奈良県五條地域における尿路感染由来の大腸菌の薬剤感受性

Შ‫ډ‬ᑣჄᇌʞఱ၏ᨈư౨ЈƞǕƨ
ᵣᵱᵠᵪ ငဃ‫ٻ‬ᐂᓏƴ᧙ƢǔǵȸșǤȩȳǹ
‫ۑ‬ኳ㔝㞞அ㸦ᪧᡤᒓ ዉⰋ┴❧஬ᲄ⑓㝔 ⌧ᡤᒓ ༡࿴ᗈᇦ་⒪௻ᴗᅋ ༡ዉⰋ⥲ྜ་⒪ࢭࣥ
ࢱ࣮㸧
㡭ᶫಙ៞㸦ᪧᡤᒓ ዉⰋ┴❧஬ᲄ⑓㝔⣽⳦᳨ᰝᐊ ⌧ᡤᒓ ዉⰋ┴❧་⛉኱Ꮫ㝃ᒓ⑓㝔⮫
ᗋ᳨ᰝ㒊㸧
࠙◊✲┠ⓗࠚ
㏆ᖺࠊඛ㐍ㅖᅜ࡟࠾ࡅࡿ⭠ෆ⣽⳦⛉⣽⳦ࡢ⸆๣⪏ᛶ໬ࡀୡ⏺ⓗၥ㢟࡜࡞ࡗ࡚࠸ࡿࠋ௨๓
ࡣ㝔ෆឤᰁ⑕ࡢཎᅉ⳦࡜ࡋ࡚ၥ㢟どࡉࢀ࡚࠸ࡓࡀࠊ᫖௒ࡣᕷ୰࡛ࡢឤᰁ౛ࡸ᪋タෆ࡛ࡢಖ
⳦⪅ࡢቑຍࡶሗ࿌ࡉࢀ࡚࠸ࡿ 1) 2)ࠋዉⰋ┴❧஬ᲄ⑓㝔㸦௨ୗࠊ஬ᲄ⑓㝔㸧ࢆཷデࡍࡿᝈ⪅࠿
ࡽ᳨ฟࡉࢀࡓ⭠ෆ⣽⳦⛉⣽⳦ࡶ౛እ࡛ࡣ࡞ࡃࠊ≉࡟ᇶ㉁≉␗ᛶᣑᙇᆺș-ࣛࢡࢱ࣐࣮ࢮ
㸦extended spectrum ș- lactamase; ESBL㸧ࢆ⏘⏕ࡍࡿ⸆๣⪏ᛶ኱⭠⳦ࡢศ㞳⋡ࡀᖺࠎቑ
ຍࡋ࡚࠸ࡿࠋESBL ࡣ࣌ࢽࢩࣜࣥ⣔ࠊࢭࣇ࢓ࣟࢫ࣏ࣜࣥ⣔࡞࡝୍⯡デ⒪࡛ᗈࡃ౑⏝ࡉࢀࡿᢠ
⳦⸆ࢆຍỈศゎࡍࡿ㓝⣲࡛࠶ࡾࠊࣉࣛࢫ࣑ࢻࡀ᥋ྜఏ㐩࡟ࡼࡾ⳦✀ࢆ㉺࠼࡚ᣑᩓࡍࡿࡓࡵ
㝔ෆឤᰁᑐ⟇࡟࠾࠸࡚ࡶ㠀ᖖ࡟㔜せ࡛࠶ࡿࠋࡑࡇ࡛ᮏ◊✲࡛ࡣࠊ஬ᲄᆅᇦ࡟࠾ࡅࡿ ESBL
⏘⏕኱⭠⳦ࡢ≉ᚩࢆᢕᥱࡋࠊᆅᇦ࡟࠾ࡅࡿᾐ㏱⋡ࠊ⏤᮶ᝈ⪅ࡢ⫼ᬒࠊឤཷᛶࣃࢱ࣮ࣥ࡞࡝
ࢆゎᯒࡋఏ᧛ᵝᘧࢆ᫂ࡽ࠿࡟ࡍࡿࡇ࡜ࢆ┠ⓗ࡟ࠊ஬ᲄ⑓㝔࡛ศ㞳ࡉࢀࡓ኱⭠⳦࡟ࡘ࠸࡚ศ
Ꮚ␿Ꮫⓗ࡟ㄪᰝࡋࡓࠋ
࠙◊✲ࡢᚲせᛶࠚ
⪏ᛶ⳦ศ㞳⋡ࡢ๭ྜࡸࠊᆅᇦูࡢ≉ᚩࢆ᫂ࡽ࠿࡜ࡍࡿࡇ࡜࡛ࠊධ㝔ᝈ⪅࡟࠾ࡅࡿึᮇᢞ
୚ᢠ⏕๣ࡢ㑅ᢥࡀ㐺ṇ໬ࡉࢀࡿ࡜⪃࠼ࡽࢀࡿࠋࡲࡓࠊᏛ⾡㞟఍➼࡛Ⓨ⾲ࡍࡿࡇ࡜࡟ࡼࡾࠊ
ᆅᇦ࡟࠾ࡅࡿ⪏ᛶ⳦ὶ⾜ࡢ≧ἣࢆၨⓎࡍࡿࡇ࡜ࡀ࡛ࡁࡿࠋࡑࡢ⤖ᯝࠊ⪏ᛶ⳦ឤᰁ⑕౛࡟ࡣ
㐺ษ࡞ᢠ⏕๣ࡀ༑ศ㔞ᢞ୚ࡉࢀࠊ୙せ࡞ᢠ⏕๣ᢞ୚ࡣ᥍࠼ࡽࢀ࡚᪂ࡓ࡞⪏ᛶ⳦ࡢฟ⌧ࢆᢚ
࠼ࡽࢀࡿࡇ࡜ࡀᮇᚅࡉࢀࡿ࡜࡜ࡶ࡟ࠊESBL ឤᰁ⑕࡛ࡢ⮴Ṛ⋡ࡢపୗ࡟ᐤ୚࡛ࡁࡿ࡜ᮇᚅࡉ
ࢀࡿࠋ
࠙◊✲ィ⏬ࠚ
2015 ᖺ 4 ᭶࠿ࡽ 2016 ᖺ 3 ᭶ࡢ㛫࡟ࠊ஬ᲄ⑓㝔࡟࠾࠸࡚ឤᰁ⑕ࡀ␲ࢃࢀ࡚ᥦฟࡉࢀࡓ⮫ᗋ
᳨య㸦ၻ⑱ࠊ⾑ᾮࠊᒀ㸧࠿ࡽ኱⭠⳦ࡀศ㞳ࡉࢀࡓಖ᭷⪅ࢆᑐ㇟࡜ࡋࡓࠋ኱⭠⳦ࡢྠᐃ࡜⸆
๣ឤཷᛶࡣ MicroScan auto SCAN4㸦Beckman coulter㸧ࢆ⏝࠸࡚᪋⾜ࡋࡓࠋ࡞࠾ࠊ⸆๣ឤ
ཷᛶヨ㦂ࡣ௨ୗࡢᢠ⏕๣࡟ᑐࡋ࡚⾜ࡗࡓ㸦ABPCࠊABPC/CVAࠊPIPCࠊPIPC/TAZࠊCTXࠊ
CAZࠊCFPMࠊAZTࠊLVFXࠊSTࠊMINOࠊGMࠊCMZࠊFOMࠊIPMࠊMEPM㸧ࠋྠᶵჾ
㸫 163 㸫
ࡢ ESBL ࢫࢡ࣮ࣜࢽࣥࢢᇶ‽ࡣ MICӍ8μg/ml
㸦Cefpodoxime㸧ࠊMICӍ4μg/ml (Ceftazidime,
Aztreonam, Cefotaxime, Ceftiaxone)࡛࠶ࡾࠊࡇࢀ࡟ヱᙜࡍࡿሙྜࡣ㆙࿌ࡀ⾲♧ࡉࢀࡿࠋ㆙
࿌ࡀ⾲♧ࡉࢀࡓ඲ᰴ࡟ᑐࡋ࡚ Double disk ἲࢆ⏝࠸࡚ ESBL ⏘⏕ࡢ☜ㄆࢆ⾜ࡗࡓࠋDouble
disk ἲ࡛ ESBL ⏘⏕ࡀ☜ㄆࡉࢀࡓᰴࡣࠕESBL ᰴࠖ࡜ࡋ࡚࣐࢖ࢡࣟࣂࣥࢡ࡟ಖᏑࡋࠊྠἲ
࡛ ESBL ⏘⏕ࡀ☜ㄆ࡛ࡁ࡞࠿ࡗࡓᰴࡣࠕ⪏ᛶᰴࠖ࡜ࡋ࡚ྠᵝ࡟࣐࢖ࢡࣟࣂࣥࢡ࡟ಖ⟶ࡋࡓࠋ
ྠ୍ே≀࠿ࡽ⮫ᗋ᳨యࡀ」ᩘᅇ᥇ྲྀࡉࢀࠊESBL ⏘⏕኱⭠⳦ࡀ」ᩘ᳨ฟࡉࢀࡓሙྜࡣࠊ௦⾲
ᰴࡢࡳࢆಖᏑࡋࡓࠋಖᏑࡋࡓ⳦ᰴࡣ඲࡚ PCR ࢆ⏝࠸࡚ ESBL 㑇ఏᏊ㸦blaCTX, blaTEM, blaSHV㸧
ࡢ᭷↓ࢆㄪᰝࡋࡓ 3)ࠋESBL 㑇ఏᏊಖ᭷ᰴ࡟㛵ࡋ࡚ࡣࠊࡑࡢ⏤᮶ᝈ⪅࡟㛵ࡋ࡚௨ୗࡢ᝟ሗ
ࢆㄪᰝࡋࡓ㸹ᖺ㱋ࠊᛶูࠊ⏕άࡢሙࠊ⏤᮶᳨యࠊ㉳⅖⳦࡜ࡋ࡚἞⒪ࡉࢀࡓ࠿ࠊ἞⒪࡟⏝࠸
ࡽࢀࡓᢠ⏕๣ࡣఱ࠿ࠊධ㝔ᮇ㛫ࠊணᚋࠋศ㞳ࡉࢀࡓ኱⭠⳦࡟࠾ࡅࡿ ESBL ⏘⏕ᰴࡢ๭ྜࢆ
ㄪᰝࡋࠊ㝔ෆឤᰁᑐ⟇ࢧ࣮࣋࢖ࣛࣥࢫ㸦Japan nosocomial infectious surveillance; JANIS㸧
ࡢࢹ࣮ࢱ࡜ẚ㍑ࡋࡓࠋ࡞࠾ࠊᮏ◊✲ࡣ஬ᲄ⑓㝔ࡢ೔⌮ጤဨ఍࡟࡚ᢎㄆࢆཷࡅࡓ㸦ཷ௜␒ྕ
H27-1㸧ࠋ
࠙ᐇ᪋ෆᐜ࣭⤖ᯝࠚ
ᑐ㇟ᮇ㛫ෆ࡟ 281 ᰴࡢ኱⭠⳦ࡀ 221 ேࡢᝈ⪅࠿ࡽ᳨ฟࡉࢀࡓࠋࡑࡢ࠺ࡕ 56 ᰴࡀ
MicroScan auto SCAN4 ࡟ࡼࡗ࡚ ESBL ࡢ⏘⏕ࢆ␲ࢃࢀࡓࠋྠ୍ே≀࠿ࡽ᳨ฟࡉࢀࡓሙྜ
ࡣ௦⾲ᰴࡢࡳࢆಖᏑࡋࡓࡓࡵࠊ᭱⤊ⓗ࡟ 37 ᰴࡢ኱⭠⳦ࢆಖᏑࡋࡓࠋࡇࡢ࠺ࡕࠊ30 ᰴࡀ Double
disk ἲ࡛ ESBL ⏘⏕⳦࡜ุᐃࡉࢀࠊ7 ᰴࡣ Double disk ἲ࡛ ESBL 㠀⏘⏕࡜ุ᩿ࡉࢀࡓࠋ
PCR ࡛ࡣࠊ๓⪅ࡣ඲ᰴ࡟࠾࠸࡚ ESBL 㑇ఏᏊࡀ᳨ฟࡉࢀࠊᚋ⪅ࡣ 3 ᰴ࡟࠾࠸࡚ ESBL 㑇ఏ
Ꮚࡀ᳨ฟࡉࢀࡓࠋ᳨ฟࡉࢀࡓ኱⭠⳦࡟࠾ࡅࡿ ESBL ⏘⏕ᰴࡢ๭ྜࡣ 15.4㸣࡛࠶ࡗࡓࠋ
ࡲࡓࠊESBL 㑇ఏᏊಖ᭷኱⭠⳦ࡢಖ⳦⪅ 33 ྡࡢ࠺ࡕࠊ┿࡟㉳⅖⳦࡜ࡋ࡚἞⒪ࡉࢀࡓࡢࡣ
23 ྡ࡛࠶ࡗࡓࠋᕷ୰Ⓨ⑕ࡣ 14 ౛ࠊ㝔ෆⓎ⑕ࡣ 9 ྡ࡛࠶ࡗࡓࠋᕷ୰Ⓨ⑕ࡢ࠺ࡕ᪋タධᡤ୰
ࡢᝈ⪅ࡣ 11 ྡ࡛ࠊ඲౛ࡀእ᮶᳨࡛యࢆ᥇ྲྀࡉࢀࠊࡑࡢࡲࡲධ㝔ຍ⒪ࢆ࠺ࡅࡓࠋࡇࡢ࠺ࡕࡢ
7 ྡࡣྠ୍᪋タ࡟ධᡤࡋ࡚࠸ࡓࠋṧࡾࡢ 3 ྡࡣ⮬Ꮿ࡛⏕άࡋ࡚࠾ࡾࠊእ᮶ຍ⒪ࢆཷࡅࡓࠋᕷ
୰Ⓨ⑕ࡢ ESBL ⏘⏕኱⭠⳦ࡣ඲࡚ CTX-M-9 group ࡛࠶ࡾࠊTEM ࢆేࡏᣢࡘᰴࡀ㸱౛ࠊ
SHV
ࢆేࡏᣢࡘᰴࡀ㸯౛࠶ࡗࡓࠋ㝔ෆ࡛㉳⅖⳦࡜ࡋ᳨࡚ฟࡉࢀࡓ ESBL ⏘⏕኱⭠⳦ࡣ 9 ౛࡛ࠊ1
౛ࡢࡳ CTX-M-1 group ࡜ OXA ࢆేࡏᣢࡗ࡚࠸ࡓࠋṧࡾࡢ 8 ౛ࡣ CTX-M-9 group ࡛࠶ࡾࠊ
ࡑࡢ࠺ࡕ 2 ౛ࡣ TEM ࢆేࡏᣢࡗ࡚࠸ࡓࠋ┿࡟㉳⅖⳦࡜ࡋ࡚἞⒪ࡉࢀࡓࡢࡣ 23 ྡ࠿ࡽ᳨ฟ
ࡉࢀࡓᰴࡢ⸆๣ឤཷᛶ࡟㛵ࡋ࡚ࡣ⾲࡟ࡲ࡜ࡵࡓࠋ
㸫 164 㸫
ᢠ⳦⸆
㻭㻮㻼㻯
㻭㻮㻼㻯㻛㻯㼂㻭
㻼㻵㻼㻯
㻼㻵㻼㻯㻛㼀㻭㼆
㻯㼀㼄
㻯㻭㼆
㻯㻲㻼㻹
㻭㼆㼀
㻸㼂㻲㼄
㻿㼀
㻹㻵㻺㻻
㻳㻹
㻯㻹㼆
㻲㻻㻹
㻵㻼㻹
㻹㻱㻼㻹
㻹㻵㻯
⪏ᛶ⋡䠄䠂䠅
㻌㼚㻩㻟㻞
᭱ᑠ
᭱኱
䠚㻝㻢 䠄㻾䠅
㻝㻜㻜
䍺㻌㻤 䠄㻾䠅 㻝㻢 䠄䠥䠅
㻟㻜㻚㻠
䠚㻢㻠 䠄㻾䠅
㻝㻜㻜
䍺㻝㻢 䠄㻿㻕
㻜
䠚㻞 䠄㻾䠅
㻝㻜㻜
㻠 䠄㻾䠅 䠚㻤 䠄㻾䠅
㻝㻜㻜
㻤 䠄㻾䠅 䠚㻝㻢 䠄㻾䠅
㻝㻜㻜
㻠 䠄㻾䠅 䠚㻤 䠄㻾䠅
㻝㻜㻜
㻞 䠄㻿㻕 䠚㻠 䠄㻾䠅
㻤㻞㻚㻢
㻜㻚㻡 䠄㻿㻕 䠚㻞 䠄㻾䠅
㻟㻠㻚㻤
㻠 䠄㻿㻕 䠚㻤 䠄㻾䠅
㻝㻣㻚㻠
㻠 䠄㻿㻕 䠚㻤 䠄㻾䠅
㻝㻡
䍺㻝㻢 䠄㻿㻕
㻜
䍺㻠 䠄㻿㻕
㻜
䍺㻝 䠄㻿㻕
㻜
䍺㻝 䠄㻿㻕
㻜
࠙⪃ᐹ࡜௒ᚋࡢㄢ㢟ࠚ
JANIS ࡟ࡼࡿ࡜ࠊ2014 ᖺᗘ࡟᳨ฟࡉࢀࡓ኱⭠⳦ࡢ⣙ 11.6%ࡀࢭࣇ࢛ࢱ࢟ࢩ࣒⪏ᛶ኱⭠⳦
࡛࠶ࡗࡓࠋࡇࡢ኱ከᩘࡀ ESBL ⏘⏕኱⭠⳦࡛࠶ࡿ࡜᥎ᐃࡍࡿ࡜ࠊ஬ᲄᆅᇦ࡟࠾ࡅࡿ ESBL
⏘⏕ᰴࡢ᳨ฟ⋡ࡣ 15.4%࡛࠶ࡿ࠿ࡽࠊ஬ᲄᆅᇦ࡛ࡣ ESBL ⏘⏕ᰴࡢ᳨ฟ⋡ࡀ㧗࠸ഴྥ࡟࠶
ࡿࡇ࡜ࡀ♧၀ࡉࢀࡓࠋ≉࡟ࠊESBL 㑇ఏᏊಖ᭷኱⭠⳦ࢆಖ⳦ࡋ࡚࠸ࡓ 33 ྡࡢ࠺ࡕࠊ10 ྡࡀ
ྠ୍᪋タ࠿ࡽධ㝔ࡋ࡚࠸ࡓࠋࡲࡓࠊ3 ྡࡶูࡢྠ୍᪋タ࠿ࡽධ㝔ࡋ࡚࠸ࡓࠋESBL ⏘⏕ᰴࡀ
┿࡟㉳⅖⳦࡜ࡋ࡚἞⒪ࡉࢀࡓᕷ୰Ⓨ⑕ឤᰁ⑕ᝈ⪅ࡣ 14 ྡ࡛࠶ࡗࡓࡀࠊࡑࡢ࠺ࡕ 11 ྡࡀ᪋
タධᡤ୰ࡢᝈ⪅࡛࠶ࡾࠊ7 ྡࡣྠ୍᪋タ࡟ධᡤࡋ࡚࠸ࡓࠋ㧗㱋⪅ࡀ㞟ᅋ⏕άࢆ⾜࠺⚟♴᪋タ
࡛ࡣ⸆๣⪏ᛶ⳦ࡢỈᖹఏ᧛ࡀ⏕ࡌࠊ⳦ࡢ ᗋ࡟࡞ࡾ࠺ࡿࡇ࡜ࡀሗ࿌ࡉࢀ࡚࠸ࡿࡀ 4)ࠊᡃࠎࡢ
ㄪᰝ⤖ᯝࡣࠊ஬ᲄᆅᇦ࡟࠾࠸࡚ࡶ⚟♴᪋タࡀ⳦ࡢࣜࢨ࣮ࣂ࣮࡜࡞ࡗ࡚࠸ࡿྍ⬟ᛶࢆ♧၀ࡍ
ࡿࡶࡢ࡛࠶ࡗࡓࠋ
஬ᲄ⑓㝔᳨࡛ฟࡉࢀࡓ ESBL ⏘⏕኱⭠⳦ࡢᢠ⳦⸆࡟ᑐࡍࡿឤཷᛶ࠿ࡽࡣࠊ࢝ࣝࣂ࣌ࢿ࣒
⣔ᢠ⳦⸆࡟ᑐࡋ࡚ 100㸣ឤཷᛶࡀ࠶ࡾࠊ࢟ࣀࣟࣥ⣔ᢠ⳦⸆࡟ᑐࡋ࡚ࡣ 100㸣⪏ᛶ࡛࠶ࡿࡇ࡜
ࡀࢃ࠿ࡗࡓࠋࡲࡓࠊࢭࣇ࣓ࢱࢰ࣮ࣝࡣ 100㸣ࡢឤཷᛶࠊ࣍ࢫ࣐࣍࢖ࢩࣥ࡟ᑐࡋ࡚ࡣ 100㸣ࡢ
ឤཷᛶࢆ♧ࡋࡓࠋESBL ⏘⏕኱⭠⳦ࡢ⳦⾑⑕࡟ᑐࡍࡿࢭࣇ࣓ࢱࢰ࣮ࣝࡢ᭷ຠᛶࢆሗ࿌ࡋࡓ◊
✲ࡶ࠶ࡿࡓࡵ 5)ࠊESBL ⏘⏕኱⭠⳦ࡀཎᅉᚤ⏕≀࡜ࡋ࡚᝿㉳ࡉࢀࡓሙྜࡢ἞⒪⸆࡜ࡋ࡚ࠊ࢝
ࣝࣂ࣌ࢿ࣒⣔ᢠ⳦⸆࡟ຍ࠼࡚ࢭࣇ࣓ࢱࢰ࣮ࣝࡶೃ⿵࡜࡞ࡾ࠺ࡿ࡜⪃࠼ࡽ࠼ࡿࠋࡑࡢ㏫࡟ࠊ
ཎᅉᚤ⏕≀࡜ࡋ࡚ ESBL ⏘⏕኱⭠⳦ࡀ᝿ᐃࡉࢀࡓሙྜ࡟ࡣࠊ࢟ࣀࣟࣥ⣔ᢠ⳦⸆ࡸࢭࣇ࢓ࣟ
ࢫ࣏ࣜࣥ⣔ᢠ⳦⸆ࢆ➨୍㑅ᢥ࡜ࡍࡿࡇ࡜ࡣ㑊ࡅࡿࡇ࡜ࡀᏳ඲࡛࠶ࡿࡇ࡜ࡀ♧၀ࡉࢀࡿࠋ
௒ᚋࡢㄢ㢟࡜ࡋ࡚ࠊᮏ◊✲ࡣ஬ᲄ⑓㝔᳨࡛ฟࡉࢀࡓ኱⭠⳦ࢆᑐ㇟࡜ࡋ࡚⾜ࡗࡓࡓࡵࠊྛ
᪋タ࡟࠾ࡅࡿ⪏ᛶ⳦ಖ᭷⋡ࡀ⟬ฟ࡛ࡁ࡞࠸ࠋ࠶ࡿ≉ᐃࡢ᪋タ࡟ධᡤࡋ࡚࠸ࡿ฼⏝⪅ࡀឤᰁ
㸫 165 㸫
⑕࡟⨯ᝈࡋࡓሙྜࠊESBL ⏘⏕኱⭠⳦ࢆᛕ㢌࡟࠾࠸ࡓᑐฎࡀᮃࡲࡋ࠸ࡇ࡜ࡣ♧၀ࡉࢀࡓࡶࡢ
ࡢࠊ࡝ࡢ⛬ᗘ㓄៖ࡍ࡭ࡁ࠿ᮍࡔ᫂ࡽ࠿࡛ࡣ࡞࠸ࠋࡲࡓࠊᮏ◊✲࡛ࡣࣃࣝࢫࣇ࢕࣮ࣝࢻࢤࣝ
㟁ẼὋືࢆ⾜ࡗ࡚࠸࡞࠸ࠋࡑࡢࡓࡵࠊྛᰴ㛫ࡢ┦ືᛶࡢ᳨ウࡀ࡛ࡁࡎࠊ᪋タෆ࡛ఏ᧛ࡋ࡚
࠸ࡿ࠿ุ᩿࡛ࡁ࡞࠸ࠋ௒ᚋࡣࠊ࠶ࡿ᪋タࡢ඲฼⏝⪅ࢆᑐ㇟࡜ࡋࠊESBL ⏘⏕኱⭠⳦ࡢಖ᭷⋡
ࢆ⟬ฟࡍࡿ࡜࡜ࡶ࡟ࡑࡢᗈࡀࡾࢆ⤒᫬ⓗ࡟ࣉࣟࢵࢺࡋࠊᰴ㛫ࡢ┦ྠᛶࢆㄪᰝࡍࡿࡇ࡜ࡀᮃ
ࡲࢀࡿࠋࡑࡋ࡚ࠊࡇࡢ⤖ᯝࢆᆅᇦࡢ㛤ᴗ་ࡸ໅ົ་ࡀ㞟ࡲࡿ◊✲఍࡛බ⾲ࡋࠊ኱⭠⳦ࡀឤ
ᰁ⑕ࡢ㉳⅖⳦࡟᝿㉳ࡉࢀࡓሙྜࡢึᮇ἞⒪࡟࠾ࡅࡿᢠ⏕๣㑅ᢥ࡟㛵ࡍࡿᥦゝࢆ⾜࠸ࠊᐇ⮫
ᗋ࡬ࡢ㑏ඖࢆ⾜ࡗ࡚࠸ࡃᚲせࡀ࠶ࡿࠋ
㸦ཧ⪃ᩥ⊩㸧
1) Ben-Ami R, et al: A multinational survey of risk factors for infection with
extended-spectrum
ǃ-lactamase-producing
enterobacteriaceae
in
nonhospitalized
patients. Clin Infect Dis 49: 682-690, 2009.
2) Yamamoto A: Extended-spectrum ǃ-lactamase (ESBL)-producing Escherichia coli is
frequently detected as a pathogen of urinary tract infection in nursing home residents.
Nihon Ronen Igakkai Zasshi 48: 530-538, 2011.
3) Yano H, et al: Molecular characteristics of extended-spectrum ǃ-lactamases in clinical
isolates from Escherichia coli at a Japanese tertiary hospital. PLoS ONE 8, e64359,
2013.
3) Doi Y, et al: The role of horizontal gene transfer in the dissemination of
extended-spectrumǃ-lactamase-producing Escherichia coli and Klebsiella pneumoniae
isolates in an endemic setting. Diagn Microbiol Infect Dis 74: 34-38, 2012.
4) Mataumura Y, et al: Multicenter retrospective study of cefmetazole and flomoxef for
treatment of extended-spectrum-ǃ-lactamase-producing Escherichia coli bacteremia.
Antimicrob Agents Chemother 59: 5107-5113, 2015.
࠙⤒㈝౑㏵᫂⣽ࠚ
࣐࢖ࢡࣟࣂࣥࢡ㸦࢖࣡࢟㸧
෇
࣑࣮࣮ࣗࣛࣄࣥࢺࣥᇵᆅ㸦ᰤ◊㸧
(6%/ ☜ㄆヨ㦂⏝ࢹ࢕ࢫࢡ㸦ᰤ◊㸧
෇
෇
⁛⳦ὸᆺ 1 ࢩ࣮ࣕࣞ㸦᪥Ỉ㸧
ᚤ㔞ᾮయ⸆๣ឤཷᛶࣉ࣮ࣞࢺ㸦ᰤ◊㸧
ᾘ⪖ရ㈝㸦ᩥල࣭ࢥࣆ࣮⏝⣬࣭࢖ࣥࢡ௦௚㸧
෇
෇
෇
ྜ ィ
෇
኱ྠ⏕࿨ཌ⏕஦ᴗᅋຓᡂ㔠
෇
㸫 166 㸫