Jan 28-29, 2006, Yokohama

1
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?17???????????? Jan 28-29, 2006, Yokohama Abst
No. P-126
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???????????????????????????? ??????????????2004?1
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3
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4) ???????????????? 5) ????????????????????
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4
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(2006?1?)
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?????? 46 ?????? 19
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???? ????????
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???? NTT???? ???????? ???? ???????? KKR???? ???? ?
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5
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???????????? ???? ?? ?????? http//www.mic-sur
veillance.com
6
?1?????
???????? ??17?7?17?12 ? ?????? ?????????????????
??? ?????? S. aureus, S. epidermidis, E.
faecalis, E. faecium, S. pneumoniae S. pyogenes,
S. agalactiae, M.catarrhalis, N. gonorrhoeae, H.
influenzae E. coli, K. pneumoniae, K. oxytoca, C.
freundii, C. koseri, E. cloacae E. aerogenes, P.
mirabilis, S. marcescens, P. aeruginosa ??????? 1
??????30 ??? ????Staphylococcus aureus ??40
??? MRSA ?MSSA ????????????????
7
??????? (2006?1?)
????? 288 293 321 323 43 293 171 19 343 23
59 203 431 49 357
????? 73 141 65 56
????? ????? ????????? ??????????
???????????? ??????????? ??????? NTT??????? KKR???
? ???????? ???????? ?????????? ?????? ????????????
?????????? ?????? ???????? ?????????? ???????????
19?? 3500??
8
Staphylococcus aureus (ß-lactam)
MRSA 228
MSSA 177
Range 4-gt128 0.5-gt128 0.5-gt128 0.5-gt128 2-gt256 0.0
3-gt128 0.125-gt128
Range 0.125-2 0.0625-32 0.25-8 0.25-4 1-8 0.03-0.2
5 0.125-1
S-ratio 0 0 3.5 8.3 9.6 11.0
9.2
BP 2 0.25 8 8 16 4 4
S-ratio 100 39.6 100 100 100 100 100
BP 2 0.25 8 8 16 4 4
MPIPC ABPC CEZ CTM CMZ IPM MEPM
MPIPC ABPC CEZ CTM CMZ IPM MEPM
BP CLSI break point S-ratio BP?????????
??15 MS/MR 9/6
?? n98
?? n292
MSSA 32.9
MSSA 73.5
MRSA 26.5
MRSA 67.1
2NaCl MHA 33?, 24hr
9
Staphylococcus aureus (non-ß-lactam)
MRSA (n228)
MSSA (n177)
Range 0.125-16 0.125-gt128 0.25-2 0.25-4 0.5-2 0.12
5-gt128 0.06-128 0.06-16 0.06-gt128 0.03-gt128 0.03-gt
16 0.125-128
Range 0.125-2 0.06-gt128 0.5-2 0.25-2 0.5-2 0.06-32
0.06-8 0.06-4 0.06-gt128 0.03-gt128 0.03-0.125 0.12
5-0.5
S-ratio 98.7 41.7 100 100 100 13.6 26.8
57.5 10.5 15.8 98.7 94.3
BP 4 4 4 4 2 2 1 4 1 2 2 4
S-ratio 100 85.9 100 100 100 94.9 96.1 100
88.1 98.3 100 100
BP 4 4 4 4 2 2 1 4 1 2 2 4
ABK GM VCM TEIC LZD LVFX GFLX MINO CAM TEL ST MUP
ABK GM VCM TEIC LZD LVFX GFLX MINO CAM TEL ST MUP
BP CLSI break point S-ratio BP?????????
10
Enterococcus faecalis (n192)
PCG insensitive isolates
Range 1-16 1-8 2-32 0.5-8 0.5-16 4-gt512 32-gt128 0.
5- gt128 0.125-32 0.06-32 0.016-8 0.016-gt16 1-4 0.1
25-1 0.5-4 8-gt128
S-ratio 97.4 100 98.9 98.4 73.4 73.4 0
63.0 68.8 27.6 92.2 85.4 100 100 99.0 0
BP 8 8 16 4 2 512 16 2
2 4 2 2 4 4 2 4
PCG ABPC PIPC IPM FRPM GM AMK LVFX GFLX MINO TEL S
T VCM TEIC LZD ABK
MIC (µg/ml)
TK1 16 8 16 64 8 16 32 8
TK5 16 4 32 64 4 16 32 8
TK10 16 4 16 64 8 16 32 8
UO12 16 4 16 128 4 8 32 8
NT260 16 8 4 16 1 1 1 8
FU21 16 4 16 gt128 4 8
32 16
PCG ABPC PIPC CPR IPM FRPM LVFX MINO
11
Streptococcus pneumoniae (n192)
Range 0.002-4 0.004-8 0.004-4 0.002-4 0.002-2 0.00
2-0.5 0.002-0.5
Range 0.004-8 0.002-1 0.06-gt128 0.004-8 0.008-32 0
.004-4 0.004-4 0.125-32 0.125-16 0.016-8 0.016-64
0.004-gt256 0.002-1
S-ratio 43.2 89.6 86.5 96.4 99.0 86.5 84.9
BP 0.06 2 1 1 1 0.12 0.25
S-ratio 99.0 96.9 39.6 70.8
53.7 91.2 59.9 53.1 98.4
98.9 26.0 29.2 100
BP 2 0.5 1 0.5 0.5 0.5 0.5 1 2 1 2 0.25 1
PCG PIPC CTRX CTX CPR IPM MEPM
AMOX FRPM CCL CFTM CFDN CDTR CFPN CPFX LVFX TFLX M
INO CAM TEL
PRSP 21.4
PSSP 43.2
BP CLSI break point S-ratio BP?????????
PISP 35.4
12
??????????

• Staphylococcus aureus
• S. aureus????MRSA?????63.3?????
• MUP?????MSSA?0?MRSA?????5.7?????
• ST???????MSSA?0?MRSA??1.3?????
• Enterococcus faecalis
• PCG????E. faecalis?6???????
• GM???????26.6?????
• VRE????????
• ?????????30???????
• Streptococcus pneumoniae
• PRSP??21.4, PISP??35.4?????
• MINO???CAM?????70???????
• TEL????????????
• LVFX?????1.6?????

13
Escherichia coli (n309)
Range 0.25-gt128 0.125-gt128 0.5-gt128 0.03-128 0.06-
32 0.004-gt128 0.008-gt128 0.016-64 0.008-16 0.06-2
0.004-0.125 0.25-128 0.25-gt128 0.06-gt128
Range 0.008-128 0.008-gt128 0.008-128 0.25-128 0.5-
gt128 0.5-gt128
S-ratio 60.2 84.8 85.1 96.1 98.7
96.4 97.4 98.1 98.7 100 100 99.7 89.3
90.3
BP 8 16 8 8 8 8 8 8 8 4 4 16
8 2
S-ratio 80.3 79.3 80.3 88.6 99.7 99.4
BP 1 2 2 4 16 16
ABPC PIPC CEZ CTM CAZ CTRX CTX CPR AZT IPM MEPM C
MZ CCL CPDX
CPFX LVFX GFLX MINO AMK ISP
CPDX gt4µg/ml 27? ESBL??? 10/17?? 14 ? 4.5 UOE-2
5?? 8? (CTX-M-14, CTX-M-18, Toho-3) CTX-M-2 1??
1? SHV type 2?? 2? TEM-52 1?? 2? unidentified
2?? 2?
BP CLSI break point S-ratio BP?????????
14
Klebsiella pneumoniae (n234)
Range 4-gt128 1-gt128 0.5-gt128 0.06-gt128 0.06-64 0.0
16- 64 0.016- 32 0.016- 4 0.008-
64 0.03-2 0.016-0.125 0.5-gt gt128 0.25-gt128 0.06-gt1
28
Range 0.008-gt128 0.016-128 0.016-128 0.13- gt
128 0.5- 8 0.25-4
S-ratio 5.1 95.7 92.7 97.9 99.6
98.7 99.6 100 97.8 100 100 98.3 96.9
98.3
BP 8 16 8 8 8 8 8 8 8 4 4 16
8 2
S-ratio 96.6 97.0 97.4 83.8 100 100
BP 1 2 2 4 16 16
ABPC PIPC CEZ CTM CAZ CTRX CTX CPR AZT IPM MEPM C
MZ CCL CPDX
CPFX LVFX GFLX MINO AMK ISP
CPDX gt2µg/ml 4? ESBL??? 2? (0.85 ) CTX-M-2 1??
1? SHV type 1?? 1?
BP CLSI break point S-ratio BP?????????
15
Klebsiella oxytoca (n103)
Range 0.008-64 0.016-32 0.016-32 0.5-128 0.5-4 0.5
-2
BP 1 2 2 4 16 16
Range 4-gt128 0.5-gt128 1-gt128 0.06-128 0063-1 0.008
-gt128 0.004-128 0.008-8 0.016-128 0.06-4 0.016-006
0.25-128 0.25-gt128 0.03-gt128
S-ratio 91.3 91.3 91.3 92.2 100 100
S-ratio 3.9 89.3 87.4 91.3 98.1
91.3 95.2 100 89.0 100 100 97.1 90.3
90.3
BP 8 16 8 8 8 8 8 8 8 4 4 16
8 2
CPFX LVFX GFLX MINO AMK ISP
ABPC PIPC CEZ CTM CAZ CTRX CTX CPR AZT IPM MEPM C
MZ CCL CPDX
BP CLSI break point S-ratio BP?????????
16
Citrobacter freundii (n116)
Range 2-gt128 0.5-gt128 1-gt128 0.063-128 0063-gt128 0
.008-gt128 0.03-gt128 0.125-16 0.008-gt128 0.125-1 0.
016-2 0.5-gt128 1-gt128 0.125-gt128
S-ratio 6.0 77.6 11.2 79.3 81.0
81.9 83.6 99.1 75.7 100 100 15.5 21.7
55.2
BP 8 16 8 8 8 8 8 8 8 4 4 16
8 2
Range 0.008-32 0.03-64 0.016-64 0.06-gt128 1-32
S-ratio 93.1 91.4 92.2 72.4 98.3
BP 1 2 2 4 16
ABPC PIPC CEZ CTM CAZ CTRX CTX CPR AZT IPM MEPM C
MZ CCL CPDX
CPFX LVFX GFLX MINO AMK
IMP-1??? 1? (0.86 ) ESBL??? 1? (SHV type)
BP CLSI break point S-ratio BP?????????
17
Citrobacter koseri (n51)
Range 32-gt128 1-gt128 1-gt128 0.06-128 0.125-gt128 0.
125-gt128 0.03-gt128 0.03-4 0.016-gt128 0.06-0.5 0.01
6-0.125 0.5-gt128 0.5-gt128 0.125-gt128
Range 0.008-gt128 0.016-gt128 0.008-64 0.5-128 0.5-1
6 0.5-2
S-ratio 0 62.8 54.9 68.6 72.6 72.6
72.6 100 60.5 100 100 68.6 64.7 58.8
BP 8 16 8 8 8 8 8 8 8 4 4 16
8 2
S-ratio 56.9 56.9 56.9 64.7 100 100
BP 1 2 2 4 16 16
ABPC PIPC CEZ CTM CAZ CTRX CTX CPR AZT IPM MEPM C
MZ CCL CPDX
CPFX LVFX GFLX MINO AMK ISP
CPDX gt4 µg/ml 16? ESBL??? 15? 29.4 CTX-M-2
11? SHV 1? SHV DHA-1 2? CTX-M-2 SHV
DHA-1 1? 15??11??????
BP CLSI break point S-ratio BP?????????
18
Enterobacter aerogenes (n87)
Range 8-gt128 0.25-64 1-gt128 0.06-gt128 0063-gt128 0.
008-gt128 0.008-gt128 0.016-8 0.008-gt128 0.125-8 0.0
16-8 1-gt128 1-gt128 0.06-gt128
Range 0.008-1 0.03-1 0.016-2 1-8 0.5-gt128 0.5-128
S-ratio 1.1 81.6 10.3 79.3 81.6
82.8 85.1 100 86.2 98.9 98.9 4.6
5.7 80.5
BP 8 16 8 8 8 8 8 8 8 4 4 16
8 2
S-ratio 100 100 100 97.7 98.9 98.9
BP 1 2 2 4 16 16
CPFX LVFX GFLX MINO AMK ISP
ABPC PIPC CEZ CTM CAZ CTRX CTX CPR AZT IPM MEPM CM
Z CCL CPDX
BP CLSI break point S-ratio BP?????????
19
Enterobacter cloacae (n193)
Range 1-gt128 0.25-gt128 1-gt128 0.063-gt128 0063-gt128
0.008-gt128 0.016-gt128 0.125-128 0.008-gt128 0.06-4
0.008-4 0.5-gt128 0.5-gt128 0.125-gt128
Range 0.008-128 0.016-128 0.008-128 0.5-gt128 0.5-6
4 0.5-32
S-ratio 5.2 84.5 5.7 67.4 84.5
77.7 78.2 96.9 82.7 100 100 6.2
6.2 60.6
BP 8 16 8 8 8 8 8 8 8 4 4 16
8 2
S-ratio 90.7 92.2 92.8 82.4 99.0 99.4
BP 1 2 2 4 16 16
ABPC PIPC CEZ CTM CAZ CTRX CTX CPR AZT IPM MEPM C
MZ CCL CPDX
CPFX LVFX GFLX MINO AMK ISP
IMP-1??? 2? (1.0 ) ESBL??? 4? (2.1 ) CTX-M-2
1? CTX-M-3 3? 6??????????
BP CLSI break point S-ratio BP?????????
20
Proteus mirabilis (n92)
Range 1-gt128 0.25-gt128 2-gt128 0.125-gt128 0.063-1 0
.004-gt128 0.016-128 0.063-gt128 0.008-2 0.063-4 0.0
16-0.25 1-16 0.5-gt128 0.03-gt128
Range 0.016-gt128 0.06-gt128 0.06-128 16-gt128 0.5-16
1-8
S-ratio 77.2 83.7 72.8 0 100 100
S-ratio 81.5 84.8 63.0 87.0 100 89.1
88.0 88.0 100 100 100 100 89.0 85.9
BP 8 16 8 8 8 8 8 8 8 4 4 16
8 2
BP 1 2 2 4 16 16
ABPC PIPC CEZ CTM CAZ CTRX CTX CPR AZT IPM MEPM C
MZ CCL CPDX
CPFX LVFX GFLX MINO AMK ISP
ESBL??? 12? (13.0) CTX-M-2 10? CTX-M-3 2?
BP CLSI break point S-ratio BP?????????
21
Serratia marcescens (n137)
Range 4-gt256 1-gt128 16-gt128 0.5-gt128 0.06-gt128 0.0
6-gt128 0.125-gt128 0.03-64 0.03-gt128 0.06-16 0.03-3
2 4-gt128 0.25-gt128 0.5-gt128
S-ratio 0.73 87.6 0 20.4 94.1 89.8 89.8 96.4 9
5.7 98.5 96.4 78.1 1.46 67.9
BP 8 16 8 8 8 8 8 8 8 4 4 16
8 2
Range 0.016-64 0.03-128 0.06-64 2-gt128 0.5-gt128 0.
5-128
S-ratio 82.5 85.4 83.9 40.9 97.8 98.3
BP 1 2 2 4 16 16
ABPC PIPC CEZ CTM CAZ CTRX CTX CPR AZT IPM MEPM C
MZ CCL CPDX
CPFX LVFX GFLX MINO AMK ISP
IMP-1??? 4? (2.9 ) ESBL??? 2? (1.5 ) CTX-M-2
2?
BP CLSI break point S-ratio BP?????????
22
?????????LVFX?CPDX?????
LVFX CPDX
Susceptibility ratio ()
E. coli
C. koseri
E. cloacae
K. pneumoniae
S. marcescens
C. freundii
E. aerogenes
K. oxytoca
P. mirabilis
23
?????????

• ???????????ESBL????Metallo-ß-lactamase???
• ???????
• ESBL????????E. coli?4.2, C. koseri?29.4, P.
  mirabilis
• ?16.4???????????????????K. pneumoniae ??
• 1.0 ??????
• Metallo-ß-lactamase?????C. freundii, E. cloacae,
  S. marcescens
• ???????
• ????????????????????????C. koseri 43,
• E. coli ???P. mirabilis 20?????????K.
  pneumoniae??
• 2.7?????LVFX?CPDX???????????E. coli???
• ?? LVFX???????????????????????
• Class Cß- lactamase????C. freundii, E. cloacae,
  E. aerogenes??
• ????????
• ??????????????????????????????

24
Pseudomonas aeruginosa (n242)
Range 0.25-gt256 0.25-gt256 0.5-gt128 0.5-gt128 0.5-gt2
56 0.5-gt128 1-gt128 0.5-gt128 1-gt128 0.25-128 0.03-gt
128
Range 0.25-gt128 1-gt128 1-gt128 0.25-gt125 0.03-gt128
0.125-gt128 0.03-gt32 0.03-64 0.06-gt128 4-gt128 0.25-
gt16 0.5-16
S-ratio 87.2 93.0 73.1 74.4 78.9 70.7 66.9 77.3 67
.4 74.4 78.5
BP 64 64 16 16 8 8 8 8 8 4 4
S-ratio 85.5 92.6 91.7 88.0 76.9 70.7 77.3 80.6 78
.5 3.7 4.6
BP 4 16 16 4 1 2 1 4 1 4 2
PIPC PIP/TAZ CPZ CPZ/SBT CAZ CFS CPR CZOP AZT IPM
MEPM
GM AMK ISP TOB CPFX LVFX TFLX PZFX PUFX MINO ST PL
-B
MIC90 4
BP CLSI break point S-ratio BP?????????
Metallo-ß-lactamase??? 6/16?? 14? 5.8 ?6, ???4,
?2, ??1, ?? 1
MDRP (IPMgt8, CPFXgt2, AMKgt16) 6/16?? 11? 4.5
(9??Metallo-ß-lactamase???)
25
IMP-1 type ??14??PFGE pattern
??C??4??4??? ????????? ??F??4??3???
???3?????????????(??????) ??C?d, e, f,
g???D?i????pattern ?????????
M a b c d e f g h i j k l m n
??A
??C
??D
??F
??E
??B
Spe? digest Pulse 3-60 sec, 22 hr
????????
26
Metallo-ß-lactamase??????MDRP?????????
MIC (µg/ml)
MDR1 32 16 16 8 gt128 128
16 4 4 4 64 gt128 gt128
MDR2 256 128 64 16 32 16
32 64 gt128 gt128 16 64 gt128
k,l,m 128-256 32-64 gt128 gt256 gt128
128 gt128 gt128 32 64 8-16 64-128 gt128
d,e,f,g 128-256 64-128 gt128 gt256 gt128 16-32
128 gt128 16-32 32 gt128 16-32 16-32
a, b 16,32 16,32 gt128 gt256 gt128 32,64 8
8 32 64 4 32 gt128
i 256 128 gt128 gt256 gt128 16 128 gt128
16 32 gt128 16 16
j 128 64 gt128 256 gt128 16
128 gt128 gt128 gt128 gt128 gt128 gt128
c 128 64 gt128 gt256 gt128 128 128 gt128
32 32 8 32 gt128
n 32 32 gt128 gt256 gt128 16 32
64 gt128 gt128 gt128 64 gt128
h 32 32 gt256 gt256 gt128 64
32 gt128 128 gt128 gt128 16 16
PIPC PIP/TAZ CPZ/SBT CAZ CZOP AZT IPM MEPM CPFX LV
FX GM AMK ISP
?????Metallo-ß-lactamase???
27
???????

• ??????
• gt 90TAZ/PIP, AMK, ISP
• gt 80 PIPC, TOB, GM, PZFX (BP 2 77.7)
• gt 75CAZ, CZOP, MEPM, CPFX, TFLX, PUFX
• IPM??74.4?????
• Metallo-ß-lactamase??P. aeruginosa??16???6????14?
  
• ?????????9????????(IPMgt8, CPFXgt2, AMKgt16)
• ?????????????????3?????????????1?
• ????Metallo-ß-lactamase?????????5 (12/240)???
• ??
• 1?????PFGE??????????4??????????? ?
• ?????????????
• Metallo-ß-lactamase????????????????????2
• ?????MDRP??????4.5 (11/242)?????

28
???

• ???????????????????????????????
• ???????????????2005???????????????
• ???????????????
• ???????????????????????????????
• ??????????????????
• ???????????????????????????????
• ????
• ??????????????????????????????????
• ???????????????????????????????
• ??????????????????ESBL????Metallo-ß-
• lactamase?????????????????
• 2006??????????????????????????????
• ?????????????????????????