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1 MRSA MRSA MRSA MSD Meiji Seika MRSA MRSA MRSA MRSA MRSA MRSA VCM MRSA MRSA MRSA Antimicrobaial stewardship team

2 MRSA MRSA MRSA MRSA MRSA vancomycinVCM teicoplaninTEIC arbekacinABK linezolidLZD daptomycinDAP / sulfamethoxazole/trimethoprimST rifampicinRFP clindamycinCLDM minocyclineMINO I1 II III MRSA 1. MRSA a.

3 1b.. 42. MRSA .. 123. MRSA a.. 18b.. 24c.. 29d. 1 .. 332 .. 40e.. 46f.. 50g.. 60h.. 68i .. 734. MRSA TDM .. 815. MRSA .. 84 - a. VCM .. 87b. TEIC .. 88c. ABK .. 90d. LZD .. 92e. DAP .. 931 MRSA a MRSA 11 MRSA a. Executive summary1. MRSA Methicillin-resistant Staphylococcus au-reus 2. 50 70 MRSA 3. MRSA VAP 40 20 10 10 5 4. 10 30 MRSA 5. MRSA CA-MRSA 6. Literature review MRSA Methicillin-resistant Staphylococcus aureus 50 70 MRSA 1 JANIS 2011 1 MRSA a MRSA 2 2 MRSA MRSA / 100 MRSA 90 1 MRSA VAP 40 20 10 10 5 1 MRSA MRSA hospital-associated methicillin-re-sistant S.

4 Aureus HA-MRSA community-associated meth-icillin-resistant S. aureus CA-MRSA 1 CA-MRSA MRSA SCCmec HA-MRSA II I III CA-MRSA IV V CA-MRSA 3 CA-MRSA 4,5 USA300 Panton-Valentine leukocidin PVL 6,7 CA-MRSA PVL 3 5 8 10 10 30 MRSA MRSA HA-MRSA CA-MRSA 11,12 1 MRSA HA-MRSACA-MRSA SCCmec type II type IV NewYork/JapanUSA300 ( ) PVL 1 MRSA a MRSA 3 MRSA active surveillance 1 2011 2011 Sa d-Salim B, Mathema B, Kreiswirth BN: Community-acquired methicillin-resistant Staphylococcus aureus: an emerging pathogen.

5 Infect Control Hosp Epidemiol. 2003; 24: 451-54 Watkins RR, David MZ, Salata RA: Current concepts on the virulence mechanisms of methicillin-resistant Staphylococcus aureus. J Med Microbiol 2012; 61: 1179-935 Chen LF, Chastain C, Anderson DJ: Community-Acquired Methicillin-Resistant Staphylococcus aureus Skin and Soft Tissue Infections: Management and Prevention. Curr Infect Dis Rep 2011; 13: 442-506 Farr AM, Aden B, Weiss D, et al: Trends in hospitalization for community-associated methicillin-resistant Staphylococcus aureus in New York City, 1997-2006: data from New York State s Statewide Planning and Research Cooperative System. Infect Control Hosp Epidemiol 2012; 33: 725-317 Mediavilla JR, Chen L, Mathema B, et al: Global epidemiology of community-associated methicillin resistant Staphylococcus aureus (CA-MRSA). Curr Opin Microbiol 2012; 15: 588-958 Yamamoto T, Nishiyama A, Takano T, et al: Community-acquired methicillin-resistant Staphylococcus aureus: community transmission, pathogenesis, and drug resistance.

6 J Infect Chemother 2010; 16: 225-549 Isobe H, Takano T, Nishiyama A, et al: Evolution and virulence of Panton-Valentine leukocidin-positive ST30 methicillin-resistant Staphylococcus aureus in the past 30 years in Res 2012; 33: 97-10910 Kawaguchiya M, Urushibara N, Yamamoto D, et al: Characterization of PVL/ACME-Positive Methicillin-Resistant Staphylococcus aureus (Genotypes ST8-MRSA-IV and ST5-MRSA-II) Isolated from a University Hospital in Japan. Microb Drug Resist 2012 [Epub ahead of print]11 Yamaguchi T, Nakamura I, Chiba K, et al: Epidemiological and microbiological analysis of community-associated methicillin-resistant Staphylococcus aureus strains isolated from a Japanese hospital. Jpn J Infect Dis 2012; 65: 175-812 Yanagihara K, Araki N, Watanabe 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.

7 Diagn Microbiol Infect Dis 2012; 72: 253-71 MRSA b MRSA 4 4b. Executive summary1. MRSA VCM TEIC ABK LZD DAP CLSI ABK CLSI GM 2. ABK DAP VCM TEIC LZD 3. MRSA VCM TEIC LZD ABK MIC90 2 g/mL DAP g/mL 4. VCM MIC MIC creep 5. VCM MIC 2 g/mL VCM 6. MRSA ST RFP MIC90 g/mL 7. CA-MRSA - 8. CA-MRSA MRSA CLDM MINO 9. MRSA 10. MIC VCM DAP MIC 1 MRSA b MRSA 5 Literature Review MRSA VCM TEIC ABK LZD DAP 5 Clinical and Laboratory Standards Institute CLSI 1 European Committee on Antimicrobial Susceptibility Testing EUCAST 2 2 ABK GM CLSI EUCAST S VCM LZD DAP TEIC 4 CLSI I EUCAST R VCM 8 TEIC 16 EUCAST 3 3 6 CLSI EUCAST TEIC ABK 2 g/mL 6 MRSA ABK DAP 2 7,8 DAP 9,10 VCM TEIC MRSA 24 8,11 LZD 12 1 3 3 6.

8 13 VCM TEIC LZD ABK MIC90 2 g/mL DAP g/mL MRSA MRSA VCM MIC MIC creep 2 MRSA Staphylococcus spp 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 susceptibility, I intermediate, R ResistanceABK breakpoint GM 1 MRSA b MRSA 6 6 14 16 MIC creeping 17,18 19,20 VCM MIC 2 g/mL 21 25 MIC 2 g/mL 2006 2009 454 56 3 6 2010 103 10 13 3 10 26 CLSI EUCAST 1,2 area under the blood concentration time curve AUC MIC AUC/MIC VCM 27,28 VCM MIC 19,20 MIC creep VCM MIC 2 g/mL VISA 29,30 VISA 2 VCM MIC 4 g/mL Vancomycin intermediated-resistant Staph-ylococcus aureus VISA MRSA VISA population Concentration g mL VCM, TEIC, ABK, LZD 557 ST, RFP.

9 DAP 103 ST SMX TMP=19 1 TMP LZDTEICVCMABKDAPSTRFPC ummlative curve % 0%20%40%60%80%100% 1 3 MRSA 3 6 13 1 MRSA b MRSA 7 VISA VCM MRSA BIVR 31 34 VCM VCM MRSA VISA Mu3 VISA BIVR MRSA 34 MRSA ST RFP MIC90 g/mL RFP ST 35,36 1 CA-MRSA 37,38 CA-MRSA SCCmec type II type II CLDM MINO 39 MRSA MRSA MRSA E-test VCM MIC g/mL MRSA 40~46 E-test VCM MIC Agar dilution method Broth dilution method 47~49 3 3 557 VCM MIC 2 g/mL 3 MRSA VCM 2 g/mLMRSA VCM 2 g/mL % 2006 RTI SSI10310 13 1 MRSA b MRSA 8 8 MIC E-test MIC 50 1 Clinical and Laboratory Standards Institute: Performance Standards for Antimicrobial Susceptibility Testing; Twenty-First Informational Supplement.

10 Vol. 31. M100-S21. Wayne, Pennsylvania: CLSI, 20112 European Committee on Antimicrobial Susceptibility Testing: Breakpoint tables for interpretation of MICs and zone diameters. Version Munich and Basel: European Society of Clinical Microbiology andInfectious Diseases, 20113 Niki Y, Hanaki H, Yagisawa M, et al: Japanese Society of Chemotherapy. The first nationwide surveillance of bacterial respiratory pathogens conducted by the Japanese Society of Chemotherapy. Part 1: a general view of antibacterial susceptibility. J Infect Chemother 2008; 14: 279-904 Niki Y, Hanaki H, Matsumoto T, et al: Nationwide surveillance of bacterial respiratory pathogens conducted by the Japanese Society of Chemotherapy in 2007: general view of the pathogens antibacterial susceptibility. J Infect Chemother 2009; 15: 156-675 Niki Y, Hanaki H, Matsumoto T, et al: Nationwide surveillance of bacterial respiratory pathogens conducted by the Japanese Society of Chemotherapy in 2008: general view of the pathogens antibacterial susceptibility.