MRSA感染症の治療ガイドライン―2017年改訂版

1 MRSA 2017 MRSA 2017 MRSA 2013 MRSA 2014 8 MRSA 2014 2 MRSA 2016 AMR MRSA MRSA MRSA MRSA MRSA

2 2015 MRSA IV 273 29 5 20 / MSD Meiji Seika 274 91 3 MRSA ABKarbekacin DAPdaptomycin LZDlinezolid TEIC teicoplanin VCMvancomycin AZTaztreonam CEZcefazolin CLDM clindamycin DOXY doxycycline FAfusidic acid FOMfosfomycin FRPM faropenem GMgentamicin LVFX

3 Levofloxacin MINO minocycline MUPmupirocin NDFX nadifloxacin NFPC nafcillin QPR/DPRquinupristin/dalfopristin / RFPrifampicin SBT/ABPC sulbactam/ampicillin / STsulfamethoxazole-trimethoprim TCtetracycline TGCtigecycline TOBtobramycin ABUasymptomatic bacteriuria AUCarea under the blood concentration time curve BALbronchoalveolar lavage CA-MRSA community acquired MRSA MRSACDCC enters for disease Control and Prevention CLSIC linical and Laboratory Standards Institute CNScoagulase negative staphylococcus COPDC hronic Obstructive Pulmonary disease COREThe Cubicin Outcomes Registry and Experience CPISC linical pulmonary infection score cSSTI complicated skin and soft tissue infection ETexfoliative toxin EUCASTE uropean Committee on Antimicrobial Suscep-tibility Testing 275 29 5 20 HA-MRSA hospital-acquired methicillin-resistant Staphylo-coccus aureus MRSAHCAPH ealthcare Associated Pneumonia IDSAI nfectious Diseases society of america

4 JANISJ apan Nosocomial Infection Surveillance JHAISJ apan Healthcare Associated Infections SurveillanceLA-MRSA livestock-associated MRSA MRSAMIC minimal minimum inhibitory concentrationminimally inhibitory concentration MRCNS methicillin-resistant coagulase negative staphylococci MRSA methicillin-resistant Staphylococcus aureus MRSE methicillin-resistant Staphylococcus epidermidis MSSA methicillin-susceptible Staphylococcus aureus NHCAPN ursing and Healthcare Associated Pneumonia NTEDN eonatal TSS-like Exanthematous disease TSS PCRpolymerase chain reaction PSBprotected specimen brush PVLP anton-Valentine leukocidin SIRS systemic inflammatory response syndrome SSIsurgical site infections SSSSS taphylococcal Scalded Skin Syndrome TSST-1toxic shock syndrome toxin 1 1 VAPventilator-associated pneumonia VISA vancomycin-intermediate resistant Staphylococ-cus aureus A I1 B II

5 C III 276 91 3 MRSA 2017 I MRSA a ..278b ..280II MRSA ..287 III MRSA ..290IV MRSA ..293V MRSA ..297VI MRSA a ..303b ..307c ..310d 1 ..3142 ..319e.

6 324f ..326g ..339h ..345i ..347j ..353k ..357 VII MRSA TDM ..360 1 a VCM ..364b TEIC ..365c ABK ..368d LZD ..369e DAP ..371277 29 5 20 I MRSA a Executive summary1 MRSA methicillin-resistant Staphylococcus aureus 2 MRSA MRSA MRSA CA-MRSA community-acquired MRSA MRSA 3 MRSA MRSA 50 4 MRSA 5 CA-MRSA 6 CA-MRSA USA300 7 CA-MRSA PVL Panton-Valentine leukocidin

7 Literature review MRSA 50 70 MRSA 1 JANIS MRSA 10 10 2 JANIS 2014 1 MRSA MRSA / 100 MRSA 3 MRSA VAP 3 MRSA MRSA 4 5 MRSA hospital-associated methicillin-resistant S.

8 Aureus HA-MRSA community-acquired methicillin-resistant S. aureus CA-MRSA MRSA LA-MRSA livestock-associated MRSA LA-MRSA HA-MRSA CA-MRSA MRSA HA-MRSA MRSA CA-MRSA 1 SCCmec I II III HA-MRSA IV V CA-MRSA 1. MRSA HA-MRSA CA-MRSA MRSA MRSA SCCmec type II type I, III type IV type V NewYork/JapanUSA300 PVL 278 91 3 SCCmec MRSA CA-MRSA HA-MRSA CA-MRSA 6 CA-MRSA HA-MRSA CA-MRSA 7 8 CA-MRSA

9 9 USA300 Panton-Valentine leukocidin PVL 10 USA300 CA-MRSA PVL 11 14 10 30 MRSA MRSA HA-MRSA CA-MRSA 15 1 2014 2015 (clsi2012).pdf2 Tanihara S, Suzuki S: Estimation of the incidence of MRSA patients: evaluation of a surveillance system using health insurance claim data. Epidemiol Infect 2016 144: 2260-73 2014 2015 Enomoto Y, Yokomura K, Hasegawa H, Ozawa Y, Matsui T, Suda T: Healthcare-associated pneumonia with positive respiratory methicillin-resistant Staphylococcus aureus culture: Predictors of the true pathogenicity.

10 Geriatr Gerontol Int 2016 Feb 5 [Epub ahead of print]5 Nagaoka K, Yanagihara K, Harada Y, Yamada K, Migiyama Y, Morinaga Y, et al: Predictors of the pathogenic-ity of methicillin-resistant Staphylococcus aureus nosocomial pneumonia. Respirology 2014; 19.