medicina58巻5号

2021年04月発行

特集 その考えはもう古い！—最新・感染症診療 診断・治療の最新の考え方 〈治療薬・治療法再考〉

ESBL産生菌，AmpC産生菌—どんなときにカバーし，どう治療する？

著者： 篠原孝幸¹ 原田壮平¹

所属機関： ¹東京大学医学宇附属病院感染症内科

ページ範囲：P.654 - P.657

Point
◎広域セファロスポリンを含めたβ-ラクタム系抗菌薬を分解するβラクタマーゼにESBL，AmpCがある．
◎ESBLはEscherichia coli, Klebsiella spp., Proteus mirabilisの一部から産生される．
◎Enterobacter cloacae, Enterobacter（Klebsiella）aerogenes, Citrobacter freundii, Serratia marcescensなどが染色体にampC遺伝子を有し，一部がAmpCを過剰産生する．
◎ESBL産生菌およびAmpC産生菌の感染症で，重症例を含めて最も確実性が高い治療薬はカルバペネムである．
◎carbapenem sparing treatmentとしてESBL産生菌でセファマイシン，AmpC産生菌でセフェピム（CFPM）がそれぞれ考慮される．

参考文献

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