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2 multiple drugresistant Acinetobacter baumannii, MDRA healthcare-associated infection KPCKlebsiella pneumoniae CarbapenemaseNDM-1 New Delhi metallo-- lactamase MRSAmethicillin-resistant Staphylococcus aureus 10 1 efflux pump NDM-1 KPC - - efflux MDRP 5
3 MBLMetallo--lactamase NDM-1 MBL MBL R MRSA PRSP ESBL VRE MBL MDRA VISA KPC VRSA NDM MBL : MDRA : Multiple Drug-Resistant Acinetobacter : KPC : Klebisiella pneumoniae CarbapenemaseNDM-1 : New Delhi metallo--lactamase 1 1 B 6
4 940 MRSA MRSA vancomycin-resistant enterococci : VRE 7 KPC 8, 9 gunshot wound VRSA VRE TAZPIPC 3 broad-spectrum 0, 11 p 10
5 ICU 1 ICU isolation CDCCenters for Disease Control and Prevention CDC What is What is MDR 4 5 ICU
6 10 MRSA 1980 MRSA 13 5 MRSA 16, 17 MRSA 3 common disease endorse 8 MRSA MRSA 9 MRSA MRSA
7 MRSA MRSA active surveillance culturing ; ASC search & destroy policys&d MRSA S&D ASC MRSA ICU PCRpolymerase chain reaction 0 MRSA MRSAhospital-acquired MRSA, HA-MRSAMRSA , MRSA MRSA MRSA MRSAcommunity-acquired MRSA, CA-MRSA 13 5 CA-MRSA VRE 1 -extended spectrum beta-lactamase : ESBL 3 ESBL 000 ESBL ESBL ESBL VRE VRE - ICT
8 CLSIClinical and Laboratory Standards Institute NCCLS : National Committee for Clinical Laboratory Standards NCCLS 3 U PIPC 64gml PIPC U TAZPIPC CLSI CLSI CLSI CLSI CLSI penicillinresistant Streptococcus pneumoniae ;PRSP 4 Staphylococcus : 00-S14gml : 00-S15gml NCCLS CLSI 007 M100-S : M100 -S17gml
9 S CLSINCCLS Staphylococcus aureus I R M100-S15 Staphylococcus spp. Coagulase negative staphylococci S I R S Enterococcus spp. I R M100-S0-U KPC MICgml 009M100-S19 S I R M100-S0 S I R M100-S1 S I R CLSI S I R MIC : gml
10 PISP PRSP 4 PISP 5 PRSP 5 MIC MIC in vitro MIC MIC MIC 1980 MIC NCCLS sensitive : S MIC 00 MIC MIC9090 MIC
11 MIC MIC MIC MIC abscess abscess 30kg MIC MIC MIC MIC 00mg00mg 00mg OFLX 500mg 30 1g
12 6g 8g PKpharmacokinetics PDpharmacodynamics therapeutic drug monitoringtdm 500mg underdose dose dependent full dose g g in vitro TDM TDM TDM survival prospective TDM TDM clinical outcome TDM the American Society of Health-System Pharmacists, the Infectious Diseases Society of AmericaIDSA the Society of Infectious Diseases Pharmacists 3 consensus review 7 consensus 011 IDSA MRSA clinical practice guidelines 15 IDSA What are the recommendations for vancomycin dosing and monitoring clinical questions Expert Panels TDM TDM MIC TDM MIC TDM
13 TDM MIC MRSA SARS HIV 9 10 TDM MIC outcome measurement 3 HPV vaccination 10 prospective HPV cancer 10 EBM evidence-based medicine
14 clinical outcome NDM International Symposium on Antimicrobial Agents and Resistance 30 ICU non-icu ESBL 0
15 1 1 microbiology audit 8, 31 5 Transplant
16 MRI CNN Gupta CNN Chief Medical Correspondent Sanjay Gupta MD ipod itunes podcast ABC World News anchor Diane Sawyer KPC
17 Acinetobacter baumannii Acinetobacter baumannii complex Pseudomonas putida 99Acinetobacter baumannii complex MDR-Ab A MIC MIC CLSI S, I, R 3 MRSA MIC
18 MRSA MRSA 006 CDC MRSA VRE MRDP KPC NDM JANIS JANIS ABPC
19 MRSA TDM
20 TB ESBL ESBL prevalence prevalence Field Epidemiology Training Program JapanFETP-J FETP residency program
21 CDC ICT 3 5
22 outcome measurement outcome measurement PKO GHQ 40 41
23 Opal SM, Vicas AP. Molecular Mechanisms of Antibiotic Resistance in Bacteria. In : Mandell, Bennett JE, Dolin R, editors. Mandell GL, Douglas, and Bennett s Principles and Practice of Infectious Diseases. 7th ed. Philadelphia : Churchill Livingston Elsevier : 79-95, 010. Rice LB, Bonomo RA. Mechanisms of Resistance to Antibacterial Agents. In : Versalovic J, editor in chief. Manual of Clinical Microbiology. 10th ed. Washington, DC : AMS press : , ,, NDM , ,,,. : 0-7, MDRP.. : 74-79, : 1-3, ,. 4 VRE.. : , Yigit H, Queenan AM, Anderson GJ, et al. Novel carbapenem-hydrolyzing -lactamase, KPC-1, from a carbapenem-resistant strain of Klebsiella pneumoniae. Antimicrob Agents Chemother. : , Won SY, Munoz-Price LS, Lolans K, et al. Emergence and rapid regional spread of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae. Clin Infect Dis. : , Pakyz AL, MacDougall C, Oinonen M, et al. Trends in antibacterial use in US academic health centers : 00 to 006. Arch Intern Med. 0: 54-60, Grijalva CG, Nuorti JP, Griffin MR. Antibiotic prescription rates for acute respiratory tract infections in US ambulatory settings. JAMA. : , Mayo Clinic.. : , Panton- Valentine. : , ,, Tatiana Baranovich,. 6 MRSA.. : , Liu C, Bayer A, Cosgrove SE, et al. Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis. 011 Feb 1 ; 53: e Epub 011 Jan 4. Erratum in Clin Infect Dis. 3: 319, 011 Aug. 16van Rijen MM, Bosch T, Heck ME, et al. Meticillin-resistant Staphylococcus aureus epidemiology and transmission in a Dutch hospital. J Hosp Infect. : , Epub 009 Jul Johnson AP. Methicillin-resistant Staphylococcus aureus : the European landscape. J Antimicrob Chemother. 011 ; 66 Suppl 4 : iv43-iv48. 18,... : , Wulf MW, Tiemersma E, Kluytmans J, et al A.J, MRSA carriage in healthcare personnel in contact with farm animals. J Hosp Infect. : , 008 Oct. 0Robotham JV, Graves N, Cookson BD, et al. Screening, isolation, and decolonisation strategies in the control of
24 meticillin resistant Staphylococcus aureus in intensive care units : cost effectiveness evaluation. BMJ. 011 Oct 5 ; 343 : d5694. doi : bmj.d5694. Available from : long 1VRE,,,,. VRE , Available from : URL : jp ~ ictict inf_practiceinf_ictshishin.pdf. ESBL.. : , Yamaguchi K, Ishii Y, Iwata M, et al. Nationwide surveillance of parenteral antibiotics containing meropenem activities against clinically isolated strains in 009. Jpn J Antibiot. : 53-95, ,. 3 penicillin-resistant Streptococcus pneumoniae ; PRSP.. : 1-16, Infectious Disease : Clinical Cases Uncovered, MEDICAL LIBRRY, ,. Available from : URL : do?id=pa0936_10 6TDM Task Force. VANCOMYCIN MONITORING GUIDELINES, DKMLCH Laboratory Bulletin, Vol.3, No.4, 1998 April.Available from : ddrugs.orghealthcareantimicrobialvancomycinmoni toringguidelines.pdf 7Michael Rybak, Ben Lomaestro, John C. et al. Therapeutic monitoring of vancomycin in adult patients : A consensus review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. Am J Health-Syst Pharm. : 8-98, Kazunari KUMASAKA, Kinya KAWANO, Keizo YAM- AGUCHI, et al. A study of quality assessment of clinical microbiology performance of independent laboratories in Tokyo -18-year of participation in the Tokyo Metropolitan Government External Quality Assessment Program. Journal of Infection and Chemotherapy. : , ,., Available from : pubopinionorgnl html 30Ramasubramanian v. MAJOR RESISTANCE PROBLEMS IN INDIA, Session 4 Major issues of resistance in the Asia Pacific region : an epicenter of resistance, 8 th INTER- NATIONAL SYMPOSIUM ON ANTIMICROBIAL AGENTS AND RESISTANCE. Seoul. Available from : : 78-85, Available from : mrsa10100teigen.html 33,. Available from : jscm.orgtazaitaisei54.html 34. multiple drug-resistant Acinetobacter baumannii. Vol.6, Suppl., 011. Available from : http: 35FETP. Available from : Available from : research.htm , Available from : new11067_news_mhlw_0.pdf 38. 6,., : , CDC the Healthcare Infection Control Practices Advisory Committee. Management of Multidrug-Resistant Organisms In Healthcare Settings. 006 Available from : http: pdf 40..,, ,, ,,,..,, ,., PHP,, 009.
E Societe de Pathologie Infectieuse de Langue Francaise (, 1991) E Spanish Thoracic Society (1992) E American Thoracic Society (ATS : 1993. ü ù2001 ) E British Thoracic Society (1993, ü è2001 ) E Canadian
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