Apr. 2012 THE JAPANESE JOURNAL OF ANTIBIOTICS 65 2 121 23 7 7 IDSA
122 24 THE JAPANESE JOURNAL OF ANTIBIOTICS 65 2 Apr. 2012 7 2005 3 10 7 2011 6 2 NTT NTT 2011 6
Apr. 2012 THE JAPANESE JOURNAL OF ANTIBIOTICS 65 2 123 25 7 MRSA 1 VISA VRSA Vancomycin-intermediate Staphylococcus aureus VISA Vancomycin-resistant S. aureus VRSA 2 VISA MIC 4 8 mg/l vana VISA 1996 VRSA MIC 16 mg/l vanavrsa 2002 2 rpob VISA rpob rpob RNA rpob MRSA 96% 90 86 2 VISA 8 VISA MRSA rpob VISA Mu3 grar* grar* Mu3graR* VISA 4 mg/l 9 3 6 mg/l 2 2 rpob Fig. 1.VISA Mu3graR* rpob
124 26 THE JAPANESE JOURNAL OF ANTIBIOTICS 65 2 Apr. 2012 Table 1. rpob VISA Mu3graR* 52 Fig. 1 rpob Mu3graR* rpob Mu3graR* RpoB MIC MIC MIC grar* MIC rpob MIC grar* rpob MIC rpob Table 1 rpob 3tness cost rpob tness costrpob grar* rpob tness cost 4 rpob MRSA MRSA 1 Staphylococcal cassette chromosome mec SCCmec -
Apr. 2012 THE JAPANESE JOURNAL OF ANTIBIOTICS 65 2 125 27 7 Penicillin-binding protein PBP MRSA MSSA 2 PBP2PBP2 - MRSA - PBP2' meca MRSA MSSA SCCmec meca SCCmec mec ccr Cassette Chromosome Recombinase2 Fig. 2. SCCmec Fig. 3.SCCmec mec Fig. 2 mec meca SCCmec 10 mec 4 A D meca Fig. 3 ccr SCCmec ccr mec 2 meca mec 1 mvas truncated mvas mvas mvas Staphylococcus eurettii mvas mec SCCmec A mec nucleotide identity 99Fig. 4 meca S. eurettii 44 S. sciuri S. eurettii Macrococcus Macrococcus mec meca - blaz blazm blar1 blar1m mecam meca Tn6045 Tn6045 Macrococcus meca
126 28 THE JAPANESE JOURNAL OF ANTIBIOTICS 65 2 Apr. 2012 Fig. 4. SCCmec mec Staphylococcus eurettii Fig. 5. mec Tn6045 Macrococcus caseolyticus mec - meca Tn6045 Macrococcus caseolyticus ccr
Apr. 2012 THE JAPANESE JOURNAL OF ANTIBIOTICS 65 2 127 29 7 mec ccr SCCmec MRSA Fig. 5 3 Macrococcus meca meca S. eurettii meca meca SCCmec SCCmec MRSA MRSA -
Apr. 2012 THE JAPANESE JOURNAL OF ANTIBIOTICS 65 2 129 31 7 IDSA Infectious Diseases Society of America IDSA 2010 2 1 MASCC 2CT -D- 4 7 2002 38.3 C 500/ mm 3 MASCC 21 100/mm 3 8 Fig. 1 MASCC 21 Table 1 MASCC MDS AML CRP 2 Fig. 1.
130 32 THE JAPANESE JOURNAL OF ANTIBIOTICS 65 2 Apr. 2012 Table 1. MASCC A-II 1 empirical therapy preemptive therapy 4 7 7 targeted therapy 4 7 CT -D-PCR 2 A-III CORDONNIER 3 RCT 97.3% 95.1% 9.1% vs 2.7%2 35 Fig. 2 IDSA A-I B-III 3 4 7 CT
Apr. 2012 THE JAPANESE JOURNAL OF ANTIBIOTICS 65 2 131 33 7 Fig. 2. Empirical vs. Preemptive vs. Candida Aspergillus B-II Fig. 3, Fig. 4 4 Fig. 3 3 CT
132 34 THE JAPANESE JOURNAL OF ANTIBIOTICS 65 2 Apr. 2012 Fig. 3. Fig. 4.
Apr. 2012 THE JAPANESE JOURNAL OF ANTIBIOTICS 65 2 133 35 7 / CT, MRI 30 B B B 4 B-III Fig. 5 IDSA IDSA 2010 4 HSCT A-I Fig. 5.
134 36 THE JAPANESE JOURNAL OF ANTIBIOTICS 65 2 Apr. 2012 posaconazole AML/MDS 13 posaconazole B-I posaconazole IDSA 2008 A-I IDSA 2009 2008 A-I B 2 B B 2 B IDSA 2010 3 A-I 3 IDSA 2009 2008 IDSA 2010 posaconazole 1 FREIFELD, A. G.; E. J. BOW, K. A. SEPKOWITZ, et al.: Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of America. Clin. Infect. Dis. 52 4 : e56 e93, 2011 2 NAKAGAWA, Y.; K. SUZUKI & T. MASAOKA: Evaluation of the risk factors for febrile neutropenia associated with hematological malignancy. J. Infect. Chemother. 15 3 : 174 179, 2009 3 CORDONNIER, C.; C. PAUTAS, S. MAURY, et al.: Empirical versus preemptive antifungal therapy for high-risk, febrile, neutropenic patients: a randomized, controlled trial. Clin. Infect. Dis. 48 8 : 1042 1051, 2009 4 PAPPAS, P. G.; C. A. KAUFFMAN, D. ANDES, et al.: Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin. Infect. Dis. 48: 503 535, 2009