講演 多剤耐性菌の現状 - medience.co.jp

1 1 - ESBL MBL KPC OXA - - World news 100 100 1911 1 Paul Ehrlich P47 606 606 4 1944 Alexander Fleming 2 PENICILLIN CURES GONORRHEA IN 4 HOURS.

2 SEE YOUR DOCTOR TODAY 4 1 2 2011 World news 1970 1980 1 50 60 50 1950 1940 1960 1970 1980 1990 - 2000 - - P47 ESBL extended-spectrum -lactamase - MBL metallo- -lactamase - KPC 1 1911 1939 1940 1950 1960 1970 1980 1990 2000 G.

3 B - - - - - - 2008 2011 World news OXA - CTX-M - ESBL ESBL 1980 ESBL - ESBL TEM SHV 2000 CTX-M - CTX-M - CTX-M - - ESBL 3 2000

4 O25 H4 ST131 ST131 CTX-M - 4 CTX-M - 2006 CTX-M - CTX-M - CTX-M-9 14 4 CTX-M-15 4 CTX-M-15 2011 5 O104 H4 CTX-M-55 CTX-M - 1 5 6 10 11 MBL MBL MBL - MBL IMP-1 imipenem impact important - impossible imp MBL VIM GIM 2011 1 World news SPM SIM 2010 8 11 - MBL NDM-1 New Delhi metallo- -lactamase 1 5

5 NDM-1 NDM-1 - CMY-4 6 11 CTX-M-15 16S rRNA NDM-1 IncA/C 2011 4 NDM-1 2011 NDM- CTX-M - Walsh T R Emerging carbapenemases: a global perspective. Int J Antimicrob Agents, 36 Suppl 3 S8-14, 2010 Cant n R, Coque T M The CTX-M -lactamase pandemic. Current Opinion in Microbiology 9 5 466-475.

6 2006 World news 30 C 12 1 30 C 6 NDM-1 MBL R NDM-1 S NDM-1 NDM-1 7 SMA disk SMA sodium mercaptoacetic acid MBL MBL SMA 7A NDM-1 7B NDM-1 MBL - SMA EDTA SMA disk disk SMA disk 20mm 10mm 8 NDM-1 MIC minimal inhibitory concentration disk SMA 8A MIC disk SMA disk 2011 NDM- SMA disk 8 modified SMA disk Walsh T R, et al Dissemination of NDM-1 positive bacteria in the New Delhi environment and its implications for human health: an environmental point prevalence study.

7 Lancet Infect Dis, 11 5 355-362, 2011 A MBL B NDM-1 CAZ IPM SMA CAZCAZSMAIPMIPMSMA8 10mm5mm8 10mm5mmSMASMAIPMMEPMA B 1 World news disk SMA disk MIC NDM-1 NDM-1 PCR KPC KPC 1990 - KPC-3 KPC-2 9 KPC - KPC

8 9 KPC KPC KPC 3 KPC OXA 2002 2003 10 8 2011 T R Emerging carbapenemases: a global perspective. Int J Antimicrob Agents, 36 Suppl 3 S8-14, 2010 World news 11 0 OXA OXA - OXA MLST multilocus sequence typing P47 ST92 CC clonal complex 92 CC92 OXA CC92 non-CC92 IMP

9 9 2011 M S, et al Infect Control Hospital Epidemiol , 31 196-197, 2010 Walsh T R Emerging carbapenemases: a global perspective. Int J Antimicrob Agents, 36 Suppl 3 S8-14, 2010 1 World news 1983 1985 1989 1994 1996 1 Moissenet D, et al:Salmonella enterica serotype Gambia with CTX-M-3 and armA resistance markers:nosocomial infections with a fatal outcome. Journal of Clinical Microbiology, 49 4 1676-1678, 2011 2 de la G ndara M P, et al:Prevalence and characterization of extended-spectrum beta-lactamases-producing Salmonella enterica isolates in Saragossa, Spain (2001-2008).

10 Microb Drug Resist, 17 2 207-213, 2011 3 Sj lund-Karlsson M, et al:CTX-M-producing non-Typhi Salmonella spp. isolated from humans, United States. Emerg Infect Dis, 17 1 97-99, 2011 4 Cloeckaert A, et al:IncI1 plasmid carrying extended-spectrum-beta-lactamase gene blaCTX-M-1 in Salmonella enterica isolates from poultry