臨床泌尿器科70巻8号

2016年07月発行

特集 もう慌てない!　重症尿路性器感染症のマネジメント

尿からESBL産生菌・MRSA・MDRPが分離されたらどのように対応するか？

著者： 堀野哲也¹

所属機関： ¹東京慈恵会医科大学感染制御部

ページ範囲：P.598 - P.604

文献概要

▶ポイント

・ESBL産生菌による尿路感染症では，カルバペネム系薬のほかにTAZ/PIPCやセファマイシン系薬などが有効である．

・MRSA尿路感染症では第一選択薬としてバンコマイシン，MDRP尿路感染症ではコリスチンや抗菌薬併用療法が推奨される．

・尿培養が陰性となっても，一時的に分離されていない可能性や他部位に定着している可能性を考慮すべきである．

参考文献

1）Melzer M and Petersen I : Mortality following bacteraemic infection caused by extended spectrum beta-lactamase （ESBL） producing E. coli compared to non-ESBL producing E. coli. J Infect 55 : 254─259, 2007

2）Ofer-Friedman H, Shefler C, Sharma S, et al : Carbapenems Versus Piperacillin-Tazobactam for Bloodstream Infections of Nonurinary Source caused by Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae. Infect Control Hosp Epidemiol 36 : 981─985, 2015

3）Harris PN, Tambyah PA and Paterson DL : β-lactam and β-lactamase inhibitor combinations in the treatment of extended-spectrum β-lactamase producing Enterobacteriaceae : time for a reappraisal in the era of few antibiotic options? Lancet Infect Dis 15 : 475─485, 2015

4）Boyle DP and Zembower TR : Epidemiology and Management of Emerging Drug-Resistant Gram-Negative Bacteria : Extended-Spectrum β-Lactamases and Beyond. Urol Clin North Am 42 : 493─505, 2015

5）Gavin PJ, Suseno MT, Thomson RB Jr, et al : Clinical correlation of the CLSI susceptibility breakpoint for piperacillin-tazobactam against extended-spectrum-beta-lactamase-producing Escherichia coli and Klebsiella species. Antimicrob Agents Chemother 50 : 2244─2247, 2006

6）Retamar P, López-Cerero L, Muniain MA, et al : Impact of the MIC of piperacillin-tazobactam on the outcome of patients with bacteremia due to extended-spectrum-β-lactamase-producing Escherichia coli. Antimicrob Agents Chemother 57 : 3402─3404, 2013

7）Doi A, Shimada T, Harada S, et al : The efficacy of cefmetazole against pyelonephritis caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae. Int J Infect Dis 17 : e159─163, 2013

8）Pilmis B, Parize P, Zahar JR, et al : Alternatives to carbapenems for infections caused by ESBL-producing Enterobacteriaceae. Eur J Clin Microbiol Infect Dis 33 : 1263─1265, 2014

9）Matsumura Y, Yamamoto M and Nagao M : Multicenter retrospective study of cefmetazole and flomoxef for treatment of extended-spectrum-β-lactamase-producing Escherichia coli bacteremia. Antimicrob Agents Chemother 59 : 5107─5113, 2015

10）Pangon B, Bizet C, Buré A, et al : In vivo selection of a cephamycin-resistant, porin-deficient mutant of Klebsiella pneumoniae producing a TEM-3 beta-lactamase. J Infect Dis 159 : 1005─1006, 1989

11）Lee CH, Chu C, Liu JW, et al : Collateral damage of flomoxef therapy : in vivo development of porin deficiency and acquisition of blaDHA-1 leading to ertapenem resistance in a clinical isolate of Klebsiella pneumoniae producing CTX-M-3 and SHV-5 beta-lactamases. J Antimicrob Chemother 60 : 410─413, 2007

12）Rodríguez-Baño J, Alcalá JC, Cisneros JM, et al : Community infections caused by extended-spectrum beta-lactamase-producing Escherichia coli. Arch Intern Med 168 : 1897─1902, 2008

13）Falagas ME, Kastoris AC, Kapaskelis AM, et al : Fosfomycin for the treatment of multidrug-resistant, including extended-spectrum beta-lactamase producing, Enterobacteriaceae infections : a systematic review. Lancet Infect Dis 10 : 43─50, 2010

14）Bergan T : Degree of absorption, pharmacokinetics of fosfomycin trometamol and duration of urinary antibacterial activity. Infection 18 : S65─69, 1990

15）Endimiani A, Luzzaro F, Perilli M, et al : Bacteremia due to Klebsiella pneumoniae isolates producing the TEM-52 extended-spectrum beta-lactamase : treatment outcome of patients receiving imipenem or ciprofloxacin. Clin Infect Dis 38 : 243─251, 2004

16）Baraboutis IG, Tsagalou EP, Lepinski JL, et al : Primary Staphylococcus aureus urinary tract infection : the role of undetected hematogenous seeding of the urinary tract. Eur J Clin Microbiol Infect Dis 29 : 1095─1101, 2010

17）Ekkelenkamp MB, Verhoef J and Bonten MJ : Quantifying the relationship between Staphylococcus aureus bacteremia and S. aureus bacteriuria : a retrospective analysis in a tertiary care hospital. Clin Infect Dis 44 : 1457─1459, 2007

18）Ishikawa K, Hamasuna R, Uehara S, et al : Japanese nationwide surveillance in 2011 of antibacterial susceptibility patterns of clinical isolates from complicated urinary tract infection cases. J Infect Chemother 21 : 623─633, 2015

19）日本化学療法学会・日本感染症学会 : MRSA感染症の治療ガイドライン. 杏林舎, 東京, 2013

20）Rolston KV, Besece D, Lamp KC, et al : Daptomycin use in neutropenic patients with documented gram-positive infections. Support Care Cancer 22 : 7─14, 2014

21）Adams N, Johnson MD, Storm DW, et al : Acute focal bacterial nephritis due to methicillin-resistant Staphylococcus aureus in an immunocompetent adult. Infection 42 : 433─436, 2014

22）Stevens DL, Herr D, Lampiris H, et al : Linezolid versus vancomycin for the treatment of methicillin-resistant Staphylococcus aureus infections. Clin Infect Dis 34 : 1481─1490, 2002

23）Levin AS, Barone AA, Penço J, et al : Intravenous colistin as therapy for nosocomial infections caused by multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii. Clin Infect Dis 28 : 1008─1011, 2009

24）Montero M, Horcajada JP, Sorlí L, et al : Effectiveness and safety of colistin for the treatment of multidrug-resistant Pseudomonas aeruginosa infections. Infection 37 : 461─465, 2009

25）二木芳人, 舘田一博, 中嶋一彦, 他 : コリスチンの適正使用に関する指針改訂版. 日化療会誌63 : 289─329, 2015

26）西尾久明, 小松 方, 末吉範行, 他 : 多剤耐性Pseudomonas aeruginosaに対する併用薬スクリーニングのためのブレイクポイント・チェッカーボード法の有用性. 日化療会誌59 : 29─33, 2011

27）Nakamura I, Yamaguchi T, Tsukimori A, et al : Effectiveness of antibiotic combination therapy as evaluated by the Break-point Checkerboard Plate method for multidrug-resistant Pseudomonas aeruginosa in clinical use. J Infect Chemother 20 : 266─269, 2014