Clostridium difficile感染症と院内感染対策について

1 JANIS JANIS difficile JANIS Clostridium difficileinfectionClostridioidesdifficil e infectionCDI Clostridioides difficile CDI CDI Although C. difficile in not currently significantly resistant to antibiotics used to treat it, it was INCLUDED in the threat assessmentbecause of its unique relationship with resistance issues, antibiotic use, and its high morbidity and mortalityClostridium difficile C. difficile CDI (CDI) 6-8 (CDI) 80 >>> >>> (TAZ/PIPC), (MEPM), (BIPM)>>> CDI 2/8 >>> C.

2 difficile 2/20 (toxin A/toxin B C. difficile (MNZ) 2/21 >>> 3/8 3/9 >>> (toxin A/toxin B C. difficile (VCM) 3/11 >>> CDI CDI CDICDICDI Wonderland HospitalCDI Wonderland Hospital1. (CDI) 1. CDI 2. CDI CDI (CDI) 1. 2. CDI VCM CDI 3.))

3 4. NG OK 80 CFPM, MEPM9/12 9/22 9/26 toxin A toxin B 10/19-11/2 10/27 toxin A toxin B 11/2 toxin A toxin B 11/4 C. difficile C. difficile CDI (CDI) Toxin AToxin BGDH (GDH) (NAAT) Binary toxin BI/NAP1/027 (toxin A and/or toxin B) CDI CDI (50-60%) (GDH) * C.

4 difficile GDH CDI C. difficile 24-48 toxin B * GDH Clostridium difficile (toxin A and/or toxin B) FA X 1-2 CDI (GDH) C. difficile C. difficile 1 toxin B FA X 1-2 ICT GDH CDI GDH GDH GDH (NAAT)C. difficile GDH CDI GDH (NAAT) GDH Binary toxin /tcdC (NAAT) GDH C.

5 difficile CDI CDI GDH CDI CDI CDI CDI BI/NAP1/027 24-48 GDH CDI PPV CDI 1. CDI CDI 2. CDI <<< RICSS CDI Oughton, M. T., et al. (2009). Infect Control Hosp Epidemiol 30, ---B. - - 2 3 - C.

6 5,000ppm 10 3,000ppm 20 1,000ppm 30 7% Virox STF (7000mg/L H2O2) 13 600 mg/L (chlorine dioxide, ClO2) 30 Perez, J et al. Am J Infect Control 2005;33 60,000 ppm CDI 30% CDI 26% Fridkin S et al. MMWR March 4, 2014) CDI 2 (PPI) FDA (2-8-2012) CDI 2.

7 3. CDI --- CDICDI Valiquette, L et al. Clin Infect Dis 2007; 45 Suppl 2, S112-121. (CDI) --- CDI CDI JANIS CDI