Transcription of 【ケーススタディ・第29回抗菌薬適正使用生涯教育セミナー …
1 134 J A N. 2 0 1 4. 29 . MSSA 1 1 .. 1 .. 2 .. 3 .. 4 .. 25 11 6 . I RBC 266 106! L Hb g! dL Hct Plt 58 104! L TP g! dL Alb g! dL BUN mg! dL Cr mg! dL CRP mg! dL T-Bil mg! dL . D-Bil mg!dL AST 14 U!L ALT 5 U!L LDH 201. 1 U! L -GTP 17 U! L ALP 232 U! L Amy 67 U! L Na 38 CV 134 mEq! L K mEq! L Cl 98 mEq! L 131 mg! CRBSI CV dL HbA1c NGSP .. pH .. ! ABPC! SBT .. methicillin-sensitive Staphylo- Fig. 1 . coccus aureus MSSA 8 ABPC! II . SBT 37 Question 1 .. 1 . 42 39 S. aureus . CTRX coagulase-negative staphylococci CNS . 43 2 .. cm kg 111 ! 110! 70. mmHg 16 ! .. 2 4 Levine II! VI.. 4! 5 . Osler Janeway.
2 WBC 6,000! L Neu Fig. 1.. 5 1 1. VOL. 62 NO. 1 29 135. CNS 2 4 .. CRBSI 4! 5 . MSSA S. aureus . Question 3 . Question 2 3 . 2 S. aureus . S. aureus MSSA MRSA MSSA . CEZ MRSA . VCM . DAP . MRSA DAP .. MRSA .. CRBSI . VCM MSSA .. VCM MSSA .. MSSA ABPC! SBT 8.. MSSA CEZ. 40 MRSA .. VCM . Question 4 . 4 . Fig. 2. CT .. 40.. 39. CT. 38. 37. 36. day 3 day 1 day0 day2 day4 day6 day8 day10 day12 day14. CTRX CEZ. 2g 2 g 3/ . VCM. 1g Fig. 3.. 136 J A N. 2 0 1 4. day0 day14. Fig. 4. CT day0 14 day14 .. CT Fig. 2 . MRI . 4 . CT 4 . MRI 6 .. CT MRI . 4 . 4 CEZ. CEZ VCM 15 .. 1 mm MRSA III . MDRS MSSA .. MSSA VCM CEZ IV.
3 Fig. 3 . MSSA CRBSI . MSSA CEZ . 7 . 14 CT Fig. CRBSI . 4 .. Question 5 8 . 5 CRBSI . S. aureus .. Raad 14 CRBSI. 2 3 3 . 2 2 . 4 11 MSSA . VOL. 62 NO. 1 29 137. fections due to coagulase-negative staphylococci. Lancet Infect Dis 2002; 2: 677-85. 2 Fowler V G Jr, Osler M K, Corey G R, Woods C W, . Cabell C H, Reller L B, et al: Clinical identifiers of complicated Staphylococcus aureus bacteremia. Arch Intern Med 2003; 163: 2066-72. CRBSI 3 Silverman J A, Perlmutter N G, Shapiro H M: Corre- lation of daptomycin bactericidal activity and mem- . brane depolarization in Staphylococcus aureus. Antimi- crob Agents Chemother 2003; 47: 2538-44.
4 4 Raad I, Hanna H, Jiang Y, Dvorak T, Reitzel R, S. aureus Chaiban G, et al: Comparative activities of daptomy- cin, linezolid, and tigecycline against catheter- . related methicillin-resistant Staphylococcus bactere- mic isolates embedded in biofilm. Antimicrob CRBSI Agents Chemother 2007; 51: 1656-60. 5 Kim S H, Kim K H, Kim H B, Kim N J, Kim E C, Oh M. D, et al: Outcome of vancomycin treatment in pa- CRBSI . tients with methicillin-susceptible Staphylococcus aureus bacteremia. Antimicrob Agents Chemother 2008; 52: 192-7. 6 Raad I, Narro J, Khan A, Tarrand J, Vartivarian S, Bodey G P : Serious complications of vascular V.
5 Catheter-related Staphylococcus aureus bacteremia in cancer patients. Eur J Clin Microbiol Infect Dis 1992;. 11: 675-82. 7 Andes D R, Urban A W, Acher C W, Maki D G: Sep- tic thrombosis of the basilic, axillary, and subclavian . veins caused by a peripherally inserted central ve- MSSA nous catheter. Am J Med 1998; 105: 446-50. 8 Raad I I, Sabbagh M F: Optimal duration of therapy for catheter-related Staphylococcus aureus bacteremia: a study of 55 cases and review. Clin Infect Dis 1992;.. 14: 75-82. 9 Ehni W F, Reller L B : Short-course therapy for catheter-associated Staphylococcus aureus bacteremia.
6 Arch Intern Med 1989; 149: 533-6. 10 Mylotte J M, McDermott C : Staphylococcus aureus . bacteremia caused by infected intravenous cathe- ters. Am J Infect Control 1987; 15: 1-6. 11 Cosgrove S E, Fowler V G Jr : Management of methicillin-resistant Staphylococcus aureus bactere- mia. Clin Infect Dis 2008; 46: 386-93.. 12 Gupta S, Koirala J, Khardori R, Khardori N : Infec- tions in diabetes mellitus and hyperglycemia. Infect Dis Clin North Am 2007; 21: 617-38. 1 von Eiff C, Peters G, Heilmann C: Pathogenesis of in.
