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 2015 MRSA IV 273 29 5 20 /

2 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 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 JANISJ apan Nosocomial Infection Surveillance JHAISJ apan Healthcare Associated Infections SurveillanceLA-MRSA livestock-associated MRSA

3 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 C III 276 91 3 MRSA 2017 I MRSA a.

4 278b ..280II MRSA ..287 III MRSA ..290IV MRSA ..293V MRSA ..297VI MRSA a ..303b ..307c ..310d 1 ..3142 ..319e ..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 Literature review MRSA 50 70 MRSA 1 JANIS MRSA 10 10 2 JANIS 2014 1 MRSA MRSA / 100

5 MRSA 3 MRSA VAP 3 MRSA MRSA 4 5 MRSA hospital-associated methicillin-resistant S. 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 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).

6 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. 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: 556-626 Montravers P, Snauwaert A, Welsch C: Current guidelines and recommendations for the management of skin and soft tissue infections. Curr Opin Infect Dis 2016; 29: 131-87 Yamaguchi T, Nakamura I, Chiba K, Matsumoto T: Epidemiological and microbiological analysis of commu-nity-associated methicillin-resistant Staphylococcus aureus strains isolated from a Japanese hospital.

7 Jpn J Infect Dis 2012; 65: 175-88 Inomata S, Yano H, Tokuda K, Kanamori H, Endo S, Ishizawa C, et al: Microbiological and molecular epide-miological analyses of community-associated methicillin-resistant Staphylococcus aureus at a tertiary care hos-pital in Japan. J Infect Chemother 2015; 21: 729-369 Karampela I, Poulakou G, Dimopoulos G: Community acquired methicillin resistant Staphylococcus aureus pneu-monia: an update for the emergency and intensive care physician. Minerva Anestesiol 2012; 78: 930-4010 Glaser P, Martins-Sim es P, Villain A, Barbier M, Tristan A, Bouchier C, et al: Demography and Interconti-nental Spread of the USA300 Community-Acquired Methicillin-Resistant Staphylococcus aureus Lineage. MBio 2016; 7: e02183-1511 Mine Y, Higuchi W, Taira K, Nakasone I, Tateyama M, Yamamoto T, et al: Nosocomial outbreak of multidrug-resistant USA300 methicillin-resistant Staphylococcus aureus causing severe furuncles and carbuncles in Japan.

8 J Dermatol 2011; 38: 1167-7112 Yamaguchi T, Okamura S, Miura Y, Koyama S, Yanagisawa H, Matsumoto T: Molecular Characterization of Community-Associated Methicillin-Resistant Staphylococcus aureus Isolated from Skin and Pus Samples of Out-patients in Japan. Microb Drug Resist 2015; 21: 441-713 Uehara Y, Ito T, Ogawa Y, Hirotaki S, Shoji T, Tame T, et al: Molecular epidemiologic study of community-associated methicillin-resistant Staphylococcus aureus with Panton-Valentine leukocidin gene among family members in Japan. J Infect Chemother 2015; 21: 700-214 Kawaguchiya M, Urushibara N, Ghosh S, Kuwahara O, Morimoto S, Ito M, et al: Genetic diversity of emerging 279 29 5 20 Panton-Valentine leukocidine/arginine catabolic mobile element (ACME)-positive ST8 SCCmec-IVa meticil-lin-resistant Staphylococcus aureus (MRSA) strains and ACME-positive CC5 (ST5/ST764) MRSA strains in Northern Japan. J Med Microbiol 2013; 62: 1852-6315 Yanagihara K, Araki N, Watanabe S, Kinebuchi T, Kaku M, Maesaki S, et al: Antimicrobial susceptibility and molecular characteristics of 857 methicillin-resistant Staphylococcus aureus isolates from 16 medical centers in Japan (2008-2009): nationwide survey of community-acquired and nosocomial MRSA.

9 Diagn Microbiol Infect Dis 2012; 72: 253-7b Executive summary1 MRSA VCM TEIC ABK LZD DAP CLSI ABK CLSI GM 2 ABK DAP VCM TEIC LZD 3 MRSA TEIC LZD MIC90 2 g/mL ABK VCM DAP 1 g/mL 4 VCM MIC 2 g/mL VCM 5 MRSA / ST RFP MIC90 g/mL 6 CA-MRSA 7 CA-MRSA MRSA CLDM MINO 8 MRSA 9 MIC VCM DAP MIC 10 MIC Literature review MRSA VCM TEIC ABK LZD DAP 5 Clinical and Labora-tory Standards Institute CLSI 1 European Committee on Antimicrobial Susceptibility Testing EUCAST 2 2 ABK

10 GM CLSI EUCAST S VCM LZD DAP TEIC 4 CLSI I EUCAST R VCM 8 TEIC 16 EUCAST 3 3 9 3 CLSI EUCAST TEIC DAP ABK 2 g/mL 2. MRSA breakpoint CLSI EUCAST CLSIEUCASTSIRSRVCM 24, 8 16 2 2 TEIC 816 32 2 2 LZD 4 8 4 4 DAP 1 1 1GM ABK 48 16 1 1S susceptible, I intermediate, R resistantABK breakpoint GM 1, 2 280 91 3 breakpoint 6 MRSA ABK DAP 2 10 11 DAP 12 13 VCM TEIC MRSA 24 11 14 LZD 12 3 MRSA 3 9 16 TEIC LZD MIC90 2 g/mL ABK VCM DAP 1 g/mL ST g/mL RFP g/ mL MRSA MRSA VCM MIC MIC creep 17 19 MIC creeping 20 21 22 23 TEIC 24 VCM MIC 2 g/mL 25 29 MIC 2 g/mL 4 10 30 CLSI EUCAST 3.