ESBL、メタロ-β-ラクタマーゼ、AmpC型 -ラクタマーゼ過剰 …

1 250 56 10 2010 . Q esbl . - - AmpC - . Double Disc Synergy Test .. A .. 2.. 1 3 . extended - spectrum beta-lactamase esbl met- 1 . allo beta-lactamase MBL AmpC beta-lactamase - esbl . AmpC - - - . - . P. aeruginosa . Acinetobacter baumannii .. 3.. esbl MBL AmpC MRSA.. esbl MBL AmpC VRE .. 1.. esbl MBL AmpC - .. 18 . 251.. esbl esbl ChromID esbl . CTX CPDX esbl .. 1.. esbl . CLSI Clinical and Laboratory Standards Institute .. CLSI esbl 2 . 2.. 3 . 4 . esbl . E. coli K. MIC . pneumoniae K. oxytoca P. mirabilis 4 . Salmonella Shigella Citrobacter koseri . esbl .. CLSI 2010 document M100 -S20 . CLSI esbl . 4, 6, 7 . CTX . 94% MIC 8 g/ml 1 g/ml IPM MEPM. 5 . 4 g/ml 1 g/ml . esbl . CAZ CTX . esbl . MicroScan SIEMENS BD . esbl E-test esbl .. esbl . DDST Double Disc Synergy Test .. DDST esbl . AmpC - .. MIC AmpC Ser- ratia marcescens Enterobacter cloacae Citrobacter DDST esbl 1 freundii . 8, 9 . AMPC/CVA . CAZ CTX . 1.. 79 . 5 9 . 97% 94 100% CLSI DDST. DDST AmpC 2 . 3-aminophe- 20mm nylboronic acid class C.

2 AmpC E. coli K. I CVA pneumoniae . 19 . 252. 1 - . 1 2 3 4 .. Ambler Buch IPM.. ABPC CTX CPR AZT CMZ MEPM. CEZ CTM CVA2 BA3 MPA4 EDTA. PIPC CAZ CFPM CRMN FMOX BIPM. DRPM.. A 2 R S S S S S S S .. C 1 R R R S S S S S S .. esbl . A 2be R R R R S R I R S S .. AmpC . C 1 R R R R I R I 1 R I R S I .. MBL. B 3 R R R R R R I R R S .. KPC . A 2f R R R R I R I R R R I .. OXA . D 2d R R R R R R R R I .. 1 CFPM 2 clavuranic acid 3 boronic acid 4 2-mercaptopropionic acid sodium mercaptoacetic acid 2 CLSI document M100 -S20 esbl . E. coli K. pneumoniae K. oxytoca Proteus mirabilis Mueller-Hinton agar Mueller-Hinton agar . CPDX 10 g CAZ . AZT . CTX . CTRX 30 g CPDX 10 g . CAZ . CTX 30 g . 35 16 18 35 16 18 . mm CPDX 17 CAZ 22 mm CAZ 22 . CPDX 22 . AZT 27 . CTX 27 CTRX 25 CTX 27 . esbl . esbl . Mueller-Hinton agar Mueller-Hinton agar CAZ 30 g . CAZ/CVA 30/10 g . CTX 30 g CAZ 30 g . CAZ/CVA 30/10 g . CTX 30 g .. CTX/CVA 30/10 g CTX/CVA 30/11 g . 35 16 18 35 16 18 . 5mm 5mm .. esbl esbl .

3 3 CLSI document M100 -S20 esbl . E. coli K. pneumoniae K. oxytoca Proteus mirabilis Mueller-Hinton broth CAMHB Mueller-Hinton broth CAMHB .. CPDX . CAZ . AZT . CTX . CTRX CPDX . CAZ . CTX. 35 16 18 35 16 18 . CPDX 8 g/ml . CAZ AZT CTX CTRX 2 g/ml CPDX . CAZ CTX 2 g/ml .. esbl esbl . CAMHB CAMHB.. CAZ CAZ/CVA . CTX CTX/CVA CAZ CAZ/CVA . CTX CTX/CVA. 35 16 20 35 16 20 .. 3 8 esbl 3 8 esbl . 20 . 253. AmpC CFX AmpC 3 . 10 . Coudron . KPC . Noyal . 11 .. I C . AmpC . cefoxitin CFX 3 esbl AmpC. 30mm 30mm 20mm 20mm CTX AMPC/CVA CAZ CTX CAZ. Mueller-Hinton agar Mueller-Hinton agar . 35 1 35 1 . 3-aminophenylboronic acid 300 g . CTX AMPC/CVA CAZ CTX CAZ. 1 1 . 1 DDST esbl 2 DDST AmpC . 5mm CFX. CFX. Mueller-Hinton agar E. coli ATCC25922 cefoxitin Mueller-Hinton agar E. coli ATCC25922 . 5mm cefoxitin . 25 30 l 35 1 35 1 . 12ml 4 .. - 5 .. CFX CFX.. E. coli . E. coli . Coudron Noyal . 3 cefoxitin AmpC . 21 . 254.. esbl . >30mm 15 20mm 2.. 1 AmpC IPM CAZ IPM CAZ SMA . Mueller-Hinton agar.

4 35 1 . sodium mercaptoacetic acid . AmpC . IPM. MIC .. IPM CAZ IPM CAZ SMA .. MBL SMA .. 4 DDST MBL . MBL . P. aeruginosa E. cloacae Pseudomonas E - test . 12 . putida A. baumannii EDTA . C. freundii Providencia IPM MIC IPM MBL . rettgeri S. marcescens K. pneumoniae E. coli .. 1.. MBL . CAZ. 12, 13 . DDST DDST . classB - .. 2.. 4 . 2-mercaptopro- MBL - . pionic acid - MIC. MBL P. sodium mercaptoacetic acid aeruginosa . 3mg IPM . CAZ 2 . MBL MBL ICU . 100% MBL. MBL MBL . I MBL . MBL . 14, 15 . EDTA DDST . MBL . EDTA MBL . IPM EDTA - MBL . 22 . 255. 16, 19 . 2. OXA . MBL . OXA Class D . 100 type . OXA-23 OXA-51 OXA-24 OXA-58 . 16 18 . A. baumannii . 1. Klebsiella pneumonia carbapenemase KPC . OXA . Class A EDTA . K. pneumoniae modif ied Hodge test . E. coli E. cloacae KPC . - . esbl .. KPC MBL . KPC CLSI . 1. / . MEPM modified Hodge test . 4 . 5 1 3 DDST 6. I DDST . R modif ied . Hodge test . KPC . 90% MBL esbl AmpC classC MBL . - .. MEPM. Mueller-Hinton agar E. coli ATCC25922*.

5 Meropenem . 20 25mm 35 1 . McF .. MEPM.. E. coli .. 5 modified Hodge Test . carbapenemase 6 DDST . 23 . 256. 7 Clinical and Laboratory Standards Institute : Performance 2. standards for antimicrobial susceptibility testing, 19. th informational supplement M100-S19. 2009. Clinical and Laboratory Standards Institute, Wayne, PA. 8 Jacoby : AmpC -lactamase. Clin. Microbiol. Rev. 22. ; 161-182, 2009. 9 Yagi T., Wachino J., Kurokawa H. et al : Practical meth- . ods using boronic acid compounds for identification of class C -lactamase-producing Klebsiella pneumoniae and Escherichia coli. J. Clin. Microbiol. 43 ; 2551-2558, 2005. 10 Coudron , Moland and Thomson : Occur- . rence and detection of AmpC beta-lactamase among Escherichia coli, Klebsiella pneumoniae and Proteus esbl AmpC MBL mirabilis isolates at a Veterans medical center. J. Clin. Microbiol. 38 ; 1791-1796, 2000. 11 Noyal M., Menezes G., Sujatha H. et al : Simple screening . test for detection of carbapenemese in clinical isolates of nonfermentative gram-negative bacteria.

6 Indian J. Med. Res. 129 ; 707-712, 2009. 12 . - - .. 55 ; 211-219, 2007. 13 Arakawa Y., Shibata N., Shibayama K. et al : Convenient 1 Bush K., Jacoby G. and Medeiros A.: A functional classifi- test for screening metallo - -lactamase-producing gram cation scheme for -lactamase and its correlation with negative bacteria by using thiol compounds. J. Clin. molecular structure. Antimicrob Agents Chemother 39 ; Microbiol. 38 ; 40 - 43, 2000. 1211-1233, 1995 14 Lee K., Lim Y. S., Yong D. et al : Evaluation of the Hodge 2 test and the imipenem-EDTA double-disk synergy test for esbl differentiating metallo- -lactamase producing isolates of . 53 ; 98 -104, 2007 Pseudomonas spp. and Acinetobacter J. Clin. Microbi- 3 CLSI ESBLs . ol. 41 ; 4623 -4629, 2003. 35 ; 923 -928, 2007 15 Walsh , Toleman , Poirel L. et al : Metallo- -lac- 4 Clinical and Laboratory Standards Institute : Performance tamase : the quiet before the storm? Clin. Microbiol. Rev. th standards for antimicrobial susceptibility testing, 20 18 ; 306 -325, 2005.

7 Informational supplement M100 -S20. 2010. Clinical and 16 Queenan and Bush K.: Carbapenemase : the versa- Laboratory Standards Institute, Wayne, PA. tile - lactamases . Clin. Microbiol. Rev. 20 ; 440 - 458, 2007. 5 Ho , Chow , Yuen et al : Comparison of a 17 Anderson , Lonsway , Rasheed et al : Evalua- novel, inhibitor-potentiated disc-diffusion test with other tion of methods to identify the Klebsiella pneumoniae car- methods for the detection of extended - spectrum -lacta- bapenemase in Enterobacteriaceae. J. Clin. Microbiol. 45 ;. mase in Escherichia coli and Klebsiella pneumoniae. J. 2723 -2725, 2007. Antimicrob. Chemother 42 ; 49 -54, 1998 18 Pateran F., Mendez T., Guerriero L. et al : Snsitive screen- 6 Clinical and Laboratory Standards Institute : Performance ing tests for suspected class A carbapenemase production th standards for antimicrobial susceptibility testing, 20 in species of Enterobacteriaseae. J. Clin. Microbiol. 47 ;. informational supplement M100-S20-U June 2010 1631-1639, 2009.

8 Update . 2010. Clinical and Laboratory Standards Insti- 19 Rasmussen and Hoiby N.: OXA-type carbapene- tute, Wayne, PA. mases. J. Antimicrob. Chemother. 57 ; 373 -383, 2006. 24.