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518( 30 ) THE JAPANESE JOURNAL OF ANTIBIOTICS 58 6 Dec. 25 2003 1. * *

Dec. THE JAPANESE JOURNAL OF ANTIBIOTICS 58 6 519( 31 ) 9 5 2003 8 2004 7 14 565 701 258 (36.8%) 443 (63.2%) Staphylococcus aureus Vancomycin (VCM) 2 m g/ml Streptococcus agalactiae Ampicillin (ABPC), Cefozopran (CZOP), Imipenem (IPM), Clarithromycin (CAM) MIC 90 0.125 m g/ml Enterococcus faecalis VCM, ABPC, IPM Escherichia coli Cefpirome (CPR) CZOP MIC 90 0.125 m g/ml E. coli [Ciprofloxacin (CPFX): MIC 4 m g/ml] 15.7% Klebsiella pneumoniae Meropenem (MEPM) CRMN CZOP Serratia marcescens MEPM Proteus mirabilis MEPM CRMN 0.125 m g/ml CMX (Cefmenoxime), Ceftazidime (CAZ), Cefixime (CFIX), Cefpodoxime (CPDX), CPR, CZOP, Cefditoren (CDTR)Pseudomonas aeruginosa IPM Amikacin (AMK) MIC 90 16 m g/ml 32 256 mg/ml CZOP (MIC 50 : 2 m g/ml) 1979

520( 32 ) THE JAPANESE JOURNAL OF ANTIBIOTICS 58 6 Dec. 1 24) 1 2 3 I. 2003 8 2004 7 565 MIC2000 Mueller-Hinton broth (Difco) 4 ml McFarland No. 0.5 10 Oxacillin (MPIPC), Ampicillin (ABPC), Piperacillin (PIPC), Cefazolin (CEZ), Cefotiam (CTM), Cefoperazone (CPZ), Cefmenoxime (CMX), Cefmetazole (CMZ), Flomoxef (FMOX), Ceftazidime (CAZ), Cefpirome (CPR), Cefozopran (CZOP), Cefsulodin (CFS), Cefaclor (CCL), Cefixime (CFIX), Cefpodoxime (CPDX), Cefditoren (CDTR), Imipenem (IPM), Meropenem (MEPM), Aztreonam (AZT), Carumonam (CRMN), Gentamicin (GM), Tobramycin (TOB), Amikacin (AMK), Arbekacin (ABK), Clarithromycin (CAM), Clindamycin (CLDM), Minocycline (MINO), Vancomycin (VCM), Ciprofloxacin (CPFX), Sparfloxacin (SPFX), Levofloxacin (LVFX) 32 II. 1. Table 1 Table 2 701 36.8% 258 Enterococcus faecalis 13.8% 97 Streptococcus agalactiae 7.8% 55 Staphylococcus aureus 6.3% 44 Staphylococcus epidermidis 2.3% 16 63.2% 443 Escherichia coli 31.0% 217 49.0% Pseudomonas aeruginosa 7.8% 55 Klebsiella pneumoniae 6.7% 47 Klebsiella okytoca 3.0% 21 Proteus mirabilis 2.3% 16 Serratia marcescens 1.9% 13 2. MIC Tables 3 11 Figs. 1 8 (1) Staphylococcus aureus (Table 3, Fig. 1) S. aureus 44 VCM MIC 90 1 m g/ml 2 m g/ml ABK MIC 90 2 mg/ml MINO MIC 90 16 mg/ml MIC 90 64 mg/ml (2) S. aureus (MRSA, MPIPC MIC 4 m g/ml) (Table 4) S. aureus 44 24 (54.5%) MRSA MRSA VCM 2 mg/ml ABK 8 mg/ml MIC 90

Dec. THE JAPANESE JOURNAL OF ANTIBIOTICS 58 6 521( 33 ) Table 1. Number of strains in detected places (2003). Table 2. Number of strains isolated from patients with urinary tract infections (2003).

522( 34 ) THE JAPANESE JOURNAL OF ANTIBIOTICS 58 6 Dec. Table 3. Susceptibility distribution of clinically isolated S. aureus (2003).

Dec. THE JAPANESE JOURNAL OF ANTIBIOTICS 58 6 523( 35 ) Fig. 1. Susceptibility cumulative curve of clinically isolated S. aureus (2003).

524( 36 ) THE JAPANESE JOURNAL OF ANTIBIOTICS 58 6 Dec. Table 4. Susceptibility distribution of clinically isolated S. aureus MPIPC MIC 4 m g/ml (2003).

Dec. THE JAPANESE JOURNAL OF ANTIBIOTICS 58 6 525( 37 ) 16 256 mg/ml (3) Streptococcus agalactiae (Table 5, Fig. 2) S. agalactiae 55 ABPC CZOP IPM CAM MIC 90 0.125 mg/ml VCM1 mg/ml MINO SPFX LVFX MIC 90 16 64 mg/ml (4) Enterococcus faecalis (Table 6, Fig. 3) E. faecalis 97 VCM 2 mg/ml MIC 90 ABPC 2 mg/ml IPM MIC 90 4 mg/ml MINO MIC 90 16 m g/mlmic 90 32 mg/ml (5) Escherichia coli (Table 7, Fig. 4) E. coli 217 b- MIC 90 4 m g/ml MEPM 0.125 m g/ml IPM 0.5 m g/ml CZOP 0.125 mg/ml 97.7% CMX, FMOX, CPR MIC 90 0.25 mg/ml CRMN MIC 90 0.25 mg/ml (6) Klebsiella pneumoniae (Table 8, Fig. 5) K. pneumoniae 47 MEPM MIC 90 0.125 mg/ml CRMN CZOP MIC 90 0.25 m g/ml FMOX CPR IPM MIC 90 0.5 mg/ml (7) Serratia marcescens (Table 9, Fig. 6) S. marcescens 13 MEPM MIC 90 0.5 m g/ml IPM 1 mg/ml CRMN GM MIC 90 4 mg/ ml CAZ, CPR, CZOP MINO CPFX LVFX MIC 90 8 mg/ml MIC 90 16 mg/ ml (8) Proteus mirabilis (Table 10, Fig. 7) P. mirabilis 16 MEPM CRMN 0.125 mg/ml CMX, CAZ, CFIX, CPDX, CPR, CZOP, CDTR MIC 90 0.125 0.25 mg/ml (9) Pseudomonas aeruginosa (Table 11, Fig. 8) P. aeruginosa 55 IPM AMK MIC 90 16 mg/ml MIC 50 CPFX 0.25 m g/ml MEPM 0.5 m g/ml TOB IPM LVFX 1 m g/ml CZOP MIC 50 2

526( 38 ) THE JAPANESE JOURNAL OF ANTIBIOTICS 58 6 Dec. Table 5. Susceptibility distribution of clinically isolated S. agalactiae (2003). Fig. 2. Susceptibility cumulative curve of clinically isolated S. agalactiae (2003).

Dec. THE JAPANESE JOURNAL OF ANTIBIOTICS 58 6 527( 39 ) Table 6. Susceptibility distribution of clinically isolated E. faecalis (2003). Fig. 3. Susceptibility cumulative curve of clinically isolated E. faecalis (2003).

528( 40 ) THE JAPANESE JOURNAL OF ANTIBIOTICS 58 6 Dec. Table 7. Susceptibility distribution of clinically isolated E. coli (2003).

Dec. THE JAPANESE JOURNAL OF ANTIBIOTICS 58 6 529( 41 ) Fig. 4. Susceptibility cumulative curve of clinically isolated E. coli (2003).

530( 42 ) THE JAPANESE JOURNAL OF ANTIBIOTICS 58 6 Dec. Table 8. Susceptibility distribution of clinically isolated K. pneumoniae (2003).

Dec. THE JAPANESE JOURNAL OF ANTIBIOTICS 58 6 531( 43 ) Fig. 5. Susceptibility cumulative curve of clinically isolated K. pneumoniae (2003).

532( 44 ) THE JAPANESE JOURNAL OF ANTIBIOTICS 58 6 Dec. Table 9. Susceptibility distribution of clinically isolated S. marcescens (2003).

Dec. THE JAPANESE JOURNAL OF ANTIBIOTICS 58 6 533( 45 ) Fig. 6. Susceptibility cumulative curve of clinically isolated S. marcescens (2003).

534( 46 ) THE JAPANESE JOURNAL OF ANTIBIOTICS 58 6 Dec. Table 10. Susceptibility distribution of clinically isolated P. mirabilis (2003).

Dec. THE JAPANESE JOURNAL OF ANTIBIOTICS 58 6 535( 47 ) Fig. 7. Susceptibility cumulative curve of clinically isolated P. mirabilis (2003).

536( 48 ) THE JAPANESE JOURNAL OF ANTIBIOTICS 58 6 Dec. Table 11. Susceptibility distribution of clinically isolated P. aeruginosa (2003).

Dec. THE JAPANESE JOURNAL OF ANTIBIOTICS 58 6 537( 49 ) Fig. 8. Susceptibility cumulative curve of clinically isolated P. aeruginosa (2003).

538( 50 ) THE JAPANESE JOURNAL OF ANTIBIOTICS 58 6 Dec. mg/ml III. 197924 1 24) 2003 8 2004 7 14 565 MIC 701 258 (36.8%) 443 (63.2%) S. aureus VCM 2 mg/ml 44 MRSA 1999 54.3% 19 /35 2000 62.5% 20 /32 2001 64.3% 18 /28 2002 78.6% 22 /28 21 24) 54.5% 24 /44 CZOP GM, TOB, CLDM, LVFX MRSA(MIC: 256 m g/ml) 4.2 91.7% 24) ABK MRSA (MIC: 32 m g/ml) S. agalactiae ABPC, CZOP, IPM, CAM E. faecalis VCM 2 mg/ml VRE (VCM resistant enterococci) 8 17 24) VCM MIC 90 2 4 mg/ml E. faecalis ABPC, IPM, VCM 25) CAM (MIC: 256 mg/ml) 48.3% VRE VRE 26 28) E. coli CZOP CPR MIC 90 0.125 mg/ml CZOP 2000 (14.0%) CLSI NCCLS (CPFX: MIC 4 m g/ml) 15.7% 2001 (Fig. 9) K. pneumoniae MEPM CRMN CZOP CZOP 2002CEZ, CTM, CCL (MIC: 256 m g/ml) S. marcescens MEPM 2002CPR CZOP

Dec. THE JAPANESE JOURNAL OF ANTIBIOTICS 58 6 539( 51 ) Fig. 9. Transition of quinolone-resistant E. coli strains (CPFX MIC 4 m g/ml). P. mirabilis MEPM CRMN 0.125 mg/ml CMX, CAZ, CFIX, CPDX, CPR, CZOP, CDTR 2002 CEZ CCL (MIC: 256 mg/ml) CPZ, CMX, CPR, CZOP, CPDX P. aeruginosa IPM AMK MIC 90 16 mg/ml 32 256 mg/ml MIC 50 0.25 8 m g/ml CZOP MIC 50 2 mg/ml 2002 E. faecalis MRSA VCM MRSA P. aeruginosa CZOP 14 1) E. coli, Klebsiella, Citrobacter Proteus Jpn. J. Antibiotics 34: 959 975, 1981 2) E. coli, Klebsiella, Citrobacter Proteus Jpn. J. Antibiotics 35: 1022 1044, 1982 3) Escherichia coli, Klebsiella, Citrobacter Proteus 3 1981 1 Jpn. J. Antibiotics 36: 1469 1503, 1983 4) 4 1982 1 Jpn. J. Antibiotics 37: 680 722, 1984 5) 5 1983 1 Jpn. J. Antibiotics 38: 2185 2229, 1985 6)

540( 52 ) THE JAPANESE JOURNAL OF ANTIBIOTICS 58 6 Dec. 6 1984 1 Jpn. J. Antibiotics 39: 2959 3006, 1986 7) 7 1985 1 Jpn. J. Antibiotics 40: 1975 2011, 1987 8) 8 1986 1 Jpn. J. Antibiotics 42: 2141 2173, 1989 9) 9 1987 1 Jpn. J. Antibiotics 43: 919 953, 1990 10) 10 1988 1 Jpn. J. Antibiotics 45: 1071 1102, 1992 11) 11 1989 1 Jpn. J. Antibiotics 48: 1131 1160, 1995 12) 12 1990 1 Jpn. J. Antibiotics 48: 1295 1316, 1995 13) 13 1991 1 Jpn. J. Antibiotics 48: 1394 1421, 1995 14) 14 1992 1 Jpn. J. Antibiotics 48: 1627 1657, 1995 15) 15 1993 1 Jpn. J. Antibiotics 48: 1757 1787, 1995 16) 16 1994 1 Jpn. J. Antibiotics 49: 465 493, 1996 17) 17 1995 1 Jpn. J. Antibiotics 50: 219 250, 1997 18) 18 1996 1 Jpn. J. Antibiotics 51: 69 111, 1998 19) 19 1997 1 Jpn. J. Antibiotics 52: 93 129, 1999 20) 20 1998 1 Jpn. J. Antibiotics 53: 201 233, 2000 21) 21 1999 1 Jpn. J. Antibiotics 54: 185 216, 2001 22) 22 2000 1 Jpn. J. Antibiotics 55: 370 398, 2002 23) 23 2001 1 Jpn. J. Antibiotics 56: 424 436, 2003 24) 24 2002 1 Jpn. J. Antibiotics 57: 246 274, 2004 25) 22: 590 592, 1995 26) ISHII, Y.; A. OHNO, S. KASHITANI, et al.: Identification of VanB-type vancomycin resistance in Enterococcus gallinarum from Japan. J. Infect. Chemother. 2: 102 105, 1996 27) (VanA) (E. faecalis) 52: 175, 1997 28) 2 15: 37 41, 1999

Dec. THE JAPANESE JOURNAL OF ANTIBIOTICS 58 6 541( 53 ) COMPARATIVE STUDIES ON ACTIVITIES OF ANTIMICROBIAL AGENTS AGAINST CAUSATIVE ORGANISMS ISOLATED FROM PATIENTS WITH URINARY TRACT INFECTIONS (2003) I. SUSCEPTIBILITY DISTRIBUTION YOSHIAKI KUMAMOTO*, TAIJI TSUKAMOTO, MASANORI MATSUKAWA and YASUHARU KUNISHIMA Department of Urology, Sapporo Medical University School of Medicine (*: a honorary professor at present) TAKAOKI HIROSE Department of Urology, Hokkaido social insurance hospital SHIRO SHIGETA Division, Bureau of Hospital Administration, Fukushima Prefectural Goverment KIYOAKI WATANABE, YOSHIO KOBAYASHI and HIROSHI UCHIDA Central Clinical Laboratories, Keio University School of Medicine SEIJI MATSUDA Department of Gynecology, Koto Hospital SHINICHI SATO Department of Clinical Laboratories, Koto Hospital MAKOTO FUJIME and KAZUHIKO FUJITA Department of Urology, Juntendo University School of Medicine OSAMU YAMAGUTI and KEI ISHIBASHI Department of Urology, Fukushima Medical University JUN IGARI Urayasu Hospital, Juntendo University School of Medicine TATSUO SUZUTANI Department of Microbiology, Fukushima Medical University TOYOKO OGURI Department of Clinical Laboratories, Juntendo University Hospital HIROSHI YOSHIDA and YUUJI IMAFUKU Department of Clinical Laboratory Medicine, Fukushima Medical University KEIZO YAMAGUCHI and NOBUHIKO FURUYA Department of Microbiology, Toho University School of Medicine MASARU MURAI Department of Urology, Keio University School of Medicine TAKASHI DEGUCHI and SATOSHI ISHIHARA Urological Devision, Disease Control Course, Gifu University Graduate School of Medicine

542( 54 ) THE JAPANESE JOURNAL OF ANTIBIOTICS 58 6 Dec. HIROSHI OOE Department of Urology, Kyoto Second Red Cross Hospital MINEKO NISHIKAWA Department of Clinical Laboratory, Kyoto Second Red Cross Hospital TOSHITSUGU OKA and MASAYA KITAMURA Department of Urology Osaka National Hospital TETSURO MATSUMOTO and KOICHI TAKAHASHI Department of Urology, School of Medicine, University of Occupational and Environmental Health SEIJI NAITO, TOSHIHISA EGASHIRA and TAKATOSHI KONISHI Department of Urology, Kyushu University Graduate School of Medicine YOSHINORI FUKUHARA Department of Clinical Laboratories, Osaka National Hospital SADAO KAMIDONO Division of Urology, Kobe University Graduate School of Medicine SOICHI ARAKAWA Department of Surgical Operation, Kobe University Hospital SHIGERU KOHNO Second Department of Internal Medicine, Nagasaki University School of Medicine YOICHI HIRAKATA, AKIRA KONDO, JUNICHI MATSUDA and MICHIKO NAKANO Department of Laboratory Medicine, Nagasaki University Hospital of Medicine and Dentistry HIROMI KUMON and KOICHI MONDEN Department of Urology, Okayama University Graduate School of Medicine and Dentistry YUMIKO SUZUKI Department of Laboratory, Yamada Evidence Research The bacterial strains isolated from 565 patients diagnosed as having urinary tract infections (UTIs) in 14 institutions in Japan were collected between August 2003 and July 2004. The susceptibilities of them to many kinds of antimicrobial agents were investigated. Of them, 701 strains were estimated as prophlogistic bacteria and used for the investigation. The strains consisted of 258 Gram-positive bacterial strains (36.8%) and 443 Gramnegative bacterial strains (63.2%). Against Staphylococcus aureus, vancomycin (VCM) showed the strongest activity and prevented the growth of all strains with 2 m g/ml. Against Streptococcus agalactiae, ampicillin (ABPC), cefozopran (CZOP), imipenem (IPM), and clarithromycin (CAM) showed a strong activity and the MIC 90 was 0.125 m g/ml or less. Against Enterococcus faecalis, VCM, ABPC, and IPM showed a strong antibacterial activity. The antibacterial activity of cephems to Escherichia coli was generally good, and especially CZOP and cefpirome (CPR) showed the strongest activity (MIC 90 : 0.125 m g/ml). Quinolone resistant E. coli [MIC of ciprofloxacin (CPFX): 4 m g/ml] was detected at frequency of 15.7%, which was higher than that in the last year. Against Klebsiella pneumoniae, meropenem (MEPM) showed the strongest activity and next, the antibacterial activity of CRMN and CZOP was good. The antibacterial activity of the other cephems, however, significantly decreased, compared

Dec. THE JAPANESE JOURNAL OF ANTIBIOTICS 58 6 543( 55 ) with that evaluated in last year. Against Serratia marcescens, MEPM had the strongest antibacterial activity. Against Proteus mirabilis, MEPM and CRMN showed the strongest activity and prevented the growth of all strains with 0.125 m g/ml or less. Nest, cefmenoxime (CMX), ceftazidime (CAZ), cefixime (CFIX), cefpodoxime (CPDX), CPR, CZOP, and cefditoren (CDTR) showed a strong activity. The antibacterial activity of the drugs to Pseudomonas aeruginosa was generally low, and MIC 90 of all the drugs was ranged from 32 to 256 m g/ml except IPM and amikacin (AMK) having 16 m g/ml. The antibacterial activity of CZOP was relatively good (MIC 50 : 2 mg/ml).

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