カルバペネム系薬投与患者における耐性菌選択リスク因子の検討
カルバペネム系薬投与患者における耐性菌選択のリスク因子を検討するために，昭和大学病院で研究協力が得られた診療科における入院患者のデータを収集し解析した．カルバペネム系薬投与後に培養検査の結果が得られた患者を，耐性菌検出群と非検出群に分け，背景因子と抗菌薬の量的因子について単変量解析と多変量解析を行い，かつ，単変量解析で有意確率が0.20未満の因子については多重ロジスティック回帰分析を行った．その結果，「年齢70歳以上」，「在院日数」，「透析導入の有無」の3つが耐性菌検出に関わるリスク因子であることが示された．本研究で耐性菌検出の有無と抗菌薬の量的因子に有意な差を認めなかったことから，医療施設内...
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| Published in | 昭和学士会雑誌 Vol. 74; no. 1; pp. 67 - 72 |
|---|---|
| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
昭和大学学士会
2014
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 2187-719X 2188-529X |
| DOI | 10.14930/jshowaunivsoc.74.67 |
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| Abstract | カルバペネム系薬投与患者における耐性菌選択のリスク因子を検討するために，昭和大学病院で研究協力が得られた診療科における入院患者のデータを収集し解析した．カルバペネム系薬投与後に培養検査の結果が得られた患者を，耐性菌検出群と非検出群に分け，背景因子と抗菌薬の量的因子について単変量解析と多変量解析を行い，かつ，単変量解析で有意確率が0.20未満の因子については多重ロジスティック回帰分析を行った．その結果，「年齢70歳以上」，「在院日数」，「透析導入の有無」の3つが耐性菌検出に関わるリスク因子であることが示された．本研究で耐性菌検出の有無と抗菌薬の量的因子に有意な差を認めなかったことから，医療施設内の耐性菌検出状況を抗菌薬の量的因子だけで評価する際は得られた結果の解釈に注意が必要である． |
|---|---|
| AbstractList | カルバペネム系薬投与患者における耐性菌選択のリスク因子を検討するために，昭和大学病院で研究協力が得られた診療科における入院患者のデータを収集し解析した．カルバペネム系薬投与後に培養検査の結果が得られた患者を，耐性菌検出群と非検出群に分け，背景因子と抗菌薬の量的因子について単変量解析と多変量解析を行い，かつ，単変量解析で有意確率が0.20未満の因子については多重ロジスティック回帰分析を行った．その結果，「年齢70歳以上」，「在院日数」，「透析導入の有無」の3つが耐性菌検出に関わるリスク因子であることが示された．本研究で耐性菌検出の有無と抗菌薬の量的因子に有意な差を認めなかったことから，医療施設内の耐性菌検出状況を抗菌薬の量的因子だけで評価する際は得られた結果の解釈に注意が必要である． |
| Author | 石野, 敬子 大戸, 祐治 馬場, 俊之 村山, 純一郎 茅野, 博行 小林, 洋一 金子, 堯一 吉田, 仁 前田, 真之 峯村, 純子 |
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| References | 4) Ueda T, Shibata H, Nakamura H, et al. Efficacy of laminar air flow room with or without clean nursing for preventing infection in patients with acute leukemia. Jpn J Clin Oncol. 1983;13 (Suppl 1):151-157. 19) Tacconelli E, De Angelis G, Cataldo MA, et al. Does antibiotic exposure increase the risk of methicillin-resistant Staphylococcus aureus (MRSA) isolation? A systematic review and meta-analysis. J Antimicrob Chemother. 2008;61:26-38. 1) Westh H, Zinn CS, Rosdahl VT. An international multicenter study of antimicrobial consumption and resistance in Staphylococcus aureus isolates from 15 hospitals in 14 countries. Microb Drug Resist. 2004;10:169-176. 13) 梅村拓巳，望月敬浩，村木優一，ほか．Anatomical therapeutic chemical classification/defined daily dose systemを利用した注射用抗菌薬の使用量と緑膿菌耐性率．日環境感染会誌．2010;25:376-382 6) Gerding DN, Larson TA, Hughes RA, et al. Aminoglycoside resistance and aminoglycoside usage: ten years of experience in one hospital. Antimicrob Agents Chemother. 1991;35:1284-1290. 7) Fridkin S K, Steward C D, Edwards J R, et al. Surveillance of antimicrobial use and antimicrobial resistance in United States hospitals: project ICARE phase 2. Project Intensive Care Antimicrobial Resistance Epidemiology (ICARE) hospitals. Clin Infect Dis. 1999;29:245-252. 18) Magiorakos AP, Srinivasan A, Carey RB, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012;18:268-281. 10) Miyawaki K, Miwa Y, Tomono K, et al. The impact of antimicrobial stewardship by infection control team in a japanese teaching hospital. Yakugaku Zasshi. 2010;130:1105-1111. 3) Ishii Y, Alba J, Kimura S, et al. Evaluation of antimicrobial activity of beta-lactam antibiotics by Etest against clinical isolates from 100 medical centers in Japan (2004). Diagn Microbiol Infect Dis. 2006;55:143-148. 17) European Committee on Antimicrobial Susceptibility Testing. Breakpoint tables for interpretation of MICs and zone diameters. Version 1.3. Basel: European Society of Clinical Microbiology and Infectious Diseases; 2011. 21) 高橋真由美，金子俊幸，平 浩幸．カルバペネム耐性緑膿菌検出に影響を及ぼす危険因子の検討．日環境感染会誌．2010;25:104-110. 8) Bantar C, Sartori B, Vesco E, et al. A hospitalwide intervention program to optimize the quality of antibiotic use: impact on prescribing practice, antibiotic consumption, cost savings, and bacterial resistance. Clin Infect Dis 2003;37:180-186. 11) 村木優一，田辺正樹，中村明子，ほか．病院情報管理システムと連動した広域抗菌薬の使用届出制の構築と有用性の評価．医療薬学．2010;36:316-322 12) Landman D, Chockalingam M, Quale JM. Reduction in the incidence of methicillin-resistant Staphylococcus aureus and ceftazidime-resistant Klebsiella pneumoniae following changes in a hospital antibiotic formulary. Clin Infect Dis 1999;28:1062-1066. 20) 小笠原康雄，長崎信浩，大野公一，ほか．Meropenem投与患者における緑膿菌耐性化因子の検討．日環境感染会誌．2012;27:419-424. 15) 池本雅章，華山博子，栗原晋太郎，ほか．広島県下24施設による抗菌薬使用密度と耐性菌分離率に関する地域共同サーベイランス．日病薬師会誌．2013;49:753-759. 9) 宮崎博章，入江利行，素元美佐，ほか．カルバペネム薬の使用制限下によるイミペネム耐性緑膿菌と多剤耐性緑膿菌の検出率の推移．環境感染．2006;21:162-167 14) Muraki Y, Kitamura M, Maeda Y, et al. Nationwide surveillance of antimicrobial consumption and resistance to Pseudomonas aeruginosa isolates at 203 Japanese hospitals in 2010. Infection. 2013;41:415-423. 5) McGowan JE Jr. Antimicrobial resistance in hospital organisms and its relation to antibiotic use. Rev lnfect Dis. 1983;5:1033-1048. 22) Warren-Gash C, Fragaszy E, Hayward AC. Hand hygiene to reduce community transmission of influenza and acute respiratory tract infection: a systematic review. Influenza Other Respir Viruses. 2013;7:738-749. 2) Bush K. New beta-lactamases in gram-negative bacteria: diversity and impact on the selection of antimicrobial therapy. Clin Infect Dis. 2001;32:1085-1089. 16) Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing; twenty-first informational supplement. Wayne: Clinical and Laboratry Standards Institute; 2011. (Clinical and Laboratry Standards Institute; M100-S21;31). |
| References_xml | – reference: 7) Fridkin S K, Steward C D, Edwards J R, et al. Surveillance of antimicrobial use and antimicrobial resistance in United States hospitals: project ICARE phase 2. Project Intensive Care Antimicrobial Resistance Epidemiology (ICARE) hospitals. Clin Infect Dis. 1999;29:245-252. – reference: 9) 宮崎博章，入江利行，素元美佐，ほか．カルバペネム薬の使用制限下によるイミペネム耐性緑膿菌と多剤耐性緑膿菌の検出率の推移．環境感染．2006;21:162-167． – reference: 22) Warren-Gash C, Fragaszy E, Hayward AC. Hand hygiene to reduce community transmission of influenza and acute respiratory tract infection: a systematic review. Influenza Other Respir Viruses. 2013;7:738-749. – reference: 13) 梅村拓巳，望月敬浩，村木優一，ほか．Anatomical therapeutic chemical classification/defined daily dose systemを利用した注射用抗菌薬の使用量と緑膿菌耐性率．日環境感染会誌．2010;25:376-382． – reference: 14) Muraki Y, Kitamura M, Maeda Y, et al. Nationwide surveillance of antimicrobial consumption and resistance to Pseudomonas aeruginosa isolates at 203 Japanese hospitals in 2010. Infection. 2013;41:415-423. – reference: 4) Ueda T, Shibata H, Nakamura H, et al. Efficacy of laminar air flow room with or without clean nursing for preventing infection in patients with acute leukemia. Jpn J Clin Oncol. 1983;13 (Suppl 1):151-157. – reference: 8) Bantar C, Sartori B, Vesco E, et al. A hospitalwide intervention program to optimize the quality of antibiotic use: impact on prescribing practice, antibiotic consumption, cost savings, and bacterial resistance. Clin Infect Dis 2003;37:180-186. – reference: 10) Miyawaki K, Miwa Y, Tomono K, et al. The impact of antimicrobial stewardship by infection control team in a japanese teaching hospital. Yakugaku Zasshi. 2010;130:1105-1111. – reference: 15) 池本雅章，華山博子，栗原晋太郎，ほか．広島県下24施設による抗菌薬使用密度と耐性菌分離率に関する地域共同サーベイランス．日病薬師会誌．2013;49:753-759. – reference: 5) McGowan JE Jr. Antimicrobial resistance in hospital organisms and its relation to antibiotic use. Rev lnfect Dis. 1983;5:1033-1048. – reference: 12) Landman D, Chockalingam M, Quale JM. Reduction in the incidence of methicillin-resistant Staphylococcus aureus and ceftazidime-resistant Klebsiella pneumoniae following changes in a hospital antibiotic formulary. Clin Infect Dis 1999;28:1062-1066. – reference: 16) Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing; twenty-first informational supplement. Wayne: Clinical and Laboratry Standards Institute; 2011. (Clinical and Laboratry Standards Institute; M100-S21;31). – reference: 2) Bush K. New beta-lactamases in gram-negative bacteria: diversity and impact on the selection of antimicrobial therapy. Clin Infect Dis. 2001;32:1085-1089. – reference: 18) Magiorakos AP, Srinivasan A, Carey RB, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012;18:268-281. – reference: 1) Westh H, Zinn CS, Rosdahl VT. An international multicenter study of antimicrobial consumption and resistance in Staphylococcus aureus isolates from 15 hospitals in 14 countries. Microb Drug Resist. 2004;10:169-176. – reference: 6) Gerding DN, Larson TA, Hughes RA, et al. Aminoglycoside resistance and aminoglycoside usage: ten years of experience in one hospital. Antimicrob Agents Chemother. 1991;35:1284-1290. – reference: 20) 小笠原康雄，長崎信浩，大野公一，ほか．Meropenem投与患者における緑膿菌耐性化因子の検討．日環境感染会誌．2012;27:419-424. – reference: 17) European Committee on Antimicrobial Susceptibility Testing. Breakpoint tables for interpretation of MICs and zone diameters. Version 1.3. Basel: European Society of Clinical Microbiology and Infectious Diseases; 2011. – reference: 11) 村木優一，田辺正樹，中村明子，ほか．病院情報管理システムと連動した広域抗菌薬の使用届出制の構築と有用性の評価．医療薬学．2010;36:316-322． – reference: 3) Ishii Y, Alba J, Kimura S, et al. Evaluation of antimicrobial activity of beta-lactam antibiotics by Etest against clinical isolates from 100 medical centers in Japan (2004). Diagn Microbiol Infect Dis. 2006;55:143-148. – reference: 21) 高橋真由美，金子俊幸，平 浩幸．カルバペネム耐性緑膿菌検出に影響を及ぼす危険因子の検討．日環境感染会誌．2010;25:104-110. – reference: 19) Tacconelli E, De Angelis G, Cataldo MA, et al. Does antibiotic exposure increase the risk of methicillin-resistant Staphylococcus aureus (MRSA) isolation? A systematic review and meta-analysis. J Antimicrob Chemother. 2008;61:26-38. |
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| Title | カルバペネム系薬投与患者における耐性菌選択リスク因子の検討 |
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