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Feb. THE JAPANESE JOURNAL OF ANTIBIOTICS 57 1 11( 11 ) 2003 12 17 (MRSA) penicillin-resistant Streptococcus pneumoniae (PRSP) 3 I.

12( 12 ) THE JAPANESE JOURNAL OF ANTIBIOTICS 57 1 Feb. 3 1997 1) (1985) 2), (1990) 3), (2001, 2002) 4 6) CDC 1999 7) II. 1. (surgical site infection) (remote infection) 1 5) 2. 2 5) 3. 3 5,8) 1.

Feb. THE JAPANESE JOURNAL OF ANTIBIOTICS 57 1 13( 13 ) 2. 3. 4.

14( 14 ) THE JAPANESE JOURNAL OF ANTIBIOTICS 57 1 Feb. CRP 5. 4 5) 4.

Feb. THE JAPANESE JOURNAL OF ANTIBIOTICS 57 1 15( 15 ) 5. 6. / 1g 10 5 CFU 5,6) LPS, 5 7. 5) 1) 2) 3) 4) 5) 8. 1) (1) 30 2 3

16( 16 ) THE JAPANESE JOURNAL OF ANTIBIOTICS 57 1 Feb. (2) 2) (1) 2 4 2 3 (2) 1 (3) 1 2 3 b - Time above MIC MIC 1 (4) 4 (5) / 3) (1) (2) (3) (4) / 3 (5) (6) 9. 1 3 6 ampicillin (ABPC) fosfomycin (FOM) FOM

Feb. THE JAPANESE JOURNAL OF ANTIBIOTICS 57 1 17( 17 ) 6. cefotetan (CTT) 4 / FOM b- III. 1. ABPC, piperacillin (PIPC), ampicillin/cloxacillin (ABPC/MCIPC) sulbactam/ampicillin (SBT/ABPC), cefazolin (CEZ), cefotiam (CTM), cefmetazole (CMZ), cefminox (CMNX) CTT, flomoxef (FMOX), FOM 11 b- FOM 2. 7, 8, 9 MIC

18( 18 ) THE JAPANESE JOURNAL OF ANTIBIOTICS 57 1 Feb. 7. MIC (mg/ml)

Feb. THE JAPANESE JOURNAL OF ANTIBIOTICS 57 1 19( 19 ) 8. (1)

20( 20 ) THE JAPANESE JOURNAL OF ANTIBIOTICS 57 1 Feb. 8.

Feb. THE JAPANESE JOURNAL OF ANTIBIOTICS 57 1 21( 21 ) 9.

22( 22 ) THE JAPANESE JOURNAL OF ANTIBIOTICS 57 1 Feb. ABPC ABPC/MCIPC SBT/ABPC ABPC 11 Enterococcus faecalis PIPC Staphylococcus aureus, Staphylococcus epidermidis Enterobacter cloacae Pseudomonas aeruginosa CEZ CTM CMZ FMOX CEZ, CTM Bacteroides fragilis FOM ABPC/MCIPC S. aureus, S. epidermidis, E. faecalis E. cloacae 3. 9 85) CEZ 2.46 CTT 2.58 CMNX 2.48 FOM 1.8 1 10 PIPC 40% ABPC/MCIPC 36.4% 11 FOM 138 CMZ, FMOX, FOM PIPC FOM PIPC, CEZ, CTM, CMZ ABPC 4. 12 CEZ, ABPC/MCIPC, FOM, CMNX 4 2% FOM 10 0.56%, 0.004%, 1 (0.001%) 86) 5. 15 4

Feb. THE JAPANESE JOURNAL OF ANTIBIOTICS 57 1 23( 23 ) 10.

24( 24 ) THE JAPANESE JOURNAL OF ANTIBIOTICS 57 1 Feb. 11.

Feb. THE JAPANESE JOURNAL OF ANTIBIOTICS 57 1 25( 25 ) 12.

26( 26 ) THE JAPANESE JOURNAL OF ANTIBIOTICS 57 1 Feb. 13.

Feb. THE JAPANESE JOURNAL OF ANTIBIOTICS 57 1 27( 27 ) 13. 13 IV. ABPC CEZ CTM FMOX b -

28( 28 ) THE JAPANESE JOURNAL OF ANTIBIOTICS 57 1 Feb. 1 MRSA 55 75% 87 89) PRSP 50% 90) b- 3 PBP b- b- FOM in vitro in vivo MIC FOM MIC PIPC FOM 91) B. fragilis group PIPC FOM CTT ceftriaxone (CTRX) MRSA MRSA MRSA MRSA V. 3 b - FOM 1) 1997 45: 553 641, 1997 2) 94: 166 176, 1985

Feb. THE JAPANESE JOURNAL OF ANTIBIOTICS 57 1 29( 29 ) 3) 6: 2529 2534, 1990 4) 49 551 556, 2001 5) 49(S-B): 71 89, 2001 6) (1) 18(S-1): 130 134, 2002 7) MANGRAM, A. J.; T. C. HORAN, M. L. PEARSON, et al.: Guidline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect. Control Hosp. Epidemiol. 20: 250 278, 1999 8) Prog. Med. 21: 659 664, 2001 9) Ampicillin 56: 2309 2316, 1979 10) Ampicillin Jpn. J. Antibiotics 37: 663 670, 1984 11) Aminobenzyl Penicillin J. Antibiotics, Ser. B 18: 180 182, 1965 12) Aminobenzyl-Penicillin Chemotherapy 16: 702 706, 1968 13) Chemotherapy 36: 403 411, 1988 14) T-1220 Jpn. J. Antibiotics 30: 582 586, 1977 15) T-1220 Chemotherapy 25: 1087 1093, 1977 16) T-1220 Chemotherapy 25: 977 982, 1977 17) XIV. Piperacillin Jpn. J. Antibiotics 34: 1401 1409, 1981 18) 34: 1353 1367, 1982 19) T-1220 Chemotherapy 25: 1141 1155, 1977 20) Aminobenzyl Penicillin Methlchloropheylisoxazolyl Penicillin (ViccillinS) 31: 432 438, 1969 21) Sulbactam Ampicillin Chemotherapy 36(S-8): 149 159, 1988 22) Sulbactam Ampicillin Chemotherapy 36(S-8): 120 125, 1988 23) FRANK, U.; E. SCHMIDT-EISENLOHR, A. JOOS-WURTTEMBERGER, et al.: Concentrations of sulbactam/ampicillin in serum and lung tissue. Infection 18: 307 309, 1990 24) Sulbactam Ampicillin Chemotherapy 36(S-8) 317 323, 1988 25) Sulbactam Ampicillin Chemotherapy 36(S- 8): 324 333, 1988 26) Sulbactam Ampicillin, Chemotherapy 36(S-8): 466 488, 1988 27) Sulbactam/Ampicillin Jpn. J. Antibiotics 42: 733 742, 1989 28) Sulbactam/Ampicillin Jpn. J. Antibiotics 42: 579 593, 1989 29) 1g cefazolin 15: 766 774, 1999 30) Ceftezole Cefazolin Chemotherapy 24: 737 744, 1976 31) CIMMINO, P. & T. GARACI: Tissue levels of cefazolin in man after parenteral administration. Antibiotica. 11: 31 44, 1973 32) COLE, D. R. & J. PUNG: Penetration of cefazolin into pleural fluid. Antimicrob. Agents Chemother. 11: 1033 1035, 1977 33) Cefazolin 2,3 Cephalosporin Chemotherapy 22: 1080 1087, 1974 34) Cefazolin 43: 1325 1328, 1982 35) CEZ CET 29: 601 605, 1977 36) CEFAZOLIN (CEZ) 39: 744 747, 1977 37) Cefazolin 14: 457 464, 1977 38) LIMON, L. L. y; C. A. T. TIRAD, F. FLORES-MERCADO, et al.: Treatment of suppurative otitis media in paediatric patients. J. Int. Med. Res. 3: 371 379, 1975

30( 30 ) THE JAPANESE JOURNAL OF ANTIBIOTICS 57 1 Feb. 39) Cefotiam (SCE-963) Chemotherapy 27(S-3): 459 466, 1979 40) Cefotiam Jpn. J. Antibiotics 36: 213 220, 1983 41) Cefotiam (SCE-963) Chemotherapy 27(S-3): 373 392, 1979 42) (V) Cefotiam (SCE-963) Chemotherapy 27(S-3): 434 451, 1979 43) Cefotiam (SCE-963) Chemotherapy 27(S-3): 558 563, 1979 44) Cefotiam Jpn. J. Antibiotics 35: 1183 1186, 1982 45) Cefmetazole 53: 66 74, 1979 46), Cefmetazole Jpn. J. Antibiotics 40: 1923 1936, 1987 47) CS-1170 Chemotherapy 26(S-5): 350 367, 1978 48) Cefmetazole Chemotherapy 27: 275 282, 1979 49) Cefmetazole Chemotherapy 30: 1115 1134, 1982 50) CS-1170 20: 1639 1647, 1978 51) 44: 797 808, 1985 52) CS-1170 Cefazolin 31: 129 135, 1979 53) Cefmetazole 52: 122 130, 1964 54) CS-1170 Chemotherapy 26(S- 5): 501 514, 1978 55) 75: 2235 2247, 1982 56) CS-1170 Jpn. J. Antibiotics 32: 205 220, 1979 57) MT-141 Chemotherapy 32(S-5): 104 113, 1984 58) MT-141 Chemotherapy 32(S-5): 290 302, 1984 59) Cefminox Piperacillin Jpn. J. Antibiotics 45: 1039 1049, 1992 60) Cefminox Chemotherapy 42: 723 728, 1994 61) Cefminox Jpn. J. Antibiotics 43: 1667 1673, 1990 62) (XXII) MT-141 Chemotherapy 32(S-5): 349 369, 1984 63) Cefminox 37: 637 650, 1985 64) Cefminox 36: 737 739, 1990 65) Cefminox 3: 659 663, 1990 66) Cephamycin Cefminox Jpn. J. Antibiotics 38: 679 692, 1985 67) Cefminox Jpn. J. Antibiotics 38: 743 750, 1985 68) Cefotetan (YM09330) Chemotherapy 30(S-1): 187 194, 1982 69) Flomoxef. Jpn. J. Antibiotics 41: 1809 1821, 1988 70) 6315-S (Flomoxef) Chemotherapy 35(S-1): 494 517, 1987 71) 6315-S (Flomoxef) RTI Chemotherapy 35(S-1): 593 598, 1987 72) 6315-S (Flomoxef) Chemotherapy 35(S-1): 599 603, 1987 73) 6315-S (Flomoxef) Chemotherapy 35(S-1): 903 911, 1987 74) (XXIX) 6315-S (Flomoxef)

Feb. THE JAPANESE JOURNAL OF ANTIBIOTICS 57 1 31( 31 ) Chemotherapy 35(S-1): 852 873, 1987 75) 6315-S (Flomoxef) 34 1986 76), 6315-S (Flomoxef) Chemotherapy 35(S-1): 968 978, 1987 77) 6315-S (Flomoxef) 34 1986 78) Fosfomycin Chemotherapy 23: 3389 3395, 1975 79) Fosfomycin-Na Jpn. J. Antibiotics 31: 549 560, 1978 80) Fosfomycin Jpn. J. Antibiotics 35: 2530 2534, 1982 81) S 18: 2673 2677, 1984 82) Fosfomycin Jpn. J. Antibiotics 37: 1279 1288, 1984 83) Fosfomycin sodium Jpn. J. Antibiotics 38: 47 57, 1985 84) Fosfomycin sodium Jpn. J. Antibiotics 36: 1581 1592, 1983 85) Fosfomycin-Na 29: 1655 1659, 1976 86) Fosfomycin sodium 10 prospective 48: 851 874, 2000 87) MRSA 46: 600 605, 1998 88) 72: 701 706, 1998 89) 2000 51: 179 208, 2003 90) 1998 2000 Streptococcus pneumoniae 51: 179 208, 2003 91) Fosfomycin Chemotherapy 23: 1649 1652, 1975 ANTIMICROBIAL PROPHYLAXIS IN SURGERY NAGAO SHINAGAWA Department of Surgery, Nagoya Midori Municipal Hospital Antimicrobial prophylaxis is widely performed in any surgical procedures to prevent postoperative infections. However, we have neither double-blind placebo-controlled studies nor sufficient surveillance of postoperative infections that are common in Europe and the United States, and therefore there is little convincing scientific basis accounting for the validity of this therapy. In addition, prophylactic agent is still uncovered by medical insurance despite the persistent arguments as to its necessity. To establish the guidelines in our own country, a greater deal of evidence needs to be accumulated. Strategies for antimicrobial prophylaxis should be determined based on the types of possible postoperative infections and the classifications of operations according to contamination levels in individual operative fields. This process may involve the precise selection of prophylactic agents for suspected contaminating bacterial species in each operative organ and their administration

32( 32 ) THE JAPANESE JOURNAL OF ANTIBIOTICS 57 1 Feb. regimens suitable for the individual surgery. Upon selection of prophylactic agents for postoperative infections, various conditions should be considered: e.g., susceptibility, resistance, blood concentrations, urinary excretion, transition into body fluid and tissues, and adverse reactions. The first and second generations of cephem and cephamycin derivatives can be the first choice, but the use of various other antibacterial agents may be necessary for resistant bacterial strains such as methicillin-resistant Staphylococcus aureus (MRSA) and penicillin-resistant Streptococcus pneumoniae (PRSP). Cyclic therapy based on penicillins (including mixtures), cephems (including cephamycins) and fosfomycins also seems useful for such resistant strains. At present, there is only limited evidence supporting the importance of prophylactic agents. Controlled trials employing well-designed protocols that endure scientific criticism must be done with due consideration for medical economics.

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