(TDM) - 一般社団法人日本臨床微生物学会

1 (TDM) 1) 1) 2)1) "2) % & " 16 12(1 ) 17 7(29 ) ,- ./ 56 7 ,- ! # $ :7 <= AB E GHI-(MRSA) ' L (VCM) M 2003 11( 2004 10(O MRSA S GHI-T M=VCM UV M5634. VCM 0 W1) X Z 5 15mg/ml ] ^ 25 40mg/ml a c Md/ W . 21e 5 . Wgh 6 XiM (TDM) UV7 W6 j 0 k 8 X m OM a c op r s ^a ^ Z (Ccr) 9:v Md/ U: 9: w ;<7 . == M M= U:Ccr a >? X x OM TDMz@ &A { UV7 |- }~MIC % I 8 KL G ^ X m Key words:VCM, TDM, MRSA,^a ^ Z PK/PD ,- ./ M= ? " ?

2 M X 7 56 % M ! # $ :7 <= . O ~ G ,- W $ W R U VQ ./ S$ 0! 7 (TDM; Therapeutic DrugMonitoring) UV 7 O G ,- X (VCM) IO ! xZ Mp 0 ~ 6 :# 0 6 p ! \ 7 <= AB { E GHI-(MRSA) ' L VCM TDM UV TDM UV M 7 I. 1) VCM TDM 2003 11( 2004 10(O MRSA S GHI-T M=VCM UV M5634. X a c TDM L a?c H X b v VCM-TDM on EXCEL 56 d Or ^a VCM-TDM M Z x VCM ! 6 a c oiM i6jk ( 290 0512) | mn575 " TEL: 0436 88 3111 FAX: 0436 88 3032E-mail: s-shouichi I 2005 I Vol.)}

3 15 No. 3 ) VCM VCM VCM- VCM- ! " $ & (Ccr) ) ! 2) Ccr $ & - $ & (Scr) . $ & Ccr 2 Scr ! $ & Ccr Ccr ) 4 6 ) 8 " 9 =>2 ? 886 Ccr B Ccr Ccr C)Q " Cockcroft Gault Q C GQ 3) E Q4) F Q5) 3Q G " H I C)Q JK L! C GQ Ccr N 140O /(72 PScr) (ml/min/kg) Ccr Q N Ccr Q Ccr N 176O P (kg) / 100 PScr (mg/dl) Ccr Q N 158O P (kg) / 100 PScr (mg/dl) F Q Ccr N 33O P (kg)/Scr (mg/dl) Ccr Q N 21O P (kg)/Scr (mg/dl) ) VCM-TDM VCM T V W X " 3Y Z[! VCM \] ]"^ TDX; d 4) MRSA VCM MIC 2004 4f 2004 10fg #h8 MRSA28j E l MIC n E p8q r 2 t x 2z{| 2l }(AST-P525)~ | 2 } $ 1mg/mlJK E II.

4 1) TDM VCM !" " () VCM ( " 34 $ VCM ( 1 L! VCM ( 5 15mg/ml VCM- / 1 ? 25 40mg/ml1) " $ ! ( B " Y 7 21 ( 14 41 ( 9 27 g ( JK L" Y 13 38 ( J Y 5 15 2 30mg/mlJ 3 9 2) Ccr Ccr . / Ccr Ccr 2 1 L! Q Ccr Ccr 4 B Q . Q STSS/EXCEL6) G ". H I 4(r) Q C E F 3 Ccr? 4 ! (p ) g Q ? ! 95 Ccr 70 ml/min ) ! 95 = K 30ml/min,95 = 116 ml/min 1 $ VCM ( 5mg/mlJK5 15mg/ml15mg/mlJ C 25 g/mlJK13 (38)6 (18)19 (56)25 40mg/ml7 (21)2 (6)9 (27)40mg/mlJ 1(3)5 (15)6 (18)C13 (38)14 (41)7 (21)34 (100) >#h?))))

5 Vol. 15 No. 3 2005. 6112 VCM 2 Ccr 70 ml/min !( g 2/day) & () +,-30 ml/min ./ 01 2 VCM 234 -)4 7 2 : 3,-116 ml/min ./ 012 -2; +,<= 3)VCM-TDM VCM ? 1: 28@ AB 2004 2D16 EFGH IJK7 M 1g 2/day(QQ K & ) 2D21 38 (T << IVW X W V3W T[\ ]^ `18000/ml,CRP mg/dl X a<b 2D22 MRSA ? &VCM g 2/day ghi g/30 min (QQ kl 3 2D24 mn Von \ ] q b MRSA)rn 2D25 CT s ( W Vu+ VCM Scr) mg/dl<y ) | VCM} ~ ) &a<). a<b QQ g 2/day ghi g/60min < / } ; +, X a< VCM ; K bb ( VCM 95 /Ccr 70 ml/min(95 n Ccr+,-230 ml/min X Ccr3,-2116 ml/min<= a( ( VCM ( J Ccr 70 ml/min !)

6 (750 mg 2/day) & () 95 +,-(30 ml/min 2 VCM 234 -24 7 : 95 3,-116 ml/min 2 -2; +,<= =\ VCM( -<2 ( VCMQQ - X }-<2 QQ 1 7( X 1 ./Ccr< /Ccr( B 3 ( 2 (./Ccr< /Ccr( H 2 (95 ( ( 2 ( X 3 (./Ccr ` = 2 =b (p ) Vol. 15 No. 3 2005. ( ; (TDM)( B< g & ( ; (TDM)( B< g & 7113 3 3 MRSA g 3/day g/60 min " $% MRSA ' ( $* ,- 3 23 VCM . 3 31 /0 1 2: 632 34 5678 : <4= > DIC?@ B 4 27 CD :E" (CHDF) H JK CK9890 U/ml, M 28950 U/ml, Cre , CRP mg/dl,:R 42000/ml-S( 5 5 T MRSA 5 7 CVPX [ MRSA VCM g 1/day min H : ^_` ' 3 $VCM: b c " e i i k mn o c " p$ e K qK ' r q = > S CHDF 1 - ^ 6 g 1/day-S(t VCM: u x e K z { | t e K 6 hK !))))))))))))))))))))]

7 " 25 40mg/ml 6-S g g/60 min 36 i e K hK x ( MRSA '@ g 1/ 36 min -x C 4 MRSA > t7 29 1 3: 602 34 4B ' S 16 12 1 ' $ X -: , T_` @ n n '( 12 7 6 H 12 12 MRSA MRSA VCM * H 12 15 T 4 5 MRSA VCM : H 6 MRSA MIC 1mg/ml 6-S( Scr mg/dl-S( VCM g 1/day g/60 min - H 12 20 Scr mg/dl MRSA MIC 2mg/ml-S( e K x !" tVCM g 2/ 31 1 VCM { mn o i VCM: { { r VCM: b K r e 6 e K(5 15mg/ml) x r hK(25 40mg/ml) x r 8 Vol. 15 No. 3 2005. :Q : :; :Q : :; 8114 4 2 VCM 5 3 VCM Vol.)))))}}}

8 15 No. 3 2005. " # &' (TDM) * " # &' (TDM) * 9115day g/90 min 12 24 g 2/day g/60 min 12 28 g 1/day g/90 min "# $ &' ( 1 3 VCM 4) MRSA VCM MICE MRSA 28, VCM MIC 6 - MIC . 401 2 MIC - 5 , III. ; < " >?@ #$A% & C DEFG@ 40 801 H H L .2003* O ,;P Q C DEFG@ RS381 MRSA /T0 2 U2 MRSA< 3 . V V4W MRSA< X56 VCM Y \L(TEIC) 7]^_ a L(ABK) #$ 9H H < O >g9 ?h RR2 TDM @9 H 1) c@6 6: X5de ij . 6: kl de /3ij - kl m b- pc@6 r YEpc@6 t de v mc@6 ^ x Epc@6 {c@6 DE ij YEpc@6 \ xrLpc@6 VCM.}

9 >g9 F G H 5 15mg/ml1) H 30mg/ml JK K >g9 M JN 5 MRSA @ P" .25 40mg/ml QR H VCM P TDMS P L { X5 H Q 2 X5 H>?. 1 U H U2 Q .Q Ccr W . c@6 H *X Ccr5 UZ H H VCM 6[\]^ . 1 2g 2 4 H G . \]^ H cd 311 e H 7) 9) 5 \]^ H . J g i J H P 9 . JN TDM J P" U2 n o H P < r . t . $ U H P vw X . t x H .P y UZ P" VCM ? Nz *X Ccr Ccr. |}m6 VCM ^ L Q " ? Q Ccr d . C G ~ ~ C G . 9 H Ccr Q iN ij.

10 C G , ~ , ~ Q Q iN? iN. H . /3 Q CcrQ N Q H e H 2), 10) #$ Ccr . 2 - Q Ccr VCM R VCM O R . Ccr 0 Scr Q Ccr 9H O H 6 MRSA28, VCM MIC E e W#$ : Vol. 15 No. 3 2005. 10116 3 VCM Ccr VCM ! r $ % 11) ' Ccr ( ) +, 0 VCM Ccr 23 4 ICU 0 5 6! CHDF 8 VCM' : < 8=% % CHDF&> VCM VCM ( ?< C 82)* E 11, 12) VCM,-. F01G% < ) < Scr VCM ( H 2 Moellering K MN K O 1G 0E Q 1G30 ( S0 T * S Scr U6( 73 Q8% :;=%0U6( W =X Scr F01G > ?