DIC vegetation 1 nonbacterial thrombogenic e

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1 Guidelines for the Prevention and Treatment of Infective Endocarditis (JCS 2003) h G Streptococcus viridans Streptococcus bovis 2 G Streptococcus 3 Enterococcus 4 Staphylococcus 5 HACEK 6 Fungus PVE Circulation Journal Vol. 67, Suppl. IV,

2 DIC vegetation 1 nonbacterial thrombogenic endocarditis NBTE NBTE NBTE 1 vegetation 1084 Circulation Journal Vol. 67, Suppl. IV, 2003

3 % %Duke IE A 2 Streptococcus viridans1streptococcus bovis HACEK Staphylococcus aureus Enterococcus B IE A B A IE B Janeway 4Osler Roth 5 IE 6IE 4 4 IE 1 Streptococcus viridans Circulation Journal Vol. 67, Suppl. IV,

4 % 4 Osler Janeway Roth % % 6 40 % % Staphylococcus aureus 3 % % Staphylococcus aureus % 2 Streptococcus viridans Streptococus bovis HACEK Staphylococcus aureus Enterococcus faecalis Duke ml Circulation Journal Vol. 67, Suppl. IV, 2003

5 % 60 % 3 10 mm 10 mm 20 % 40 % 10 mm % 58 % 24 % 17 % 86 % 65 % % % % % 28 % 98 % 87 % 95 % % Circulation Journal Vol. 67, Suppl. IV,

6 IE IE IE No 1 Yes TDM 4 MRSA MRSE methicillin-resistant Staphylococcus epidermidis Enterococcus 5PVE, prosthetic valve endocarditis 2 6 MIC minimum inhibitory concentration TDM therapeutic drug monitoring Staphylococcus aureus G PCG G 8 12 g 1088 Circulation Journal Vol. 67, Suppl. IV, 2003

7 in vitro 4 G G mm Streptococcus bovis 3 2 Streptococcus viridans G 50 % 40 % G G G G PVE VRE vancomycin-resistant enterococcus VRE 2 VRE in vitro 4 Streptococcus viridans Staphylococcus aureusstreptococcus pyogenes 1 - G nafcillin oxacillin 1 1 G G Circulation Journal Vol. 67, Suppl. IV,

8 G Streptococcus Streptococcus viridans Streptococcus bovis A G 2,400 1,800 3, B G C D E GA 60mg or 1mg/kg x 2 3/ 8 12g/ mg or 1mg/kg x 2 3/ 2 g x 1/ 60mg or 1mg/kg x 2 3/ 25mg/kg/loading dose20mg/kg/ G Streptococcus F G A 60mg or 1mg/kg 2 3/ B G C H E 3 Enterococcus I C 8 12 g/4~6 60mg or 1mg/kg x 2 3/ 25mg/kg/loading dose20mg/kg/ g/4 6 60mg or 1mg/kg x 2/ J 25mg/kg/loading dose20mg/kg/ mg or 1mg/kg x 2 3/ 4 Staphylococcus-methicillin sensitive K L 2 g x 3 4/ 60mg or 1mg/kg x 2 3/ 25mg/kg/loading dose20mg/kg/ J 60mg or 1mg/kg x 2 3/ 5 Staphylococcus- -methicillin resistant M 25mg/kg/loading dose20mg/kg/ e.g. 60mg or 1mg/kg x 2 3/ G 2 PC 4 =25 40 g/ml =10 g/ml g/ - TDM g Circulation Journal Vol. 67, Suppl. IV, 2003

9 4 6 Streptococcus Streptococcus viridans Streptococcus bovis Enterococcus N G B O G GA 60mg or 1mg/kg x 2 3/ 8 12 g/ mg or 1mg/kg x 2 3/ P 25mg/kg/loading dose20mg/kg/ J 60mg or 1mg/kg x 2 3/ 7 Staphylococcus-methicillin sensitive Q K 2 g x 3 4/ 60mg or 1mg/kg x2 3/ 450~600 mg/ 1 2 R 25mg/kg/loading dose20mg/kg/ J 60mg or 1mg/kg x 2 3/ 450~600 mg/ Staphylococcus- -methicillin resistant S 25mg/kg/loading dose20mg/kg/ M e.g. 60mg or 1mg/kg x 2 3/ 450~600 mg/ Enterococcus G Enterococcus Enterococcus TDM MRSA Staphylococcus epidermidis coagulase-negative staphylococci CNS MRSA TDM TDM 1 MRSA VRE cytochrome P-450 Circulation Journal Vol. 67, Suppl. IV,

10 % 10 % HACEK in vitro Pseudomonas aeruginosa 3 4 In vitro 6 B B 5-FC % 30 % nutritionally variant streptococci SIRS systemic inflammatory response syndrome mg 1mg/kg 2 3 / g/ml 1 g /ml 2 1 2g 1g 65 1 / 8 loading dose 25mg/kg 1 / 20mg/kg 1 /.1 red man loading dose mg/ mg 1 / 30 TDM g/ml 10 g /ml 6 50 TDM 7 40 g/ml 20 g/ml * mg/ 1 2 MRSA *TDM 1092 Circulation Journal Vol. 67, Suppl. IV, 2003

11 a Streptococcus viridans Enterococcus Staphylococcus aureus CNS Streptococcus viridans b Staphylococcus aureus c MRSA MRSE Staphylococcus aureus 4 5 empiric therapy targeted therapy 1 Streptococcus viridans 3 4 nutritionally variant streptococci HACEK 2 prosthetic valve endocarditis PVE 2 early PVElate PVE 40 % Staphylococcus epidermidis Staphylococcus aureus 2 50 % 10 % MRSA Circulation Journal Vol. 67, Suppl. IV,

12 Regimen A~H Regimen N~P Regimen I, J Regimen K~M Regimen Q~S Regimen Regimen 7 Regimen Regimen 2 CNS MRSA CRP Staphylococcus aureus 1 2 Staphylococcus aureus drug fever 3 4 Staphylococcus aureus 1094 Circulation Journal Vol. 67, Suppl. IV, 2003

13 8 1 2 drug fever % 20 % 8 % Enterococcus Streptococcus pneumoniae Staphylococcus aureus 2 New York Heart Association NYHA 2 Staphylococcus aureus 3 NYHA 2 3 % Circulation Journal Vol. 67, Suppl. IV,

14 % % % 2 28 % 88 % 87 % 95 % % % 76 % 2 10 mm % 65 % mm % 9.7 % 64.6 % 31.5 %2.8 %1.1 % Staphylococcus aureus 1096 Circulation Journal Vol. 67, Suppl. IV, 2003

15 10 % 23 % 4 CT MRI MRI MR 5 mm 5 mm 7 10 CT CT % CT 2-3 TIA Circulation Journal Vol. 67, Suppl. IV,

16 CT % CT MRI % CT CT % 9 27 % 10 CT 11 DIC in vitro in vivo DIC Staphylococcus aureus Pseudomonas aeruginosa DIC 3 5 % 30 % Circulation Journal Vol. 67, Suppl. IV, 2003

17 1 NYHA 2 CRP MRSA Staphylococcus aureus mm 10 mm mm % % % % % Circulation Journal Vol. 67, Suppl. IV,

18 % CT MRI MRA 2 1 viable graft mm 2 10 mm Circulation Journal Vol. 67, Suppl. IV, 2003

19 ICD Circulation Journal Vol. 67, Suppl. IV,

20 fi PCI Circulation Journal Vol. 67, Suppl. IV, 2003

21 1 5 % % 45 % 31 % 5 31 % % % 12 2 Circulation Journal Vol. 67, Suppl. IV,

22 maximal barrier precautions ml Streptococcus viridans Streptococcus viridans 2.0 g 50mg kg 2.0 g 30 mg kg g 2.0 g 1104 Circulation Journal Vol. 67, Suppl. IV, 2003

23 g mg kg g mg kg mg 1 20 mg kg g 1 50 mg kg mg 1 15 mg kg mg mg kg g mg kg g mg mg mg mg mg Enterococcus faecalis Circulation Journal Vol. 67, Suppl. IV,

24 g 1.5 mg kg 120 mg g 1 g 50 mg kg 2.0 g 1.5 mg kg mg kg 25 mg kg 1.0 g mg kg 120 mg mg kg mg kg 120 mg g mg kg g mg kg g mg kg IVH Circulation Journal Vol. 67, Suppl. IV, 2003

25 Duke 1 25 % Osler Roth Janeway % 3 80 % Circulation Journal Vol. 67, Suppl. IV,

26 Streptococcus viridans Streptococcus bovis % % Osler Roth Janeway G 1 1 * G Staphylococcus aureus * 6-8 Staphylococcus aureus Staphylococcus epidermidis Haemophilus sp G G 6-8 Fungus B B 8 * G kg mg kg mg kg mg kg 4 : mg kg mg kg 4 B mg kg 1 TDM 1108 Circulation Journal Vol. 67, Suppl. IV, 2003

27 Ross Fontan AZM Azithromycin AMPH-B Amphotericin-B AMPC Amoxicillin ABK Arbekacin ABPC Ampicillin IPM/CS Imipenem/cilastatin CAM Clarithromycin CLDM Clindamycin GM Gentamicin SBT/ABPC Sulbactam/ampicillin SBT/CPZ Sulbactam/cefoperazone CEZ Cefazolin CDX Cefadroxil CEX Cefalexin CDTR Cefditoren CTRX Ceftriaxone TEIC Teicoplanin VCM Vancomycin G PCG Penicillin G RFP Rifampicin Circulation Journal Vol. 67, Suppl. IV,

R06_01

R06_01 Staphylococcus aureus (MSSA) PCG (N=118,334) 57,369 (48.5%) 判定不能 :3 (0.0%) 60,962 (51.5%) CEZ (N=143,723) I:42 (0.0%) 143,635 (99.9%) R:46 (0.0%) CVA/AMPC (N=19,281) R:14 (0.1%) 19,265 (99.9%) 判定不能 :2