JAID/JSC感染症治療ガイドライン2015 ―尿路感染 …

1 jaid /JSC 2015 jaid /JSC 1 2 3 4 5 6 7 8 9 10 1 2 3 4 JCHO 5 6 7 8 9 10 1 28 1 20 I .. 3II .. 41 .. 42 .. 73 ..114 ..135 ..146 ..157 ..17 III ..211 ..212 ..22IV ..242 90 1 I ESBL Collateral damage 2012 jaid /JSC 2011 2014 jaid /JSC 2014 1 A B C I II III IV 2 3

2 jaid /JSC 2015 3 28 1 20 II 1 Executive summary Staphylococcus saprophyticus Escherichia coli BLI -lactamase inhibitor 90 BLI BII E. coli BLI BII ESBL FRPM FOM BII AII 2 3 CIV 1 2 3 BIV CIV 3 4 AII E.

3 Coli 70 Proteus mirabilis Klebsiella 80 85 15 20 Staphylococcus Streptococcus Enterococcus 5 6 E. coli BLI ST 10 5 6 E. coli 5 ESBL 70 FOM FRPM 6 jaid /JSC 2011 E. coli ESBL 7 3 S. saprophyticus 17 E. coli BLI 90 6 4 90 1 jaid /JSC 2015 BLI BII 9 E. coli 18 BLI BII ST 3 BLI 7 7 3 3 8 9 I 1 1 5 7 10 BIV 80 90 E.

4 Coli P. mirabilis Klebsiella 20 S. saprophyticus Staphylococcus Streptococcus Enterococcus 5 6 E. coli BLI BLI 90 5 6 BII 3 4 BII BLI BII ESBL 70 FOM FRPM TAZ/PIPC ESBL LVFX 1 500mg 1 1 3 CPFX 1 200mg 1 2 3 3 TFLX 1 150mg 1 2 3 CCL 1 250mg 1 3 7 CVA/AMPC 1 125mg/250mg 1 3 7 CFDN 1 100mg 1 3 5 7 CFPN-PI 1 100mg 1 3 5 7 CPDX-PR 1 100mg 1 2 5 7 FOM 1 1g 1 3 2 FRPM 1 200mg 1 3 7 ESBL 1 2 11 I 3 CPFX 3 1 12 AI

5 5 28 1 20 jaid /JSC 2015 E. coli E. coli BLI BII ESBL FRPM FOM BIV 50 65 1 1 13 BII CCL 1 250mg 1 3 7 CVA/AMPC 1 125mg/250mg 1 3 7 CFDN 1 100mg 1 3 5 7 CFPN-PI 1 100mg 1 3 5 7 CPDX-PR 1 100mg 1 2 5 7 LVFX 1 500mg 1 1 3 CPFX 1 200mg 1 2 3 3 TFLX 1 150mg 1 2 3 FOM 1 1g 1 3 2 FRPM 1 200mg 1 3 7 ESBL 1 3 CIV 1 1 5 7 ST

6 13 BII CVA/AMPC FOM BIV 14 BII CFDN 1 100mg 1 3 5 7 CFPN-PI 1 100mg 1 3 5 7 CPDX-PR 1 100mg 1 2 5 7 CCL 1 250mg 1 3 7 CVA/AMPC 1 125mg/250mg 1 3 7 FOM 1 1g 1 3 2 3 6 90 1 jaid /JSC 2015 1 4 E. coli Klebsiella Citrobacter Enterobacter Serratia Proteus Pseudomonas aeruginosa Enterococcus Staphylococcus ESBL MRSA 8 9 BII BIV de-escalation BIV BIV LVFX 1 500mg 1 1 7 14 CPFX 1 200mg 1 2 3 7 14 TFLX 1 150mg 1 2 7 14 STFX 1 100mg 1 1 7 14 CVA/AMPC 1 125mg/250mg 1 3 7 14 SBTPC 1 375mg 1 3 7 14 CFDN 1 100mg 1 3 7 14 CPDX-PR 1 200mg 1 2 7 14 CFPN-PI 1 100 150mg 1 3 7 14 MEPM 1 1 2 3 14 DRPM 1 1 2 3 14 IPM/CS 1 1 2 3 14 CFPM 1 1g 1 2 3 14 CZOP 1 1g 1 2 3 14 TAZ/PIPC 1 1 2

7 3 3 14 2 Executive summary AI 3 empiric therapy definitive therapy BII 24 14 AI AI 7 28 1 20 jaid /JSC 2015 CT AII SIRS Systemic Inflammatory Response Syndrome 2 AII 4 5 CVA tenderness E. coli 7 CRP15 16 PCT 16 SIRS 2 15 17 AI 3 empiric therapy definitive therapy BII 14 AI AI urosepsis severe sepsis septic shock AII BII 20 40 AI AII CT 18 AII 2 1 17

8 SIRS definitive therapy Empiric Therapy 1 1 19 20 21 AI 3 8 90 1 jaid /JSC 2015 empiric therapy definitive therapy 22 BII 14 AI BIV TDM Therapeutic drug monitoring AI E. coli K. pneumoniae ESBL E. coli BIII one-time intravenous agent CTRX AMK PZFX LVFX AI LVFX 1 500mg 1 1 7 14 CPFX 1 200mg 1 3 7 14 TFLX 1 150mg 1 3 7 14 STFX 1 100mg 1 2 7 14 CDTR-PI 1 200mg 1 3 14 CFPN-PI 1 150mg 1 3 14 CPDX-PR 1 200mg 1 2 14 CTM 1 1 2g 1 3 4 1 CTRX 1 1 2g 1 1 2 CAZ 1 1 2g 1 3 1 AMK 1 200 400mg 1 1 PZFX 1 1,000mg 1 2 2 TAZ/PIPC 1 1 3 MEPM 1 1g 1 3 1 2g 3 4 2 E.

9 Coli 20 6 22 BII CIV 2 2 2 1 2 1 2 1 9 28 1 20 jaid /JSC 2015 2 3 2 1 20 40 AI 2 1 AII ST one-time intravenous agent CTRX AI CDTR-PI 1 200mg1 3 14 CFPN-PI 1 100 150mg 1 3 14 CPDX-PR 1 100 200mg 1 2 14 CTM 1 1 2g 1 3 4 CAZ 1 1 2g 1 3 CTRX 1 1 2g 1 1 2 2g 3 4 2 4 BI 2 1 AII 4 5 Enterococcus Staphylococcus E.

10 Coli Klebsiella Citrobacter Enterobacter Serratia Proteus P. aeruginosa empiric therapy 3 empiric therapy definitive therapy 22 BII de-escala-tion 22 BII 24 14 23 AI ESBL 2 15 24 AII one-time intravenous agent CTRX AMK PZFX LVFX AI 10 90 1 jaid /JSC 2015 LVFX 1 500mg 1 1 7 14 CPFX 1 200mg 1 3 7 14 21 TFLX 1 150mg 1 3 7 14 STFX 1 100mg 1 2 7 14 CDTR-PI 1 200mg 1 3 14 CFPN-PI 1 150mg 1 3 14 CPDX-PR 1 200mg 1 2 14 CAZ