medicina47巻4号

2010年04月発行

今月の主題 抗菌薬の使い方を究める 手強い菌の感染症に対する治療

MRSA感染症に対する抗菌薬治療

著者： 柳秀高¹

所属機関： ¹東海大学医学部総合内科

ページ範囲：P.674 - P.678

ポイント

★MRSAも黄色ブドウ球菌であり，皮膚軟部組織感染，血流感染などを起こす．

★カテーテル採血でない血液培養からMRSA（に限らず黄色ブドウ球菌）が検出されれば通常は治療すべきである．

★喀痰培養からMRSAが検出されても，臨床的に肺炎かどうか検討する必要がある．

★感染部位により治療法は異なる．

★バンコマイシン，リネゾリド，シナシッド，クリンダマイシン，ST合剤，ミノサイクリンなどが用いられる．

参考文献

文献1）Que Y, Moreillon P：Chapter 195 Staphylococcus aureus（Including Staphylococcal Toxic Shock）, Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 7th ed. Churchill Livingstone, 2009

2）Cosgrove SE, et al：The impact of methicillin resistance in Staphylococcus aureus bacteremia on patient outcomes：mortality, length of stay, and hospital charges. Infect Control Hosp Epidemiol 26：166-174, 2005

3）Stryjewski ME, et al：Use of vancomycin or first-generation cephalosporins for the treatment of hemodialysis-dependent patients with methicillin-susceptible Staphylococcus aureus bacteremia. Clin Infect Dis 44：190-196, 2007

4）Soriano A, et al：Influence of vancomycin minimum inhibitory concentration on the treatment of methicillin-resistant Staphylococcus aureus bacteremia. Clin Infect Dis 46：193-200, 2008

5）Yanagihara K, et al：Efficacy of linezolid against Panton-Valentine leukocidin（PVL）-positive meticillin-resistant Staphylococcus aureus（MRSA）in a mouse model of haematogenous pulmonary infection. Int J Antimicrob Agents 34：477-481, 2009

6）Rybak M, et al：Therapeutic monitoring of vancomycin in adult patients：A consensus review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. Am J Health Syst Pharm 66：82, 2009

7）Jang H-C, et al：Salvage treatment for persistent methicillin-resistant Staphylococcus aureus bacteremia：Efficacy of linezolid with or without a carbapenem. Clin Infect Dis 49：395, 2009

8）Fowler VG Jr, et al：Daptomycin versus standard therapy for bacteremia and endocarditis caused by Staphylococcus aureus. N Engl J Med 355：653-665, 2006

9）Cosgrove SE, et al：Initial low-dose gentamicin for Staphylococcus aureus bacteremia and endocarditis is nephrotoxic. Clin Infect Dis Mar 48：713-721, 2009

10）Rajendran PM, et al：Randomized, Double-Blind, Placebo-Controlled Trial of Cephalexin for Treatment of Uncomplicated Skin Abscesses in a Population at Risk for Community-Acquired Methicillin-Resistant Staphylococcus aureus Infection. Antimicrob Agents Chemother 51：4044-4048, 2007

11）Wunderink RG, et al：Linezolid vs vancomycin：analysis of two double-blind studies of patients with methicillin-resistant Staphylococcus aureus nosocomial pneumonia. Chest 124：1789-1797, 2003

12）Wunderink RG, et al：Early microbiological response to linezolid vs vancomycin in ventilator-associated pneumonia due to methicillin-resistant Staphylococcus aureus. Chest 134：1200-1207, 2008