✚⺑✛⤥⩶ߣ⮎೷⠴ᕈ⌀ᥓବᒾ  ችᧄᐘᕺ  㧕ᕺኼ✚ว∛㒮 ౝ⑼㧕ᕺኼ✚ว∛㒮 ᬌᩏቶ‫ޤߦ߼ߓߪޣ‬ࠄߪ޿ߕࠇ߽㧨ዪᚲߩࡃ࡝ࠕ࡯߇⎕ߚࠎߒߡ޿ࠆߣ

ᧄภ 85 㗁86 㗁ߦᎹ᧛ࠄߪᒰ㒮ߢ 2012 ᐕᐲߦዩ޿߁఺∉ਇో㧪ߢ޽ࠆ‫ޕ‬ஜᐽੱ㧔৻⥸ߦోり⊛఺∉〝߆ࠄಽ㔌ߐࠇߚ✛⤥⩶ߩ⮎೷ᗵฃᕈߦߟ޿ߡႎ๔ᱜᏱࠍᜰߔ㧕ߢ߽଀߃߫ⷺ⤑Ἳߩᴦ≮߇ㆃࠇࠇ߫ᷙߒߡ޿ࠆ‫ᧄޕ‬Ⓜߢߪዩ〝એᄖ߽฽߼ߚᧄ⩶ᗵᨴ∝ߣỘߩߚ߼ᄬ᣿ߔࠆᕟࠇ߇޽ࠆ‫৻ޕ‬ᣇ㧘⊕ⴊ∛ᴦ≮ߥ⮎೷ᗵฃᕈߦߟ޿ߡ᭎⺑ߒߚ޿‫ߪ⩶⤥✛ޕ‬ㅢᏱߩჇߤߦ߅ߌࠆ㜞ᐲߥᅢਛ⃿ᷫዋߢߪ⩶ⴊ∝㧔ਥߦᶖൻᱺߢߪ㉄⚛ࠍⷐߔࠆࠣ࡜ࡓ㒶ᕈ᪝⩶ߢ޽ࠆ‫ࠅ߹޽ޕ‬▤߆ࠄଚ౉㧕ࠍ߈ߚߔ‫ᦨߪ∝ᧄޕ‬ㄭᷫዋߒߡ޿ࠆ߽ᩕ㙃⚛ࠍᔅⷐߣߖߕ⇇㕙ᵴᕈ೷ߥߤߩᶖᲥ⮎ߦߒ߫ߩߩ㧘㜞ᐲߥᅢਛ⃿ᷫዋᖚ⠪߇ේ࿃ਇ᣿ߩ⊒ᾲࠍ߈ߒ߫⠴ᕈߢ޽ࠆ‫ޕ‬᳓߹ࠊࠅ㧘࿯ფ㧘ᬀ‛㧘ஜᐽੱ߿ߚߒߚ႐วߦᛩਈߔࠆ᛫⩶⮎ߪᔅߕ᛫✛⤥⩶૞↪ࠍേ‛ߩᶖൻ▤ߣᐢߊಽᏓߔࠆ‫ޕ‬Ḩߞߚ࿕ᒻ⍹㣨㧘⛮᦭ߔࠆ߽ߩࠍㆬᛯߔࠆߣ޿߁㋕ೣߪ⃻࿷߽቞ࠄࠇߡ߉⿷ߒࠍߒߡ޿ࠆࠪࡖࡦࡊ࡯ߥߤߦᄙ㊂ߦ฽߹ࠇߡ޿ࠆ‫ޕ‬ᅢਛ⃿ᷫዋߣ޿߁ోり⊛఺∉ਇోߩ㧝ߟߢ޽޿ࠆน⢻ᕈ߇޽ࠅ㧘㒮ౝߢߪ࿕ᒻ⍹㣨ࠍ૶ࠊߕ㧘ᶧࠆ‫ߦ߁ࠃߩߎޕ‬⒳‫∉఺ߩޘ‬ਇో㧔ᄢ߹߆ߦ⸒ߞߡዪ૕⍹㣨ኈེߪߥࠆߴߊ૶޿ᝥߡߣߔࠆ‫↉⧎ࠍ⧎↢ޕ‬ᚲ޽ࠆ޿ߪోり㧕ࠍ⢛᥊ߦ✛⤥⩶ᗵᨴ∝ߪ⿠ߎࠆ‫ޕ‬ߦ㘼ࠆߎߣߪ✛⤥⩶ߩၮ࿾ࠍ∛ቶߦ⸳⟎ߔࠆߎߣߢ৻ᣇ㧘✛⤥⩶߇ᧄ᧪ή⩶ߥᬌ૕㧔ⴊᶧ㧘⣖⣄㜑Ἳ㧘޽ࠅ൘߼ࠄࠇߥ޿‫߽ߢࠇߘޕ‬ḨߞߚⅣႺ㧔㒮ౝ㧘㒮⢷᳓ߥߤ㧕߆ࠄߢߪߥߊ㧘߽ߣ߽ߣ⩶ߛࠄߌߩᬌ૕ᄖ޿ߕࠇ߽㧕ߦߪᏱߦ✛⤥⩶߇ሽ࿷ߒߡ߅ࠅ㒰⩶ߪ㧔໼∷㧘ዩ㧘ଢߥߤ㧕߆ࠄಽ㔌ߐࠇߡ߽㧘਄⸥ߩᗵ࿎㔍ߢ޽ࠆ‫ޕ‬ሽ࿷ߒ߁ࠆߣ⠨߃ߡኻᔕߔࠆߎߣ߇⃻ᨴ࡝ࠬࠢߩߥ޿႐วߪᴦ≮ኻ⽎ߢߪߥ޿႐ว߽ᄙ޿‫ޕ‬ታ⊛ߥᗵᨴኻ╷ߢ޽ࠈ߁‫ޕ‬‫⩶ޣ‬ฌቯ⌕㧘ᗵᨴ㧘ᗵᨴ∝ߣߪ‫ޤ‬⩶ฌቯ⌕㧘ᗵᨴ㧘ᗵᨴ∝ߣ޿߁㧟ߟ⸒⪲߇޽ࠆ‫ޕ‬‫ࠆࠃߦ⩶⤥✛ޣ‬ᗵᨴ∝ߩ⊒∝ᯏᐨ‫ޤ‬
ᧄ⩶ߪᄙᓀߥᱞེߢ㊀◊ߥ∔ᖚࠍ߈ߚߒ߁ࠆ߇㧘ଢߩਛߦߪᄙ⒳㧘ᄙ㊂ߩ⩶߇ሽ࿷ߒߡ޿ࠆ‫ߏߩߘޕ‬ࠪࡖࡦࡊ࡯߆ࠄᄙ㊂ߩ✛⤥⩶ࠍ޽߮ߡ߽⊒∝ߔࠆੱ

ߊߏߊዋ㊂ߥ߽ߩߣߒߡ✛⤥⩶߇ሽ࿷ߒߡ޿ࠆ㧔ዋߪ߶߷޿ߥ޿‫⁁ߥ߁ࠃߩߤޕ‬ᴫߢ⊒∝ߔࠆߩ߆㧦఺㊂ߥߩߢㅢᏱߩଢၭ㙃ߢߪ㒶ᕈߣߐࠇࠆߛࠈ߁㧕‫ߒޕ‬∉ਇోࠍ᦭ߒߡ޿ࠆ႐วߢ޽ࠆ‫ߒߛߚޕ‬㧨఺∉ਇో߆ߒ㧘↢૕ߪ⣺ౝߩ✛⤥⩶ߦోߊ෻ᔕߒߡ޿ߥ޿‫ޕ‬㧪ߣ޿߁න⺆ࠍṼὼߣ૶߁ߎߣߪㆱߌࠆߴ߈ߢ޽ࠆ‫ޕ‬

ߎࠇࠍ⩶ฌቯ⌕㧔ࠦࡠ࠽ࠗ࠯࡯࡚ࠪࡦ㧕ߣ޿߁‫߽ޕ‬᳇▤ᡰ᜛ᒛ∝߇޽ࠆߚ߼ߦ❫Ძ૞↪ߥߤ᳇▤ᡰࠍήߒ⣾⢲ౝࠞ࠹࡯࠹࡞⇐⟎ᖚ⠪ߩዩߦ⊕ⴊ⃿߇Ⴧ߃⩶⁁ᘒߦ଻ߟᯏ⢻߇⎕უߐࠇߡ޿ࠆ㧘ౣ೑↪ဳࠦࡦ㧔⤥ዩࠍ߈ߚߒߡ޿ࠆ㧕
㧘⩶߇ಽ㔌ߐࠇߚ႐ว㧘ᖚ⠪࠲ࠢ࠻࡟ࡦ࠭ߩ⣕⌕ߢⷺ⤑ߦ៊்ࠍ߈ߚߒߡ޿ࠆߪోߊή∝⁁ߣߒߡ߽↢૕߇෻ᔕߒߡ޿ࠆ㧔⤥ዩ㧕㧔࡟ࡦ࠭ࠍ଻ሽߒߡ޿ࠆ᳓ߦኈᤃߦ✛⤥⩶߇Ⴧᱺߔߩߢᗵᨴ㧔ࠗࡦࡈࠚ࡚ࠢࠪࡦ㧕ߣ๭߫ࠇࠆ‫ޕ‬ਅ⣻ㇱࠆ㧕㧘⣾⢲ౝࠞ࠹࡯࠹࡞⇐⟎ߩߚ߼⣾⢲ౝߩ⥄ᵺ૞↪

∩㧔⣾⢲Ἳ㧕㧘⊒ᾲ㧔⣢⋃⣢Ἳ㧕ߥߤߩ∛⊛∝⁁߇⩶ߦࠃࠆή⩶⁁ᘒ⛽ᜬᯏ⢻߇⎕ߚࠎߒߡ޿ࠆ㧘᳇▤ౝߩᲥᕈ㧘ଚⷅߦࠃߞߡ߅ߎߞߚ႐วߪᗵᨴ∝㧔ࠗࡦᝌ▤ߩߚ߼෰∷߇߁߹ߊ޿߆ߕᝌ▤࠴ࡘ࡯ࡉ߆ࠄߩࡈࠚࠢࠪࡖࠬ ࠺ࠖࠫ࡯࠭㧕ߣߔࠆ‫ޕ‬ᗵᨴߣᗵᨴ∝ೝỗ߽޽ࠅ⢛ㇱߩ⢖⯯⣕߇߅߈߿ߔߊ⢖Ἳߦߥࠅ߿ࠍ߹ߣ߼ߡᗵᨴߣ⸥タߔࠆߎߣ߇ᄙߊ㧘ᤨߦᷙੂࠍߔ޿㧘ਇᴺ⮎‛ߩਇẖߥᵈ኿ࠍ➅ࠅ㄰ߒߚߚ߼ߦਇ↢߻߆߽ߒࠇߥ޿‫ోޕ‬り⁁ᘒ߇ਇ⦟ߢ⊒ᾲߒߡ޿ࠇ⚐‛߇ⴊᵹߦ౉ࠅਃውᑯߦᒰߚߞߡ்ߟߌߡ޿ࠆ߫Ⓧᭂ⊛ߦ᛫✛⤥⩶⮎ࠍᛩਈߔࠆ߇㧘቟ቯߒߡ޿ࠆ㧔்ߪᔃౝ⤑Ἳߩ⢛᥊ߣߥࠅ㧘⮎‛ࠍṁ⸃ߔࠆߚ߼႐วߪ⮎೷ࠍ᷷ሽߒߚ߶߁߇⠴ᕈൻ੍㒐ߦߥࠆ‫ߚޕ‬ߦ૶ߞߚ᳓ߦᚻᵞ޿႐ߦ૑߻✛⤥⩶߇ᷙ౉ߔࠆߎߣߛߒߘߩ඙೎ߪ࿎㔍ߥߎߣ߇ዋߥߊߥ޿‫ޕ‬Ꮉ᧛ࠄߩ

ߢ⩶ⴊ∝ࠍ߈ߚߒᔃౝ⤑Ἳߣߥࠅ߁ࠆ㧕㧘⣖ᄖ⑼ᚻⴚ

ႎ๔଀ߦ߽৻ㇱ㧘ᗵᨴߣᗵᨴ∝ߩ඙೎߇࿎㔍ߥ∝଀ᓟߩ⣖ቶ࠼࡟࠽࡯ࠫ߆ࠄ⣖ቶ㜑⤑Ἳࠍ߈ߚߔ㧦ߎࠇ߇฽߹ࠇࠆน⢻ᕈ߇޽ࠆ߆߽ߒࠇߥ޿‫ޕ‬－1－‫⮎ޣ‬೷ᗵฃᕈᬌᩏߩ⺒ߺᣇ‫ޤ‬ ࡜ࠢ࠲ࡓ⮎ߪ߶߷ోṌߣߥࠆ‫ߪ♽ࡓࡀࡍࡃ࡞ࠞޕ‬⮎೷⠴ᕈߣᗵᕈ㧔ᗵฃᕈ޽ࠅ㧕ߪߤߩࠃ߁ߦ᳿߹ࡉ࡞࡯ࠪ࡯࠻ߩⓣࠍㅢㆊߒߡ⩶ߦଚ౉ߔࠆ߇㧘ߘߩࠆߩ߆‫ޕ‬ᣣᧄߢߪ USA ߩၮḰ㧔CLSI㧕߇߽ߞ߬ࠄⓣ߇ήߊߥࠇ߫ଚ౉ߢ߈ߥ޿‫ߩ♽ࡓࡀࡍࡃ࡞ࠞޕ‬㧝ណ↪ߐࠇߡ޿ࠆ‫ޕ‬MIC㧘ࡉ࡟ࠗࠢࡐࠗࡦ࠻ߣ޿ߞߚߟߢ޽ࠆ࠴ࠛ࠽ࡓ®ߪ㧝⒳ߩⓣߒ߆ㅢㆊߢ߈ߥ޿߇㧘ࠠ࡯ࡢ࡯࠼߇޽ࠆ߇޽߃ߡ⇛ߔࠆ‫ࠆ޽ޕ‬᛫⩶⮎ߦᗵࡔࡠࡍࡦ®㧘ࡈࠖ࠾ࡃ࠶ࠢࠬ®ߪઁ⒳ߩⓣࠍㅢㆊߢ߈ฃᕈ޽ࠅ㧘ߣ޿߁ᩣ㧔✛⤥⩶ߣ޿߁ฬ೨ߪ⒳ߩฬ೨

ࠆߚ߼㧘࠴ࠛ࠽ࡓ®⠴ᕈ㧘ࡔࡠࡍࡦ®ᗵᕈ߇޽ࠅ߁ࠆ‫ޕ‬ߢ޽ࠆ‫ޕ‬㧨ੱ㑆㧪ߣหߓ‫৻ߩߘޕ‬඘৻඘ߪ⇣ߥࠆᕈ⸳⸘࿑ߩࠦࡇ࡯ᯏ߇ࠠࡁࡠࡦ⮎ߢ㇎㝷ߢ߈ߥ޿ࠃ߁⁁ࠍ᦭ߒ㧘ᩣߣ๭߫ࠇࠆ㧕ߪ㧘USA ߢផᅑߐࠇࠆ᛫ߦ᭴ㅧࠍᄌ߃ࠇ߫⠴ᕈߣߥࠆ‫ࡁࡒࠕޕ‬㈩♧૕ߪኅౕ⩶⮎ߩ㊂ࠍㆡಾߦ૶↪ߒߚߣ߈ߦᗵᨴ∝߇ࠦࡦ࠻ࡠࠍ૞ࠆᄢᎿࠍ㇎㝷ߔࠆ߇㧘ࠕࡒࡁ㈩♧૕ࠍಽ⸃ߔࠆ࡯࡞ߢ߈ࠆน⢻ᕈ߇㜞޿㧘ߣ޿߁ߎߣߢ޽ࠆ‫ޕ‬㊀∝ᯏེ߇㈩⟎ߐࠇߚࠅ㧘ᄢᎿ߇ᕈᩰࠍᄌ߃ߡࠕࡒࡁ㈩✛⤥⩶ᗵᨴ∝ߥࠄ㧘ࡍࡦ࠻ࠪ࡝ࡦ®ߥࠄ㊀∝ߢ㧟㨓㨤♧૕ࠍήⷞߔࠆࠃ߁ߦߥࠇ߫ήലߣߥࠆ‫ޕ‬ოߣࡉ࡞

6 ࿁/ᣣ㧘࠱ࠪࡦ®ߥࠄ 4.5㨓㨤4 ࿁/ᣣ㧘ࡕ࠳ࠪࡦ®ߥ࡯ࠪ࡯࠻ߩ㑆ߦ᛫⩶⮎ࠍ᝝߃ߡߔߋ⚦⢩ᄖ߳᡼ࠅ಴

ࠄ㧞㨓㨤3 ࿁/ᣣ㧘ࡔࡠࡍࡦ®ߥࠄ 1g㨤㧟࿁/ᣣߣ޿ߞߔࡐࡦࡊࠍ૞ࠆߎߣ߇޽ࠆ‫⮎ࡓ࠲ࠢ࡜  ߇ࠇߎޕ‬㧘ߚౕวߢ޽ࠆ‫ޕ‬ᣣᧄߩ଻㒾⸻≮߇㊂ࠍㆊዋߦ⸳ቯߒࠠࡁࡠࡦ⮎㧘ࠕࡒࡁ㈩♧૕ߩ޿ߕࠇࠍ߽᡼ࠅ಴ߔᒝߡ޿ࠆ႐ว㧘ᗵฃᕈ޽ࠅߩᩣߢ߽ᛩਈ㊂߇ዋߥ޿ߚജߥࡐࡦࡊߢ޽ࠇ߫㧘⒳㘃ߩ⇣ߥࠆ⮎೷ߦหᤨߦ⠴߼ᗵᨴ∝߇ᴦࠄߥ޿ߣ޿߁࡝ࠬࠢ߇޽ࠆ‫ޕ‬หߓ㧨ᗵᕈߣߥࠆ‫ޕ‬ᄙ㧔multi㧕೷(drug)⠴ᕈ(resistant)✛⤥ฃᕈ޽ࠅ㧪ߩ್ቯߢ߽ߘߩ⮎೷߳ߩᗵฃᕈ߇ߣߡ߽⩶(Pseudomonas aeruginosa):MDRP ߣ๭߫ࠇ㧘Ꮉ⦟޿߽ߩߣ߉ࠅ߉ࠅലߊߛࠈ߁ߣ޿߁߽ߩ߇޽ࠅ㧘᧛ࠄߩᬌ⸛ߢ߽ 1 ᩣ߇⷗ߟ߆ߞߡ޿ࠆ‫࡯ࠪ࡯࡞ࡉޕ‬೨⠪ߥࠄㆊዋᛩਈߢ߽ᴦ≹ߔࠆน⢻ᕈ߇޽ࠆ߇㧘ᓟ࠻ߩ᭴ㅧࠍᄌ߃ࠄࠇߡߒ߹߁ߣᄙߊߩ⮎೷߇ଚ౉ߢ⠪ߢߪᴦ≮ߦᄬᢌߔࠆน⢻ᕈ߇㜞޿ߩߢᵈᗧࠍⷐߔ߈ߥߊߥࠆ‫⩶ޕ‬૕ߣ⩶߇ಽᴲߔࠆ‛⾰ߢო㧔ࡃࠗࠝࠆ‫ޕ‬㊀∝ᗵᨴ∝ߢߪߎߩ㧨ផᅑ㊂㧪ࠍᏱߦᗧ⼂ߒߡࡈࠖ࡞ࡓ㧕ࠍᒻᚑߔࠆߣၷ࿕ߥၔߣߥࠅ᛫⩶⮎ߪ⩶ᴦ≮ࠍ߅ߎߥ߁ᔅⷐ߇޽ࠆ‫ޕ‬๟࿐߳೔㆐ߔࠆߎߣߔࠄ࿎㔍ߣߥࠆ‫ޕ‬‫⮎ߩ⩶⤥✛ޣ‬೷⠴ᕈ‫ޤ‬‫⮎ޣ‬೷⠴ᕈߣ᛫⩶⮎ߩㆬᛯ‫ޤ‬✛⤥⩶ߩჇᱺߦߟ޿ߡߚߣ߃⹤ࠍߔࠆ‫ޕ‬ዊߐߥᮮ਄⸥ߩࠃ߁ߥ⠴ᕈᯏᐨߩ߁ߜߤࠇࠍᴦ≮ኻ⽎ߣߥ㐳ߩኅߦធߒߡหߓ߽ߩࠍ૞ࠅ㧘ో૕߇ቢᚑߔࠆߣࠆ✛⤥⩶ᩣ߇᦭ߒߡ޿ࠆߩ߆ࠍᣣᏱᬌᩏߢ್೎ߔࠆធߒߚოߪಽഀߐࠇߡᣂߒ޿ኅߪ⁛┙ߔࠆ‫ޕ‬ኅߩਛߎߣߪᔅߕߒ߽ኈᤃߢߪߥ޿‫ᦨޕ‬ೋߩၭ㙃ߢಽ㔌ߐߦߪ⸳⸘࿑߇޽ࠅߘߩࠦࡇ࡯ߪᣂߚߥኅߦᔅ㗇ߢ޽ࠇߚ✛⤥⩶ߦή߆ߞߚ⠴ᕈ߇㧘ᴦ≮ㆊ⒟ߢ⊒⃻ߒߡࠆ㧔ࠢ࡜ࡆ࠶࠼®㧘ࠪࡊࡠ®ߥߤߩࠠࡁࡠࡦ⮎߇ࠦࡇߊࠆน⢻ᕈ߇޽ࠆߎߣߪߐࠄߥࠆ໧㗴ߢ޽ࠆ‫ߣ߽ޕ‬࡯ᯏࠍ㇎㝷ߔࠆ㧕‫⸘⸳ޕ‬࿑ࠍ߽ߣߦ޿ࠈ޿ࠈߥኅౕࠍ߽ߣ⠴ᕈㆮવሶࠍ᦭ߒߡ޿ߚ߇⠴ᕈߣ޿߁ᕈᩰࠍ޽૞ࠆᄢᎿ߽޿ࠆ㧔ࠥࡦ࠲ࠪࡦ®㧘ࠕࡒࠞࠪࡦ®㧘ࡂࡌ߹ࠅ⊒⃻ߒߡ޿ߥ߆ߞߚߩߦ᛫⩶⮎ߦࠃߞߡ⠴ᕈㆮࠞࠪࡦ®ߥߤߩࠕࡒࡁ㈩♧૕ߪߎࠇࠍ㇎㝷ߔࠆ㧕‫ޕ‬ოવሶ߇ߒߞ߆ࠅ⋡ⷡ߼⠴ᕈߣߥࠆߣ޿߁႐ว㧘⓭ὼߪࡍࡊ࠴࠼ࠣ࡝ࠞࡦߣ๭߫ࠇ㧘᧚ᢱࠍ߽ߣߦᰴ‫ߣޘ‬ᄌ⇣ߢ⠴ᕈᯏᐨࠍᜬߟࠃ߁ߦߥࠆ႐ว㧘ઁߩ⩶߇᦭ઃߌ⿷ߒߡ޿ߊᄢᎿࠍ⋥ធ㇎㝷㧔ࡍ࠾ࠪ࡝ࡦ♽㧘࠮ߒߡ޿ࠆ⠴ᕈㆮવሶࠍ߽ࠄ޿ฃߌࠆ႐ว㧘ߣ޿ߞߚࡈࠚࡓ♽㧘ࠞ࡞ࡃࡍࡀࡓ♽ߥߤߩ  ࡜ࠢ࠲ࡓ⮎㧕ߔߎߣ߇ᗐቯߐࠇࠆ‫ޕ‬᛫⩶⮎ߦࠃߞߡ⠴ᕈㆮવሶ߇⋡ࠇ߫㧘ო߇ߢ߈ߥ޿ߩߢኅߪ⎕ߚࠎߔࠆ‫ޕ‬ოߩ๟ࠅⷡ߼ࠆ႐วߪ⺃ዉߣ๭߫ࠇࠆ‫ޕ‬એ਄ߩࠃ߁ߥ⒳‫ߩޘ‬ߦᒛࠄࠇߚࡉ࡞࡯ࠪ࡯࠻ߦߪⓣ߇޽޿ߡ޿ߡ㧘 ࡜⠴ᕈᯏᐨߦߔߴߡߦ౒ㅢߣߪ⸒߃ߥ޿߹ߢ߽㧘ᴦ≮ࠢ࠲ࡓ⮎ߩ߁ߜಾࠅᧅߣߥࠆࠞ࡞ࡃࡍࡀࡓ♽ߪߘߩߔߴ߈႐วߪචੑಽߥ㊂ߢߒߞ߆ࠅߚߚߊߎߣ߇⠴ⓣࠍㅢࠆ‫ޕ‬ᕈߩ੍㒐ߦዋߒߪᓎ┙ߟߣ޿߁ᗧ⷗߇޽ࠆ‫ޕ‬ਛㅜඨ᛫⩶⮎߳ߩ⠴ᕈᯏᐨߪታߦᏁᅱߢᄙ⒳ᄙ᭽ߥ߽ߩ

┵ߥ㊂ߢඨᲕߒߦߔࠆߣㆮવሶ߇ᄌൻߒ߿ߔ޿‫ޕ‬᛫߇޽ࠅ㧘✛⤥⩶ߪߘߩᄙߊࠍ౗ߨ஻߃ߡ޿ࠆ‫ޕ‬ᄢᎿ✛⤥⩶⮎㧔ઍ⴫⊛ߦߪࡍࡦ࠻ࠪ࡝ࡦ®㧘࠱ࠪࡦ®㧘ࡕߦߊߞߟ޿ߡ㇎㝷ߔࠆ  ࡜ࠢ࠲ࡓ⮎ࠍṁ߆ߒߡߒ߹࠳ࠪࡦ®㧘ࡑࠠࠪࡇ࡯ࡓ®㧘࠴ࠛ࠽ࡓ®㧘ࡔࡠࡍࡦ®㧘߁ᯏེࠍᄢᎿߩ๟࿐ߦ஻߃ࠆ㧔 ࡜ࠢ࠲ࡑ࡯࠯ߣ޿ࡈࠖ࠾ࡃ࠶ࠢࠬ®㧘ࠪࡊࡠ®㧘ࠥࡦ࠲ࠪࡦ®㧘ࠕࡒࠞࠪ߁㧕‫ߪ♽ࡓࡀࡍࡃ࡞ࠞޕ‬ᄙߊߩߘߩṁ⸃ᯏེߦ⠴߃ࠆࡦ®ߥߤ㧕ߩਛߢ޽ࠆ⠴ᕈᯏᐨߦߟ޿ߡ⺃ዉߒߦߊ޿߇㧘ߘࠇࠍ߽ṁ߆ߒߡߒ߹߁ᯏ⒳߽޽ࠆ‫ߩߎޕ‬႐ว㧘߽ߩ㧘ߒ߿ߔ޿߽ߩ㧘ߣ޿ߞߚ޿ߊߟ߆ߩ⹜㛎▤ౝ

－2－ߩ⎇ⓥ߇޽ࠆ‫⥃ޕ‬ᐥߢ߽ࠪࡊࡠ®ࠍߥࠆߴߊ૶↪ߒߥ

bacteremia޿ࠃ߁ߦ೙㒢ߒߚࠄࠪࡊࡠ®ߩߺߥࠄߕࠞ࡞ࡃࡍࡀ

UPTODATE(This topic last updated: 5 17, 2012. )ࡓ♽ߦ߽ᗵฃᕈ߇ᡷༀߒߚߣ޿߁⎇ⓥ߇޽ࠆ‫࠳ࡕޕ‬5) Kanj SS et al. Other Pseudomonas aeruginosaࠪࡦ®ࠃࠅࡑࠠࠪࡇ࡯ࡓ®ߩᣇߢ⠴ᕈ⺃ዉ߇ዋߥ߆ߞ

infections.

ߚߣ޿߁ႎ๔߽޽ࠆ‫߁޿ߣ޿ߥߊࠃ߇®ࡓ࠽ࠛ࠴ޕ‬ႎ

updated: 3 28, 2012.)

๔ߪᲧセ⊛ᄙ޿‫ߥ߁ࠃߩߤޕ‬ㆮવሶࡄ࠲࡯ࡦ߇ᄙߊ

6) Elena BM et al.: Pseudomonas aeruginosa: all฽߹ࠇࠆ߆ߦࠃߞߡ⎇ⓥ⚿ᨐߪ⇣ߥࠆߣផ᷹ߐࠇࠆ‫ޕ‬

roads lead to resistance. Trends in MicrobiologyᣣᏱߩ⥃ᐥߢࠊࠇࠊࠇߦߢ߈ࠆߎߣߪ

19: 419-426, 2011de-escalation ߒ߆ߥ޿ߩ߆߽ߒࠇߥ޿‫࡞ࠞ߫߃଀ޕ‬7) Wolter DJ et al: Mechanisms of -lactamࡃࡍࡀࡓ♽㧘ࠪࡊࡠ®㧘࠱ࠪࡦ®ߔߴߡߦᗵᕈߥࠄ࠱

resistanceࠪࡦ®ࠍ૶↪ߒߚᣇ߇ࠃ߆ߞߚߣ޿ߞߚߎߣࠍ⸽᣿

Current pharmaceutical Design 19: 209-222, 2013ߒߚ߽ߩߪᬌ⚝ߒߚ㒢ࠅߥ߆ߞߚ߇ߤ߁ߛࠈ߁߆‫ޕ‬8) Lewis GJ et al: Decreased resistance ofߜߥߺߦ૬↪≮ᴺߢߚߚߊߎߣߢ⠴ᕈൻࠍ੍㒐ߔࠆ㧘

Pseudomonas aeruginosa with restriction ofߣ޿߁⠨߃ߪฎߊ߆ࠄሽ࿷ߔࠆ߇⥃ᐥ⊛ᗧ⟵ߪਇ᣿

ciprofloxacin in a large teaching hospital`sߣ⸒ࠊࠇࠆ‫ߩߘޕ‬࿾ၞ㧘∛㒮ߏߣߦ᛫↢‛⾰ߩᗵฃintensive care and intermediate care units.

ᕈࡄ࠲࡯ࡦࠍ⍮ࠆ㧔ࠕࡦ࠴ࡃࠗࠝࠣ࡜ࡓߣ๭߫ࠇࠆ‫ޕ‬InfectionᎹ᧛ࠄߪᒰ㒮ᴲዩེ⑼ߢߩࠕࡦ࠴ࡃࠗࠝࠣ࡜ࡓࠍ૞

33:368-373,2012ߞߚߎߣߦߥࠆ㧕ߎߣߪᗵฃᕈਇ᣿ߥᤨᦼߢߩᴦ≮ߦ᦭↪ߢ޽ࠆ߇㧘㐳ᦼ౉㒮ᖚ⠪ߢߪ⠴ᕈ⩶ߩ㗫ᐲ߇㜞޿ߚ߼ᵈᗧ߇ᔅⷐߢ޽ࠆ‫ޕ‬‫ޤߦࠅࠊ߅ޣ‬✛⤥⩶ᗵᨴ∝ߣ⠴ᕈߦߟ޿ߡ᭎⺑ߒߚ‫߇⩶⤥✛ޕ‬ᗵᨴ∝ࠍᧄᒰߦ߈ߚߒߡ޿ࠆߩ߆ࠍࠃߊᬌ⸛ߔߴ߈

ߢ޽ࠆ‫ޕ‬቟ᤃߥ᛫⩶⮎ᛩਈߪ⠴ᕈ⺃ዉࠍ↢߻‫৻ޕ‬ᣇ㧘ᗵᨴ∝ߣ್ᢿߒߚࠄᗵฃᕈࠍ᦭ߔࠆ⮎೷ࠍᣧᕆߦච



ੑಽߥ㊂ߢᛩਈߔࠆ‫ޕ‬ᗵฃᕈࡄ࠲࡯ࡦߥߤࠍෳ⠨ߦߢ߈ࠆߛߌ⠴ᕈ⺃ዉߩዋߥ޿⮎೷ࠍㆬᛯߔࠆᚢ⇛ߦߟ޿ߡ੹ᓟߩ⎇ⓥ߇ᦼᓙߐࠇࠆ‫ޕ‬ߏᩞ㑛ߊߛߐߞߚ㊄ᴛක⑼ᄢቇᗵᨴ∝ቇ 㘵ᴧ↱༹ᢎ᝼ߦᷓ⻢޿ߚߒ߹ߔ‫ޕ‬‫ޣ‬ᢥ₂‫ޤ‬1) Pier GB, Ramphal R. Pseudomonas aeruginosa ,in Principles and practice of infectious diseases.
Mandell GL et al, seventh ed, 2010, 2815-2860,
Churchill Livingstone, Philadelphia2) KanjnSS et al, Treatment of Pseudomonas

aeruginosa infections. In UPTODATE(This topic
last updated: 10 1, 2012. )3) Kanj SS et al. Epidemiology and pathogenesis
ofPseudomonas

aeruginosa

infection.

InUPTODATE(This topic last updated: 6 19, 2012. )





4) Kanj SS et al. Pseudomonas aeruginosa－3－andInendocarditis.

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