashita, Keiji; Teranishi, Futoshi; Otobe, Yoshihiro; Ishihara, Hiroshi; Adachi, Hitoshi; Itahashi, Yuuji; Ono, Masuyuki; Nishiwaki, Keiji; Suzui, Katsuya; Takaka, Moritsugu; Kitano, Masayoshi; Ishikawa, Shu; Yura, Jiro Author Information

アメーバ赤痢は本邦ではまれな疾患であるが, 炎症性大腸疾患の鑑別診断上重要な疾患の1つである. 一般には下痢を主症状とする慢性の経過をとることが多いが, まれには症状が急激に進行して穿孔などの重篤な合併症を併発して不幸な帰転をとることもある.今回, われわれは急性腹症を呈した激症型アメーバ性大腸炎の1例を経験したので報告する.症例は45歳男性で, 主訴は右下腹部痛と水様性下痢. 右下腹部の腹膜刺激症状と強い急性炎症所見があり, 注腸検査で盲腸に潰瘍を認めた. 確定診断には至らなかったが, 症状が進行しており穿孔の危険があるので, 急性腹症と判断し回盲部切除術を施行した. PAS染色で組織学的に栄養型赤痢アメーバを認め本症と確定診断した. 本症は抗アメーバ剤によく反応するが診断が遅れれば死亡率が高いので注意が必要である. 本症例を経験し, 炎症性大腸疾患の鑑別診断には本症を念頭におく必要があると痛感した.

Antimicrobial activity of cefuzonam (CZON) against bacteria isolated from intraperitoneal infection and penetration characteristics into peritoneal fluid were studied in 11 patients with cholelithiasis to evaluate the efficacy of CZON for prophylaxis in abdominal surgery. The mean peak concentration of CZON in peritoneal fluid after 1 g iv bolus injection (group 1, n=6) was 33.4±7.6 μg/ml, and 52.0±8.2 μg/ml, after 2 g iv bolus injection (group 2, n=5). In group 1 the area under the curve (AUC) in peritoneal fluid was 86.8 h μg/ml, and that in serum was 60.5 h μg/ml. MIC80s of CZON against Staphylococcus aureus, Esherichia coli and Klebsiella pneumoniae were 3.13, 0.2 and 0.1 μg/ml, respectively. In both groups the times above MIC in peritoneal fluid against these bacteria were more than 6 h. It is concluded that CZON will be effective for prophylaxis in abdominal surgery.