医療関連感染対策7 - pref.aomori.lg.jp

1 24 24 11 21 15:30-17:00 ( ) ( RutersHealth Information , 2001 I. 1. 2. 3. II. Campaign to Prevent Antimicrobial resistance in Healthcare Settings Campaign to Prevent Antimicrobial resistance in Healthcare Settings 1. (ESBLs )3. 4. 2. ( PBP (MRSA, PRSP, BLNAR) VRE 1.))

2 (MRSA) (VRSA)2. (PRSP MRSP)3. VRE 4. 5. 6. Class B - 7. ESBL ( Extended spectrum -lactamases) (NDM-1 ) MRSA Latin America (29%)Australia (30%)Taiwan (61%)Japan (74%)Singapore (63%)Hong Kong (80%)China (39%)Source: Lowy FD. New Engl J Med. 1998;339:520-532 CDC. MMWR. 1997;46:624-628, 635 NNIS Antimicrobial resistance Surveillance Report. 1999 ( /EARSS 2003 Germany (19%)Spain (23%)Italy (38%)France (33%)South Africa (49%)Nigeria (21%)UK (44%)US (55%)Company Confidential and Proprietary - Internal Use Only Zyvox Worldwide Operating Plan Source: Oguri et al, Japanese Journal of Antibiotics (55) p1-28, 2002 MRSA European Antimicrobial resistance Surveillance System EARSS 2005 MSSA ( 1991 2003)* 2003 02,0004,0006,0008,00010,00012,00014,0001 6,00019911992199319941995199619971998199 92000200120022003* MRSA MSSAM R S AM S S AMMWR February 7, 2003 (Community acquired:CA)MRSA ( ) ( ) ( ) (Hospital acquired :HA) MRSA MRSA 10,000 1990-1999 2000-2001 2002-2003 SHEA 15th Annual Scientific Meeting.)

3 Abstract 2005 2008 4 2 Acinetobacter baumannii OXA-51 like Acinetobacter baumannii A. baumanii CDC Public Health Image Library Acinetobacter baumannii ICU,NICU 5 Acinetobacter MDRA) / (IPM/CS) 16 /ml (AMK) 32 /ml 4 g/ml MDRA A.

4 Baumannii 1991-1992 13 ICU 31 A. baumannii ICU ICU 2000 ICU 7 A. baumannii 1 2003 11 A. baumannii 2005-2006 ICU 19 A. baumannii 8 2006 / 10 32 A. baumannii 2007-2008 ICU 57 A. baumannii 19 4 J Clin Microbiol 1994;32:2677-81 J Hosp Infect 2003;53:97-102 JAMA 2004 22;292:3006-11 J Hosp Infect 2008;70:109-18 J Med Microbiol 2009;58:1499-507 J Korean Med Sci 2010 ;25:999-1004A.

5 Baumannii J Korean Med Sci. 2010;25:999-1004 A. baumannii ICU 57 7/65 Infect Control Hosp Epidemiol 2008;29:410-7 A. baumannii ICU 14 12/42 A. baumannii Am J Infect Control 2010;38:S25-33 Disinfection, sterilization, and antisepsis Rutala WA, eds .Association for Professionals in Infection Control and Epidemiology, Inc; 2010 A. baumannii J Hosp Infect 2002;52:259-62 J Clin Microbiol. 36: 1938, 1998 A. baumannii A. baumannii ICU N EnglJ Med 2008;358:1271-81 ( ) A.

6 Baumannii A. baumannii A. baumannii colistin PPE 2 NDM-1 59 2 2007 10 2008 1 - - -1 NDM-1 NDM-1 NDM-1 Lancet Infectious Diseases 10, 578-579, 2010 Lancet Infectious Diseases 10, 578-579, 2010 Lancet NDM-1 NDM-1 25 2008 NDM-1 NDM-1 37 17 NDM-1 37 21, 7, 5 21 PFGE 20 7 PFGE Chennai HarynaImipenem0%0%0%Meropenem3%3%3%Piper acillin-tazobactam0%0%0%Cefotaxime0%0%0% Ceftazidime0%0%0%Cefpirome0%0%0%Aztreona m11%0%8%Ciprofloxacin8%8%8%Gentamicin3%3 %3%Tobramycin0%0%0%Amikacin0%0%0%Minocyc line0%0%0%Tigecycline64%56%67%Colistin89 %94%100%NDM-1 Lancet Infectious Diseases 10, 578-579, 2010 ESBL Escherichia coli JAC 64 (suppl 1): i3 i10, 2009 ESBLs Extended-spectrum b-lactamases ( ) - 1 4 ESBL E.

7 Coli, P. mirabilis 2005 1 2011 5 ESBL E. coli 2-3% ESBL P. mirabilis 25% ESBL (MIC) ( g/ml) (n=71) MIC90 (%)ABPC 256 256 256100 PIPC64 256 256/4 256 256 256100 CAZ1 256 CFX AmpC IPMMEPMAMK TAZ MIC LVFX I. 1. 2. 3. II. , ( ( 0 23456789102010/6/32010/6/102010/6/172010 /6/242010/6/302010/7/72010/7/142010/7/21 2010/7/282010/8/72010/8/142010/9/01 2010/9/212010/9/14 epispdes/1,000024681093/1-4 93/5-8 93/9-12 94/1-4 94/5-8 94/9-12 95/1-4 95/5-8 95/9-12020406080100120140160180200 DDD/1,000 patient-daysESBL-KPnon-ESBL-KPCAZ AAC 42(1)))

8 53,1998 ( ) ICU, NICU, CCU, , , , ( ), , , , (Falkirk & District Royal Infirmary NHS Trust) MRSA ( ( ( MRSA MRSA CDC 2006 2007 10 : NSH Northwestern University 2011 3 2009 3 I.)))

9 1. 2. 3. II. , , MRSA Latin America (29%)Australia (30%)Taiwan (61%)Japan (74%)Singapore (63%)Hong Kong (80%)China (39%)Source: Lowy FD. New Engl J Med. 1998;339:520-532 CDC. MMWR. 1997;46:624-628, 635 NNIS Antimicrobial resistance Surveillance Report. 1999 ( /EARSS 2003 Germany (19%)Spain (23%)Italy (38%)France (33%)South Africa (49%)Nigeria (21%)UK (44%)US (55%)Company Confidential and Proprietary - Internal Use Only Zyvox Worldwide Operating Plan Source: Oguri et al, Japanese Journal of Antibiotics (55) p1-28, 2002CA-MRSA Deleo FR et al. Lancet 2010 A. baumannii outbreak OXA-23 OXA-24/40 OXA-58 OXA type hospital transfer of colonized/infected patients J Infect Dev Ctries 2009; 3(5): 335-3412010 3 21 MDRA 2008 10 2009 1 OXA-51-like 2009 7 OXA-23, OXA-69 EU Campaign to PreventAntimicrobial ResistanceCenters for Disease Control and PreventionNational Center for Infectious DiseasesDivision of Healthcare Quality PromotionClinicians hold the solution!)

10 , , Healthcare Associated Infection (Boston, Beth Isr. Deacon. Med. Center) Pop-Vicas et al. CID 2005;40:1794 Weinstein. 2006 SHEA annual meeting I. 1. 2. 3. II. ICT Top & Total Risk Management II. 1. 2. 3. Harbarth S et al. Lancet Infect Dis 20010,000,100,200,300,400,500,600,700,80 OthersCancer centresRehabilitation / LTCM ilitary hospitalsPrivate hospitalsLocal hospitalsPsychiatric hospitalsGeneral hospitalsUniversity hospitalsType of healthcare facilityPrevalence of MRSA-infected patients (%)20012006 Raisin.