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.

2 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 - .. AmpC E. coli K.

3 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.

4 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 CLSI document M100 -S20 ESBL . E. coli K. pneumoniae K. oxytoca Proteus mirabilis mueller - hinton broth CAMHB mueller - hinton broth CAMHB.

5 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.

6 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 . 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.

7 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.

8 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* . 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.

9 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.

10 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. 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.