Ventilation of middle ear cavity by insertion of tympanostomy tubes and changes of virulence in Streptococcus pneumoniae

鼓膜置管对中耳腔的通气及肺炎链球菌毒力的变化

• 批准号: 18591882
• 负责人: HOTOMI Muneki
• 金额: $ 2.62万
• 依托单位: Wakayama Medical University
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (C)
• 财政年份: 2006
• 资助国家: 日本
• 起止时间: 2006 至 2007
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-18591882/
• 关键词: Acute otitis; ventilation tube; Streptococcus pneumoniae; 換気チューブ挿入術

Recently it has been a serious problem in Japan that acute otitis media (AOM) of children, especially in younger age, is getting intractable in spite of treatment with antibiotics. High prevalence of drug-resistant microbes in younger age and immature immunity to AOM pathogens are thought to be major causes for this intractability of AOM. It is widely accepted that myringotomy is the efficient treatment modality of AOM especially for severe and/or intractable cases. We know empirically that myringotomy can provide pain and fever relief more promptly than antibiotics. But there is no evidence in long term this surgical treatment is superior in improvement of otitis proneness than conservative treatment using antibiotics. Today, we can choose as surgical device for myringotomy not only a conventional knife also a CO_2 laser. By conventional myringotomy, the incision on the drum will close within 4-5 days and may result insufficient ventilation effect on the middle ear cavity. On the othe … More r hand, laser assisted myringotomy can keep the ventilation long enough 2-3 weeks and can be safety performed on very young children.In this study, we compared clinical efficacies on cases with intractable AOM among laser-assisted myringotomy, conventional myringotomy and medication with antibiotics. In both LAM and COM groups, Drum Scores 2 weeks after treatments were significant decreased rather than those at the time of treatment, while the patients treated with conservative medication did not show such significant reduction of Drum Scores at 2 weeks after. Separating patients by severity of Drum Scores, both LAM and COM were effective against severe cases rather than moderate cases of otitis media. Bacteriological study evaluated the serotypes distribution of Streptococcus pneumoniae (S. pneumoniae) and antimicrobial resistances. The prevalence of serotypes were 19F (19.8%), 23F (15.8%), 14 (11.9%), 6B (11.9%), 6A (8.9%), and 3 (8.9%). Penicillin susceptible S. pneumoniae (PSSP), penicillin intermediately resistant S. pneumoniae (PISP), and penicillin resistant S. pneumoniae (PRSP) were 34.7%, 40.6%, and 24.8%, respectively. By use of the chinchillas, S. penumonaie showed different outcomes of experimental acute otitis media depending on serotypes. Serotype 6A and 19F were carried long time in middle ear cavities. Serotype 6A was not lethal but all of chinchilla infected with serotype 19F died. In contrast to the former two serotypes, serotype 14 did not infect to chinchillas and cleared very fast from the tympanic bulla.The current study revealed that S. pneumoniae showed different virulence depending their capsular types. In fact, S. pneumoniae changes the virulence according to the environmental condition, such as in hypoxic environment the pathogen enthicked capsule and become virulence. So we considered that surgical drainage show relative early and in short-term improvement of tympanic membrane in intractable AOM. Less

近年来，在日本，儿童急性中耳炎（AOM）已成为一个严重的问题，特别是在年轻的年龄，是越来越难治，尽管用抗生素治疗。年轻人中耐药菌的高患病率和对AOM病原体的不成熟免疫被认为是AOM难以治疗的主要原因。鼓膜切开术是治疗急性中耳炎的有效方法，尤其是对严重和/或难治性病例。经验上我们知道鼓膜切开术可以比抗生素更迅速地缓解疼痛和发烧。但没有证据表明这种手术治疗在改善中耳炎易感性方面优于抗生素保守治疗。目前，鼓膜切开术的手术器械除传统的手术刀外，还有CO_2激光。传统鼓膜切开术，鼓膜上的切口将在4-5天内闭合，并可能导致中耳腔通气效果不足。另一方面， ...更多信息 激光辅助鼓膜切开术可维持2-3周的通气时间，对年龄较小的儿童可安全进行，本研究比较了激光辅助鼓膜切开术、常规鼓膜切开术和药物治疗难治性AOM的临床疗效。在LAM和COM组中，治疗后2周的鼓评分比治疗时显著降低，而保守药物治疗的患者在治疗后2周的鼓评分未显示出如此显著的降低。按鼓膜评分的严重程度区分患者，LAM和COM对重度中耳炎病例有效，而对中度中耳炎病例有效。细菌学研究评价了肺炎链球菌（S。肺炎）和抗微生物剂抗性。血清型检出率分别为19 F（19.8%）、23 F（15.8%）、14 F（11.9%）、6 B（11.9%）、6A（8.9%）和3 A（8.9%）。青霉素敏感S.肺炎链球菌（PSSP）、青霉素中间耐药链球菌（S. pneumoniae（PISP）和青霉素抗性S.肺炎链球菌感染率分别为34.7%、40.6%和24.8%。利用龙猫S.肺炎链球菌表现出不同血清型的实验性急性中耳炎的不同结果。血清型6A和19 F在中耳腔长期携带。血清6A型不致死，而血清19 F型感染的灰鼠全部死亡。与前两种血清型相比，血清14型不感染毛丝鼠，并且从鼓泡中清除得非常快。pneumoniae的毒力因荚膜类型不同而不同。事实上，S.肺炎克雷伯氏菌的毒力随环境条件的变化而变化，如在低氧环境中，病原菌增厚荚膜而产生毒力。因此，我们认为手术引流对顽固性AOM的鼓膜有较早、较短期的改善作用。少

项目成果

Can Etest correctly determine the MIC of Haemophilus influenzae with Beta-lactamase Negative Ampicillin Resistant(BLNAR)for beta-lactam and cephalosporin antibiotics?

Etest 能否正确测定 β-内酰胺酶阴性氨苄西林耐药 (BLNAR) 流感嗜血杆菌对 β-内酰胺和头孢菌素类抗生素的 MIC？

• 发表时间: 2007
• 期刊: Antimicrob Agents Chemother 51
• 作者: Hotomi M;Suzumoto M;Itahashi K;Nagura J;Fukushima T;Shimada J;Billal;DS;Yamauchi K;Fujihara K;Yamanaka;N;Dewan S. Billal;Dewan S. Billal
• 通讯作者: Dewan S. Billal

Bactericidal efficacies of azithromycin on nontypeable Haemophilus influenzae adhered to and invaded cultured human epithelial cells

阿奇霉素对粘附和侵袭培养人上皮细胞的不可分型流感嗜血杆菌的杀菌效果

• 发表时间: 2007
• 作者: Hotomi M;Fujihara K;Tamura S;Tomita T;Saito S;Yamanaka;N
• 通讯作者: N

Determination of pneumococcal serotypes/genotypes in nasopharyngeal secretions of otitis media children by multiplex PCR

• DOI: 10.1007/s00431-007-0510-3
• 发表时间: 2008-04-01
• 期刊: EUROPEAN JOURNAL OF PEDIATRICS
• 影响因子: 3.6
• 作者: Billal, Dewan S.;Hotomi, Muneki;Yamanaka, Noboru
• 通讯作者: Yamanaka, Noboru

上気道感染症はなぜ難治化したのか?-細菌のしたたかな戦略と宿主の防御能の最前線-

为什么上呼吸道感染变得如此难以治疗？ - 细菌策略和宿主防御的前线 -

• 发表时间: 2007
• 作者: Hotomi M;Billal;DS;Shimada J;Suzumoto M;Yamauchi K;Fujihara K;Yamanaka;N;Muneki Hotomi;保富 宗城
• 通讯作者: 保富 宗城

Efficacy of a novel oral carbapenem, tebipenem pivoxil(TBM-PI), against experimental otitis media caused by penicillin resistant Streptococcus pneumoniae in chinchilla

新型口服碳青霉烯类特比培南匹酯（TBM-PI）对龙猫耐青霉素肺炎链球菌引起的实验性中耳炎的疗效

• 发表时间: 2007
• 期刊: Vaccine 25
• 作者: Hotomi M;Suzumoto M;Itahashi K;Nagura J;Fukushima T;Shimada J;Billal;DS;Yamauchi K;Fujihara K;Yamanaka;N
• 通讯作者: N