medicina61巻10号

2024年09月発行

特集 内科医が知っておくべきICU・ERでの薬の使い方 感染

薬剤耐性グラム陰性桿菌を想定した抗菌薬選択

著者： 黒田浩一¹

所属機関： ¹神戸市立医療センター中央市民病院感染症科

ページ範囲：P.1720 - P.1726

Point
◎本邦のICUで比較的検出頻度の高い薬剤耐性グラム陰性桿菌は，ESBL産生腸内細菌目細菌，AmpC産生腸内細菌目細菌，薬剤耐性緑膿菌である．
◎ESBL産生腸内細菌目細菌による感染症の第1選択薬は，カルバペネム系抗菌薬であるが，重症度や感染部位によって，タゾバクタム/ピペラシリンやセフメタゾールの使用が検討できる．
◎AmpC産生腸内細菌目細菌による感染症の第1選択薬は，セフェピムである．
◎緑膿菌感染症の標的治療は，感受性検査結果と耐性機序から判断する．既存のβ-ラクタム系抗菌薬にすべて耐性の場合，新規β-ラクタム系抗菌薬の使用が検討される．

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