Apr. 2012 THE JAPANESE JOURNAL OF ANTIBIOTICS 65 2 111 13 B ACTIONs Bundle ACTIONs Bundle 2009 7 ACTIONs Bundle ACTIONs project Appropriate Candidal Treatment, Implementation Of Nonneutropenic strategies ABC A Antifungals B Blood stream infection C Colonization & -Dglucan 2011 ABC Bundle Bundle Bundle Candida albicans non-albicans C. glabrata C. parapsilosis non-albicans
112 14 THE JAPANESE JOURNAL OF ANTIBIOTICS 65 2 Apr. 2012 non-albicans 4 non-albicans C. glabrata, C. parapsilosis, C. tropicalis, C. krusei 4 C. guilliermondii C. famata C. guilliermondii C. glabrata non-albicans FLCZ non-albicans 4 Candida spp. C. albicans non-albicans C. albicans FLCZ C. albicans 1 non-albicans C. glabrata, C. krusei, C. guilliermondii VRCZ non-albicans 4 C. parapsilosis C. guilliermondii C. famata 2 L- AMB B AMPH-B C. albicans non-albicans Aspergillus AMPH-B C. lusitaniae C. lusitaniae in vitro MIC C. parapsilosis MIC FLCZ MIC 1 g/ml 2 g/ml MIC C. parapsilosis C. glabrata MIC C. glabrata C. glabrata VRCZ 2009 IDSA C. glabrata VRCZ IDSA VRCZ FLCZ
Apr. 2012 THE JAPANESE JOURNAL OF ANTIBIOTICS 65 2 113 15 MIC MIC AMPH-B MIC 50% AMPH-B MIC MIC Bundle Bundle 1 3 ACTIONs project ABC B blood stream infection 1.Bundle Bundle BAL C. albicans non-albicans 4 C. guilliermondii Bundle 2 3
114 16 THE JAPANESE JOURNAL OF ANTIBIOTICS 65 2 Apr. 2012 2.Bundle 3.Bundle TPN PFALLER, M. A., et al.: Clin. Microbiol. Rev. 20 1 : 133 163, 2007 100% empiric -D- Bundle 2 2 frequently missed detect
Apr. 2012 THE JAPANESE JOURNAL OF ANTIBIOTICS 65 2 115 17 2 2 1 CNS Bacillus 2 2 -D- empiric Bundle empiric empiric empiric presumptive -D- -D- -D- ICU 20 40% 3 4 L-AMB MIC 4. KUHN, D. M., et al.: Antimicrob. Agents Chemother. 46 6 : 1773 1780, 2002
116 18 THE JAPANESE JOURNAL OF ANTIBIOTICS 65 2 Apr. 2012 L-AMB L-AMB Bundle 2009 7 Earlier appropriate therapy 1 1st F-FLCZ MCFG sepsis L-AMB 1st F-FLCZ MCFG F-FLCZ MCFG L-AMB 1st F-FLCZ MCFG C. glabrata MCFG sepsis septic shock L-AMB sepsis 1,400 sepsis 28 50% sepsis Bundle 1st L-AMB 2 1. Earlier appropriate therapy
Apr. 2012 THE JAPANESE JOURNAL OF ANTIBIOTICS 65 2 117 19 2.Bundle L-AMB AMPH-B MCFG L-AMB 4 non-albicans Acute physiology and chronic health evaluation APACHE 20 sepsis septic shock L-AMB septic shock 3 g/ MRSA L-AMB L-AMB L-AMB septic shock AMPH-B L-AMB L-AMB C. glabrata C. krusei empiric MCFG L-AMB 2nd L-AMB 2nd F-FLCZ 5 MCFG 3 Bundle
118 20 THE JAPANESE JOURNAL OF ANTIBIOTICS 65 2 Apr. 2012 MCFG 3 3 5 2nd 2nd sepsis C. glabrata C. krusei L-AMB L-AMB F-FLCZ MCFG F-FLCZ VRCZ VRCZ TDM VRCZ VRCZ L-AMB VRCZ 2 Bundle 5 F-FLCZ AMPH-B L-AMB 5-FC nonalbicans Bundle F-FLCZ 5. Bundle Bundle 2 2 Bundle Bundle Yes/No
Apr. 2012 THE JAPANESE JOURNAL OF ANTIBIOTICS 65 2 119 21 6. L-AMB 3. Antifungal heterogeneity L-AMB 6 L-AMB AMPH-B 3 L-AMB MCFG C. parapsilosis Trichosporon Antifungal heterogeneity Antifungal heterogeneity 3 L-AMB AMPH-B Infection control team ICT Bundle 1 Jpn. J. Antibiotics 62 5 : 415 434, 2009 2 ARENDRUP, M. C.: Curr. Opin. Critics Care 16 5 : 445 452, 2010 3 TUMBARELLO, M. et al.: J. Clin. Microbiol. 45 6 : 1843 1850, 2007