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136ﾑ80303090706026ｧ8 03000803080308096ｧ9 2006; 18 (1): 49-58 09030ｷ302fi020ｸ7apple09 000309 046ｧ9 090003060208076ｧ90206 0400 04030007006ｧ90ｹ0 0ｸ7applefi 6ｾ40ｸ70700046ｧ8 02080309026ｧ8 09000306020807 0ｸ8026ｧ8 ﾒ0703 030409: 09 040ｸ70407fi020902, 02 6ｧ90206 02 06 09 000ｸ7 06040309046ｧ9 020ｷ307 apple 030809fi070ｷ307 0006020308080309 070604000607 0007fi0ｹ0 02 閨070203080ｸ7 ﾒ. ｦ ｨB 07 閨02080ｸ71 03. ﾞ080007020702090ｹ02 ｦﾌ. ﾞ07020ｷ30708apple086ｦ003080ｸ71 ﾞ. ﾒ applefi090309 1 09. ｦﾌ 006 5 02070309 2. 09080ｸ704020702 0ｹ02. ｦ 04080ｸ7080702090ｹ02 09. ﾆ0903080906070707090ｹ02 6ﾑ8. 09 030700080ｸ7-07 1 1 09060203086 506080308090602fi 02 06 2 03000803080308090602fi ｦ 006ｧ800, 縺03 ﾞ 00. 縺0007070900 02070ｹ003, ﾞ036ｧ807 0900036ｧ903096 709 6ｾ40208applefi0ｹ0: ) ﾇ 000003 閨0209 020ｷ307 6 5 0202090306 020607 02 06 000ｸ702090206 0406020607 06-026ｧ90ｷ307 02090ｹ0 apple0003060208076ｧ90206 0ｹ0 0400 04030007006ｧ90ｹ0 0ｸ7applefi 6ｾ40ｸ70700046ｧ8 02080309026ｧ8 09000306020807 0ｸ8-026ｧ8 ﾒ0703 030409 (6ｾ40209 ﾒ), 09 040ｸ70407fi020902 apple0800fi070ｷ304090ｹ0 02 06 08 閨03000904080ｹ0 000ｸ7-06040309046ｧ9 0ｹ0 02080ｸ70ｹ0 0402080ｸ70ｹ0 07020600060203086 506 02086ｦ00ｹ0 apple 030709080702000ｹ0. 6 5) ﾇ 00apple060308096ｧ8 02090ｹ0 apple03 閨0807 02 020703030903090ｹ0 030406026ｧ80ｹ0 0000apple00060306026ｧ80ｹ0 030003 apple006ｧ9 0ｹ0. 09) ﾇ 0002026ｧ900090409 02090ｹ0 040ｸ70407fi020902 0ｹ0 02090ｹ0 apple0003060208076ｧ90206 0ｹ0 (incidence) 0400 04030007006ｧ90ｹ0 0ｸ7applefi 6ｾ40209 ﾒ (00apple000604fi 06 / 040300076ｧ8/ 閨02080ｹ0) 02 06 0806 000002 6 50803 閨0ｹ0 02090ｹ0. 08030602fi-09 閨0308 0806: 09000300026ｧ804 0000 07 030800060207 fi03000ｹ0 02060ｹ0 apple000306apple0206-0400060ｹ0 apple0003060208076ｧ90206 0ｹ0 0400 04030007006ｧ90ｹ0 0000 6ｾ40209 ﾒ applefi 020807 ｦﾐ 07080ｸ707030608 02080ｸ7 2001 閨0ｷ30ｹ0 0208 040002 閨006 5030608 02080ｸ7 2004. 0003 02 030803000307 apple000306020807 0ｸ80207 0ｸ7090307 0000 >100 03000ｸ70208026ｦ00202 03 /00L 02 0303060003096ｧ8030902 07 0906 0003fi6 506 02 06 07 0003fi- 6 506 6 5 02026ｧ80306 02 06 006ｦ0020902000ｹ0. 09000207 080ｸ7090802 閨070203090409, 100 ml apple000306020807 0ｸ8-02086ｦ0 0ｸ70903086ｦ0, 0208 6ｧ9ｨB0900 0007080803 030006ｨBfi02 07 0400 BacTAlert (BacTAlert system, Bio Merieux, France) 6ｧ8 BacTec (Becton Dickinson, Meylan Cedex, France) 08060703000ｹ0 02 06 0400 040200030007 030300apple02060207 0ｸ703060207 ( 0600 02086ｦ00408 0709 03, 0408020803 02fi0403080ｸ707, MacConkey, Sabouraud dextrose 0709 03). H 020ｸ7apple08apple086ｧ9090409 020ｷ307 0402000300040607 apple080ｸ7 apple0800080706030902 07 閨09060700 0000 02 040ｸ704026ｧ800-02 API 20 E, API 20 NE, API STAPH, API STREP, Coryne API 02 06 0000 0208 VITEK-2 (biomerieux Vitek two France). O 閨03000904080ｹ0 02090ｹ0 000ｸ7 06-040309046ｧ9 0ｹ0 0402 0702066 5060802060207 閨09060700 0000 0209 00 閨0308 08 02090ｹ0 0607040ｸ704090ｹ0 020ｷ307 6ｧ9-04020ｷ307 (Kirby-Bauer) 0400 Mueller-Hinton 0709 03 02 06 08 0ｸ7apple08030809060400fi0ｹ0 020ｷ307 MICs 0000 E-test (AB Biodisk Solna, Sweden) 02 06 0208 046ｦ004020900 VITEK-2 0906 02 0703000202060207 04020003 閨0409. ﾞapple08020003 閨0400 02 : ﾒ 0207 0209 060703020006 02090ｹ0 000003 閨02090ｹ0, 0400 42 04030007006ｧ90ｹ0 06 09070604020902 07 92 00apple000604fi 06 apple0003060208076ｧ90206 0ｹ0, 74 (80,43%) 0000 03000206026ｧ8 020907 02 030306 閨03090006 02080ｸ7 apple000306020807 0ｸ802086ｦ0 0ｸ70903086ｦ0 02 06 18 (19,57%) 0000 0307090206-026ｧ8. ﾇ 090ｷ30406070808060306026ｧ8 apple0003060208076ｧ90206 (090ｷ3040607080806036ｧ9 apple000306020807 0ｸ802086ｦ0 0ｸ70903086ｦ0) apple080203006ｧ90403090200 applefi 02060ｹ0 apple000306apple02060400060ｹ0 apple0003060208076ｧ90206 0ｹ0 0000 030803000307 0ｸ7090307, 03060300fi 020ｸ7020207030ｷ307 >100/00L 02 06 0307090206026ｧ8 02 030306 閨03090006. Aapplefi 02 74 00apple000604fi 06, 0ｷ30ｹ0 00fi0708 6ｧ9020608 apple0003060208076ｧ90206 0ｹ0, apple0800080706030902 07 02 Gram030002060207, Gram- 03070902060207 6 5 02026ｧ80306 02 06 09 Candida spp 0400 51 (68,92%), 19 (25,68%) 02 06 2 (2,70 %) apple000306apple02060400060ｹ0 07026ｧ90402080604. 046ｦ008 (2,70%) 00apple000604fi 06 000602026ｧ80ｹ0 03086ｧ9000ｷ301090ｹ0 0000 >1 0007020003060207 6 5 02026ｧ80306 (Enterococcus, E. coli) apple030802036ｧ8030902 07 applefi 036ｧ80109 000702 閨03080ｸ7. O06 0208 0902080ｸ703070409-030709020602086ｧ9 0402 080ｸ703fi020802020806 (CoNS) 02 06 0806 Enterococcus spp apple0800080706030902 07 0400 49

13 ﾒ. ｦ ﾆ ﾞ036ﾑ8ｦ O08 ﾒ ﾞｦﾐ 6ｾ40803. 6ﾑ80303090706026ｧ8 03000803o03o096ｧ9 18, 2006 28 (37,84%) 02 06 11 (16,21%) apple000306apple02060400060ｹ0 07026ｧ904020806-04. 090303 Gram-030002060207 Corynebacterium spp, Bacillus spp 02 06 S. aureus apple0800080706030902 07 0400 0006020307 apple080408040207, 5,41%, 5,41% 02 06 2,70% 07026ｧ90402080604. 0906 00fi0708 apple00036ｧ9apple020ｷ30409 (1,35%) apple0003060208076ｧ90206 0ｹ0 applefi 07 0003fi- 6 506 (Clostridium histolyticum) 06 0907060402090200. O Proteus mirabilis (5,41%) 02 06 09 Pseudomonas aeruginosa (4,05%) 020ｸ7apple08apple08066ｧ8030902 07 0ｷ30ｹ0 02 040ｸ70407fi020003 6ｧ90206 apple0003060208076ｧ90206 0ｹ0 applefi Gram- 03070902060207 6 5 02026ｧ80306. ﾇ 00026ｧ8-0406 040ｸ70407fi020902 02090ｹ0 apple0003060208076ｧ90206 0ｹ0 020ｸ700 0607fi02 07 applefi 1,3-1,7. O 閨03000904080ｹ0 000ｸ7 06040309046ｧ9 0ｹ0 0402 0702066 5060802060207-00060100 04 000903fi apple0804080402fi 070208046ｧ80ｹ0 (17,85%) 020ｷ307 CoNS 040209 methicillin (MRS) 02 06 000ｸ7 06040309046ｧ9 fi030ｷ307 020ｷ307 Enterococcus spp 040209 vancomycin. 086 70903fi apple0804080402fi (50%) 020ｷ307 Enterococcus 006ｧ90400 0ｸ76 70903086ｦ0 00apple06apple 陦080ｸ7-070208046ｧ8 040209 gentamicin. 0003 02 Gram- 03070902060207 6ｧ802 07 apple08030ｸ7000ｸ7 6ｧ904030902 000202fi0ｹ0 applefi 2 0007 08070804080208000006 0207 040200-03 閨0409 Acinetobacter baumannii. 6ｾ40ｸ700apple0003070400 02 : ) ｦ Gram-030002060207 6 5 02026ｧ80306 0ｷ30ｹ0 6ｧ90206 apple0003060208076ｧ90206 0ｹ0 0400 04030007006ｧ90ｹ0 0000 6ｾ40209 ﾒ apple - 0702086ｦ007 2,5 080803 閨0ｹ0 040ｸ70407fi020003 applefi 02 Gram- 03070902060207. 6 5) O06 CoNS, 020803080ｸ703086ｦ00000070806 applefi 02080ｸ70ｹ0 00070200030802fi02-02080ｸ70ｹ0 006ｧ907 06 02 apple03 閨0807 040ｸ7040707 6ｧ90206 apple0003060208076ｧ90206 0ｹ0. 09) ﾇ apple0800fi070ｷ30409 apple0003060404fi0200030ｷ307 02080ｸ7 0007fi0ｹ0 000702000306020607 6 5-020209036ｧ90ｷ307 apple08020003006ｧ9 0604040ｸ7036ｧ8 閨07 00060109 000ｸ702000308apple 03086ｦ00ｹ0 apple00-03060208076ｧ90206 0ｹ0 0400 04030007006ｧ90ｹ0 0000 6ｾ40209 ﾒ. ) 09 0307 020907 02 03-0306 閨03090006 0000090703090ｹ0 apple0804fi020902 0ｹ0 apple000306020807 0ｸ802086ｦ0 0ｸ70903086ｦ0 0208 apple0804080402fi apple0003060208076ｧ90206 0ｹ0 0000 0307090206026ｧ8 02 030306 閨03090006 apple - 03 00 閨070006 0ｸ76 70903fi. 00) ﾇ 0000apple00060306026ｧ8 04036ｧ80409 vancomycin + ceftazidime 0000 6 5070409 0209 040ｸ70407fi020902 apple0800fi070ｷ304090ｹ0 020ｷ307 6 5 0202090306 020607 0006 0607 02 06 020907 000ｸ7 06040309046ｧ9 02080ｸ70ｹ0 0402 0702066 5060802060207 02 036ｦ0apple020006 040208 03000803080308090602fi 02006ｧ800 apple08-020003000400 02060207 fi0308 0208 006ｦ003080ｹ0 020ｷ307 06026ｧ90ｷ307 02090ｹ0 apple0003060208076ｧ90206-0ｹ0 0400 04030007006ｧ90ｹ0 0ｸ7applefi 6ｾ40209 ﾒ. 0402) ﾇ 00apple060308096ｧ8 02090ｹ0 0000apple00060306026ｧ80ｹ0 030003 apple006ｧ9 0ｹ0 03 apple03 鐶pple0006 07 006ｧ907 06 0006 06026ｧ8 0906 0208 02 閨07020308 02 06 07 apple030804 0300fiｨB0002 06 04020907 0208apple06026ｧ8 00apple06 09-0006080308096ｧ9 02090ｹ0 apple0003060208076ｧ90206 0ｹ0. 閨0100060ｹ0 02030006 0607: 090ｷ30406070808060306026ｧ8 apple0003060208076ｧ90206, 02 03-0306 閨03090006 apple000306020807 0ｸ802086ｦ0 0ｸ70903086ｦ0, apple0003060208076ｧ90206, 040ｸ70700046ｧ80ｹ0 08080309026ｧ8 apple000306020807 0ｸ8026ｧ8 020703 030409. 6ｾ4020907 07 03080006026ｧ8 0ｸ7026ｧ8 000003 閨0209 000100020704 0000 02 6 5 0202090306 0207 02 06 000ｸ702090206 04060207 6ｧ90206 02090ｹ0 apple0003060208076ｧ90206-0ｹ0 0400 04030007006ｧ90ｹ0 0ｸ7applefi 6ｾ40209 ﾒ, 0209 040ｸ70407fi020902 apple0800fi- 070ｷ304090ｹ0 02 06 020907 000ｸ7 06040309046ｧ9 0402080ｸ70ｹ0 07020600060203086 506 02086ｦ00ｹ0 apple 030709080702000ｹ0. ｦﾌ07040006 02080ｸ7 0208apple0602086ｦ0 00080702 閨03080ｸ7 03086ｧ9000ｷ301090ｹ0 02 06 02090ｹ0 070208046ｧ80ｹ0 0402 0702066 5060802060207, 02 0308036ｧ904 0000 0208 apple03 閨0807 02 02070303090308 02 06 apple08020003000400 020602fi 030003 apple000ｸ7020602fi 04046ｧ800 0906 020907 030406026ｧ8 0000apple00060306026ｧ8 0207030ｸ76 709 020ｷ307 040ｸ70407fi- 0200030ｷ307 06026ｧ90ｷ307 apple0003060208076ｧ90206 0ｹ0. ｦ 閨03080ｹ0 00020206006ｧ804 0000 0209 040ｸ70407fi020902 02090ｹ0 apple0003060208076ｧ90206 0ｹ0 (incidence) 0400 040300-07006ｧ90ｹ0 0ｸ7applefi 6ｾ40209 ﾒ (00apple000604fi 06 / 040300076ｧ8/ 閨02080ｹ0) 02 06 02060ｹ0 0000-02 6 50803 閨0ｹ0 02090ｹ0 02 0207 0209 060703020006 4 00020607 (2001-2004). ﾞ04030007006ｧ90ｹ0 ｨC 00 閨0308 0806 09000300026ｧ804 0000 07 030800060207 ( applefi 020807 ｦﾐ 07080ｸ707030608 02080ｸ7 2001 閨0ｷ30ｹ0 0208 040002 閨006 5030608 02080ｸ7 2004) fi03 02 00apple0006-04fi 06 apple0003060208076ｧ90206 0ｹ0 0400 04030007006ｧ90ｹ0 0ｸ7applefi 6ｾ40209 ﾒ. ﾇ 060709070ｷ30409 02090ｹ0 apple0003060208076ｧ90206 0ｹ0 閨09060700 00fi070807 0008fi040807 08 040300076ｧ80ｹ0 apple 03080ｸ7046ｧ9 ｨB00 6ｦ008 02080ｸ70307040604020807 applefi 02 02fi03080ｸ703 020306026ｧ80306 0400 08apple080608 6ｧ8apple080200 040ｸ707 0ｸ7-0400fi: 1) 040ｸ700apple020600 02 02 06 040900006ｧ9 apple000306020807 0ｸ8026ｧ80ｹ0 08030009-0008076ｧ80ｹ0 (6ｧ8apple0608 0208060306 02fi0ｹ0 applefi07080ｹ0, 04 000903fi0ｹ0 apple0ｸ7030002fi0ｹ0 02 06 6ｧ8apple06 0208060306 026ｧ8 000ｸ7 06040309046ｧ9 ), 2) 030803000307 apple000306020807 0ｸ80207 0ｸ7090307 0000 >100 03000ｸ70208026ｦ00202 03 /00L 02 06 50% apple08030ｸ7000803-0808apple6ｦ0030907 02 06 3) 6 5 02026ｧ80306 04020907 Gram 0403060409 6ｧ8 04020907 02 030306 閨03090006 02080ｸ7 apple000306020807 0ｸ802086ｦ0 0ｸ70903086ｦ0 1. ﾇ 090ｷ30406070808060306026ｧ8 apple0003060208076ｧ90206 (090ｷ3040607080806036ｧ9 apple000306020807 0ｸ802086ｦ0 0ｸ70903086ｦ0) apple080203006ｧ90403090200 applefi 02060ｹ0 apple000306apple02060400060ｹ0 apple0003060208076ｧ90206 0ｹ0 0000 030803000307 0ｸ7090307, 03060300fi 020ｸ7020207030ｷ307 >100/00L 02 06 0307090206026ｧ8 02 030306 閨03090006. ﾇ 090ｷ3040607080806036ｧ9 02080ｸ7 apple000306020807 0ｸ802086ｦ0 0ｸ70903086ｦ0 02 0308036ｧ9ｨB0002 06 applefi 020907 apple 03080ｸ7046ｧ9 >100 090ｷ304060708086ｧ9030ｷ307/00L 6ｧ8 >10% 090ｷ304060708086ｧ9030ｷ307 02080ｸ7 08030602086ｦ0 03060300086ｦ0 020ｷ307 03000ｸ70208020ｸ7020207-030ｷ307. ﾇ 06 08080306026ｧ8 060709070ｷ30409 6 5 046ｧ90402090200 0402 02fi- 03080ｸ703 04 03 02020903060402060207 02090ｹ0 090ｷ30406070808060306026ｧ80ｹ0 apple0003060208-076ｧ90206 0ｹ0: 2 1) 070008000306 000ｹ0 apple000306020807 0ｸ802fi 0ｸ70903fi 0400 06-03006ｧ9apple080ｸ704 6 5070409, 2) apple080ｸ7046ｧ9 apple0ｸ7030002086ｦ0, 3) 00apple000604fi 06 0208060306 026ｧ80ｹ0 0ｸ7040808036ｧ9 0ｹ0 0000 apple080ｸ7046ｧ9 0208060306 026ｧ80ｹ0 000ｸ7 06-040309046ｧ9 0ｹ0, 4) 03060300fi 03000ｸ70208020ｸ7020207030ｷ307 >100/00L (040ｸ7-076ｧ8030ｷ30ｹ0 170-1900/00L) 0000 <60% apple08030ｸ70008030808apple6ｦ0030907, 5) applefi030ｸ70208 03060300fi 090ｷ304060708086ｧ9030ｷ307 >100/00L 6ｧ8 >10% 090ｷ304060708086ｧ9030ｷ307 02 06 6) 0307090206026ｧ8 02 030306 閨03090006. ﾇ 02 030900000306076ｧ8 08030807026ｧ9 02080ｸ7 040900006ｧ9080ｸ7 0001fi 080ｸ7 02080ｸ7 02 0300026ｧ803 apple000306000307006 5 0700 apple036ｦ004060008 006ｧ9 08080307 020907 0900 閨03 0000 povidone iodine (betadine 6ｧ8 oxisept), 01 鐶pple030ｸ700 0000 apple0804020006030ｷ300 閨0708 070003fi (water for injection), 0402 閨09070ｷ300 0000 apple0804020006030ｷ300 閨0709 0907ｨB, 0008 03-0008096ｧ8 betadine solution 02 06 00apple060207030ｸ76 709 0000 0ｸ7020802fi03-03090209 0907ｨB. 030ｹ0 00 閨03080ｹ0 02090ｹ0 02 030900000306076ｧ80ｹ0 08030807026ｧ9 0ｹ0 02080ｸ7 040900006ｧ9080ｸ7 0001fi 080ｸ7 02080ｸ7 02 0300026ｧ803 applefi 02080ｸ70ｹ0 040300-07006ｧ90ｹ0, 0008 030008ｨBfi02 07 030806086ｧ8 mupirocin (bactroban) 0906 020907 apple03fi03096 709 020ｷ307 030806000601000ｷ307 applefi S. aureus fi0406 apple0003060404fi02000308 applefi 5 080803 閨0ｹ0 0906 020907 apple08080ｸ7096ｧ8 0707- apple020ｸ701090ｹ0 070300020206020607 6 5 020209036ｧ90ｷ307 02 06 00apple066 503 6 5086ｦ00ｹ0 00apple6ｧ9-03 04090ｹ0 04020807 02 0300026ｧ803. 0003 02 030803000307 apple000306020807 0ｸ80207 0ｸ7090307 0000 >100 03000ｸ70208026ｦ00202 03 /00L 02 0303060003096ｧ8030902 07 0906 0003fi6 506 02 06 07 0003fi6 506 6 5 02026ｧ80306 02 06 006ｦ0020902000ｹ0. 縺06 020907 02 030306 閨03090006 02080ｸ7 apple000306020807 0ｸ802086ｦ0 0ｸ70903086ｦ0 0008 0300fi040309-0200 09 apple030802000607fi00000709 applefi 020807 Isenberg 00 閨0308 080ｹ03. ﾇ 0200040706026ｧ8 apple000306000307006 5 0700 02 02fi03080ｸ703 040207 06 : 1) 07070000060109 02080ｸ7 apple00030600040800 閨07080ｸ7 02080ｸ7 040702080ｸ7 10 080803 閨0ｹ0, 2) apple08036ｦ000 070409 02080ｸ7 040900006ｧ9080ｸ7 036ｧ86 7090ｹ0 0006090007020ｷ307 0000 50

136ﾑ80303090706026ｧ8 03000803080308096ｧ9 18, 2006 096ﾑ806ｦﾐｦ O03ｦﾐｦ ｦﾐ04 ﾞ 6ｾ46ﾑ8 ﾞ6ｾ4056ﾑ8036ﾑ8ｦﾐ6ｾ4 0809O 6ｾ408036ﾑ801 ﾇ 02O06 ﾇｦ ﾇ 096ﾑ806ｦﾐｦ O03 ﾞ07 ﾒ ﾇ ﾒ ﾞ05 ﾞ066ｾ4 ﾇ (2001-2004) povidone iodine 02 06 036ｧ86 709 100 ml 0ｸ70903086ｦ0, 3) 036ｧ903-00090409 020ｸ7020207030ｷ307, 4) 0208apple0803 閨02090409 02080ｸ7 0ｸ70903086ｦ0 0400 2 040ｷ3-030907070306 020ｷ307 50 ml 02 06 080ｸ7090802 閨070203090409 0906 20 min 0400 3000 g, 5) apple03080400020206026ｧ8 applefi0303066 709 45-48 ml 0ｸ7apple000302000600 閨07080ｸ7 applefi 02070300 040ｷ303090707030608 02 06 07 046ｦ0-0402 0409 02080ｸ7 06ｨB6ｧ800 02080ｹ0, 6) apple036ｦ00409 02080ｸ7 06ｨB6ｧ800 02080ｹ0 0000 apple030804036ｧ80209 45 ml apple0804020006030ｷ300 閨07080ｸ7 D.W. 02 06 00apple - 070703096 709 020ｷ307 0402 6ｧ90ｷ307 4 02 06 5 02 06 7) 04030904060008apple086ｧ9090409 02080ｸ7 06ｨB6ｧ800 02080ｹ0 00000207 0208 040207 0608 6 0906 0007080803 0300060400fi 020ｷ307 0ｸ70306020607 02 06 apple 03 0402000ｸ76ｧ8 00apple0604036ｧ90400 02080ｹ0 0906 040306-0409 Gram. ｦ 08 6ｧ9ｨB0900 0007080803 030006ｨBfi02 07 0400 BacTAlert (Bac TAlert system, Bio Merieux, France) 6ｧ8 0400 BacTec (Becton Dickinson, Meylan Cedex, France) 08060703000ｹ0 ( 0003fi6 506000ｹ0 02 06 07 0003fi6 506000ｹ0), apple080ｸ7 00apple0ｷ307ｨB080702 07 0906 7 0900 閨03000ｹ0 02 06 0400 040200030007 030300apple02060207 0ｸ703060207 ( 0600 02086ｦ00408 0709 03, 0408020803 02fi0403080ｸ707, MacConkey, Sabouraud dextrose 0709 03). H 020ｸ7apple08apple086ｧ9090409 020ｷ307 0402000300040607 apple080ｸ7 apple0800080706030902 07 閨09060700 0000 02 040ｸ704026ｧ800 02 API 20 E, API 20 NE, API STAPH, API STREP, Coryne API (biomerieux France) 02 06 0000 0208 VITEK 2 (biomerieux Vitek two France). O 閨03000904080ｹ0 02090ｹ0 000ｸ7 06040309046ｧ9 0ｹ0 0402 0702066 5060802060207 閨09060700 0000 0209 00 閨0308 08 02090ｹ0 0607040ｸ704090ｹ0 020ｷ307 6ｧ904020ｷ307 (Kirby-Bauer) 0400 Mueller-Hinton 0709 03 046ｦ000080ｷ307 0000 02060ｹ0 040ｸ70402070400060ｹ0 02080ｸ7 NCCLS 3 02 06 08 0ｸ7apple08030809060400fi0ｹ0 020ｷ307 MICs 0000 E-test (AB Biodisk Solna, Sweden) 02 06 0208 046ｦ004020900 VITEK-2 0906 02 0703000202060207 04020003 閨0409. 6ｾ402 0206040206026ｧ8 0707030ｸ70409 O06 00026ｧ80406000ｹ0 020600 閨0ｹ0 02090ｹ0 apple0003060208076ｧ90206 0ｹ0 (00apple000604fi- 06 / 040300076ｧ8/ 閨02080ｹ0) 02 06 0806 02 02 ｯ 閨02080ｹ0 0303 09 閨0ｹ0 040209 040ｸ7-0407fi020902 apple0800fi070ｷ304090ｹ0 020ｷ307 Gram-03000206020607 02 06 Gram- 0307090206020607 6 5 020209036ｧ90ｷ307 040ｸ70902036ｧ9030902 07 02 06 07 036ｦ0030902 07 0402 02060402060207 0000 0208 x 2 02080ｸ7 Pearson 02 06 0000 0209 6 5086ｧ8030006 02080ｸ7 apple03080903070000 02080ｹ0 SPSS for windows version 12. ﾞapple08020003 閨0400 02 ﾒ 0207 0209 060703020006 02090ｹ0 000003 閨02090ｹ0, 0400 42 04030007006ｧ90ｹ0 06 09070604020902 07 92 00apple000604fi 06 apple0003060208076ｧ90206 0ｹ0, 74 (80,43%) 0000 03000206026ｧ8 020907 02 030306 閨03090006 02080ｸ7 apple000306020807 0ｸ8-02086ｦ0 0ｸ70903086ｦ0 02 06 18 (19,57%) 0000 0307090206026ｧ8 (096ｧ907. 1). Aapplefi 02 74 00apple000604fi 06, 0ｷ30ｹ0 00fi0708 6ｧ9020608 apple0003060208076ｧ90206 0ｹ0, apple0800080706030902 07 02 Gram-030002060207, Gram- 03070902060207 6 5 02026ｧ80306 02 06 09 Candida spp 0400 51 (68,92%), 19 (25,68%) 02 06 2 (2,70 %) apple000306apple02060400060ｹ0 07026ｧ90402080604 (096ｧ907. 2). 046ｦ008 (2,70%) 00apple000604fi 06 000602026ｧ80ｹ0 03086ｧ9000ｷ301090ｹ0 0000 >1 0007020003060207 6 5 02026ｧ80306 (Enterococcus, E. coli) apple030802036ｧ8030902 07 applefi 036ｧ80109 000702 閨03080ｸ7. O06 0208 0902080ｸ703070409-030709020602086ｧ9 0402 080ｸ703fi020802020806 (CoNS) 02 06 0806 Enterococcus spp apple0800080706030902 07 0400 28 (37,84%) 02 06 11 (16,21%) apple000306apple02060400060ｹ0 07026ｧ904020806-04. 090303 Gram-030002060207 Corynebacterium spp, Bacillus spp 02 06 S. aureus apple0800080706030902 07 0400 0006020307 apple080408040207 5,41%, 5,41% 02 06 2,70% 07026ｧ90402080604. 096ｧ9 00fi0708 apple00036ｧ9- apple020ｷ30409 (1,35%) apple0003060208076ｧ90206 0ｹ0 applefi 07 0003fi6 506 (Clostridium histolyticum) 06 0907060402090200. O Proteus mirabilis (5,41%) 02 06 09 Pseudomonas aeruginosa (4,05%) 020ｸ7apple08apple08066ｧ8030902 07 0ｷ30ｹ0 02 040ｸ70407fi020003 6ｧ90206 apple00-03060208076ｧ90206 0ｹ0 applefi Gram- 03070902060207 6 5 02026ｧ80306 (096ｧ907. 3). ﾇ 00026ｧ80406 040ｸ70407fi020902 02090ｹ0 apple0003060208076ｧ90206 0ｹ0 020ｸ700 06-07fi02 07 applefi 1,3-1,7. O06 00026ｧ80406000ｹ0 000002 6 50803 閨0ｹ0 020ｷ307 0206000607 02090ｹ0 apple0003060208076ｧ90206 0ｹ0 02 06 0806 02 02 ｯ 閨02080ｹ0 0303 09 閨0ｹ0 04020907 040ｸ7-0407fi020902 apple0800fi070ｷ304090ｹ0 020ｷ307 Gram-03000206020607 02 06 Gram- 0307090206020607 6 5 020209036ｧ90ｷ307 00 6 503 閨030902 07 0402 0206-0402060207 040900 07020602 閨0ｹ0 (p=0,757) (096ｧ907. 4). O 閨03000904080ｹ0 000ｸ7 06040309046ｧ9 0ｹ0 0402 0702066 5060802060207 陦0006-0100 04 000903fi apple0804080402fi 070208046ｧ80ｹ0 (17,85%) 020ｷ307 CoNS 040209 methicillin (MRS) 02 06 000ｸ7 06040309046ｧ9 fi030ｷ307 020ｷ307 Enterococcus spp 040209 vancomycin. 086 70903fi apple0804080402fi (50%) 020ｷ307 Enterococcus 006ｧ90400 0ｸ76 70903086ｦ0 00apple06apple 陦080ｸ7 070208046ｧ8 040209 gentamicin (096ｧ907. 5). 0003 02 Gram- 03-070902060207 6ｧ802 07 apple08030ｸ7000ｸ7 6ｧ904030902 000202fi0ｹ0 applefi 2 0007 0807080408-0208000006 0207 04020003 閨0409 Acinetobacter baumannii (096ｧ907. 6). 096ｧ907 02 0ｹ0 1. 6ｾ40ｸ70407fi020902 apple00030602080706026ｧ9 0ｷ307 0000 03000206026ｧ8 02 06 0307090206026ｧ8 02 030306 閨03090006 02 0207 02 閨0209 2001-2004 6ﾑ8apple000604fi 06 ﾞ04030007006ｧ90ｹ0 0000 00apple000604fi 06 090003060208076ｧ90206 000ｹ0 0000 090003060208076ｧ90206 000ｹ0 0000 apple0003060208076ｧ90206 0ｹ0 apple0003060208076ｧ90206 0ｹ0 0300020602 閨0ｹ0 02 030306 閨03090006000ｹ0 030709020602 閨0ｹ0 02 030306 閨03090006000ｹ0 92 42 (74) 80,43% (18) 19,57% 096ｧ907 02 0ｹ0 2. 6ｾ40ｸ70407fi020902 apple0800fi070ｷ304090ｹ0 6 5 0202090306 020607 02 06 000ｸ702090206 0406020607 06026ｧ90ｷ307 apple0003060208076ｧ90206 0ｹ0 040300070607 apple080ｸ7 0ｸ7apple086 5036ｧ8030902 07 0400 6ｾ40209 ﾒ 02 0207 02 閨0209 2001-2004 Gram-030002060207 6 5 02026ｧ80306 ( 閨07 6ｧ9020608) Gram- 03070902060207 6 5 02026ｧ80306 ( 閨07 6ｧ9020608) 090602026ｧ8 03086ｧ9000ｷ30109 096ｦ0020902000ｹ0 (51/74) 68,92% (19/74) 25,68% (2/74) 2,70% (2/74) 2,70% 51

13 ﾒ. ｦ ﾆ ﾞ036ﾑ8ｦ O08 ﾒ ﾞｦﾐ 6ｾ40803. 6ﾑ80303090706026ｧ8 03000803o03o096ｧ9 18, 2006 096ｧ907 02 0ｹ0 3. ｦﾌ 0202090306 0207 02 06 000ｸ702090206 04060207 6ｧ90206 74 apple000306apple020604000ｷ307 apple0003060208076ｧ90206 0ｹ0 040300070607 apple080ｸ7 0ｸ7apple086 5036ｧ8030902 07 0400 6ｾ40209 ﾒ 02 0207 0209 060703020006 020ｷ307 00020607 2001-2004 O0309 07060400086ｧ9 6ｾ40ｸ70407fi020902 apple0800fi070ｷ304090ｹ0 n (%) coagulase- 030709020602086ｧ9 Staphylococci (S. epidermidis, S. capitis, S. hominis, S. hyicus, S. haemolyticus, S. warneri) 28 (37,84) Staphylococcus aureus 2 (2,70) Streptococcus viridans 1 (1,35) Enterococcus faecalis 9 (12,16) Enterococcus faecium 3 (4,05) Corynebacterium spp 4 (5,41) Bacillus spp 4 (5,41) Pseudomonas aeruginosa 3 (4,05) Pseudomonas stutzeri 1 (1,35) Pseudomonas fluorescens/putida 2 (2,70) Enterobacter cloacae 1 (1,35) Enterobacter agglomerans 1 (1,35) E. coli 2 (2,70) Proteus mirabilis 4 (5,41) Stenotrophomonas maltophilia 2 (2,70) Acinetobacter baumannii 1 (1,35) 090602026ｧ8 03086ｧ9000ｷ30109 applefi E. faecalis 02 06 E. coli 1 (1,35) Acinetobacter lwoffii 1 (1,35) 090602026ｧ8 03086ｧ9000ｷ30109 applefi E. faecalis, Citrobacter koseri 02 06 Acinetobacter baumannii 1 (1,35) Clostridium histolyticum 1 (1,35) Candida albicans 1 (1,35) Candida glabrata 1 (1,35) 6ｾ46ｦ007080308 74 096ｧ907 02 0ｹ0 4. 6ｾ40ｸ70407fi020902 (00apple000604fi 06 / 040300076ｧ8/ 閨02080ｹ0) 02 06 00026ｧ80406000ｹ0 0303 09 閨0ｹ0 040209 040ｸ70407fi020902 apple0800fi070ｷ304090ｹ0 020ｷ307 06026ｧ90ｷ307 apple0003060208076ｧ90206 0ｹ0 02 0207 02 閨0209 2001-2004 030209 2001 2002 2003 2004 ﾞ04030007006ｧ90ｹ0 0400 6ｾ40209 ﾒ (n) 25 24 24 28 6ﾑ8apple000604fi 06 apple0003060208076ｧ90206 0ｹ0/ 04030007006ｧ90ｹ0 (n) 25/15 17/13 29/17 21/15 6ｾ40ｸ70407fi020902 (00apple000604fi 06 / 040300076ｧ8/ 閨02080ｹ0) 1,6 1,3 1,7 1,4 ﾞ04030007006ｧ90ｹ0 0000 0ｸ7apple08020308apple0607ｨB080ｸ704 apple0003060208076ｧ90206 n (%) 1/15 (6,7) 1/13 (7,7) 2/17 (11,8) 1/15 (6,7) ﾒ 030306 閨03090006-0307090206026ｧ8 n (%) 5 (20) 4 (23,53) 5 (17,24) 4 (19,05) ｦﾌ 02026ｧ80306 Gram-030002060207 n (%) 16 (80) 10 (76,92) 13 (54,17) 12 (70,59) Gram- 03070902060207 n (%) 4 (20) 3 (23,08) 8 (33,33) 4 (23,53) 090602026ｧ8 03086ｧ9000ｷ30109 n (%) 0 0 2 (8,33) 0 096ｦ0020902000ｹ0 n (%) 0 0 1 (4,17) 1 (5,88) 6ｾ46ｦ007080308 n (%) 20 (100) 13 (100) 24 (100) 17 (100) 6ｾ40ｸ7ｨB6ｧ802090409 ﾇ apple0003060208076ｧ90206 apple 03 00 閨070006 02fi00 0006 026ｦ00306 00apple06apple0308026ｧ8 02090ｹ0 6ｾ40209 ﾒ. 09 03 020002 00 閨0709 02 06 04086 5 036ｧ8 apple0003060208076ｧ90206 00apple0803006ｧ9 07 08 09096ｧ8040006 0400 apple08020ｸ7046ｧ9 02090ｹ0 apple000306020807 0ｸ8026ｧ80ｹ0 020703 0304090ｹ0. 縺06 0208 03fi0908 0ｸ702fi, 09 02-04006ｧ9 060709070ｷ30409 02 06 09 0700000409 閨07 030109 02090ｹ0 030003 apple006ｧ9 0ｹ0 02090ｹ0 apple0003060208076ｧ90206 0ｹ0, apple030607 020907 apple0800fi070ｷ30409 02080ｸ7 080309-07060400086ｦ0 apple080ｸ7 020907 apple0308020703000400, 006ｧ907 06 07 0902 6ｧ9 09 020907 02 036ｧ8 閨026 5 0409. ﾇ 00apple060308096ｧ8 02080ｸ7 02 020703030903080ｸ7 0702066 50608-020602086ｦ0 6 5 046ｧ9ｨB0002 06 04020907 0208apple06026ｧ8 00apple06 090006080308096ｧ9 020ｷ307 026ｦ0-03060ｷ307 0006020308080309 070604000607 apple080ｸ7 apple030802 03086ｦ007 020907 03086ｧ9000ｷ3-0109 02 06 020907 000ｸ7 06040309046ｧ9 02080ｸ70ｹ0 0402080ｸ70ｹ0 07020600060203086 506-02086ｦ00ｹ0 apple 030709080702000ｹ0. 09080303086ｧ9 0003000ｸ7070902 閨0ｹ0 040ｸ707060402086ｦ007 fi0206 02 00apple0600 閨03080ｸ70ｹ0 02 閨070203 03 apple03 鐶pple0006 040ｸ7070004060ｹ0 07 apple 03-020803080ｸ703086ｦ007 020907 00apple06 090006080308096ｧ9 02090ｹ0 apple0003060208076ｧ90206 0ｹ0 0400 04030007006ｧ90ｹ0 0000 6ｾ40209 ﾒ, 06040200 0208 apple030ｷ302fi0208030308 030003 apple006ｧ9-0ｹ0 07 apple030804 0300fiｨB0002 06 0402060ｹ0 0208apple0602 閨0ｹ0 040ｸ707036ｧ802000ｹ0 02080ｸ7 52

136ﾑ80303090706026ｧ8 03000803080308096ｧ9 18, 2006 096ﾑ806ｦﾐｦ O03ｦﾐｦ ｦﾐ04 ﾞ 6ｾ46ﾑ8 ﾞ6ｾ4056ﾑ8036ﾑ8ｦﾐ6ｾ4 0809O 6ｾ408036ﾑ801 ﾇ 02O06 ﾇｦ ﾇ 096ﾑ806ｦﾐｦ O03 ﾞ07 ﾒ ﾇ ﾒ ﾞ05 ﾞ066ｾ4 ﾇ (2001-2004) 096ｧ907 02 0ｹ0 5. ﾞ070208046ｧ8 (%) 020ｷ307 apple080008070ｷ303 閨07020ｷ307 GramｨC03000206020607 6 5 020209036ｧ90ｷ307 0402080ｸ70ｹ0 07020600060203086 506 02086ｦ00ｹ0 apple 030709080702000ｹ0 02 0207 02 閨0209 2001ｨC2004 6ﾑ86ｧ9 080ｹ0 GramｨC0300020602086ｦ0 6 5 020209036ｧ9080ｸ7 (n=53) ﾞ070208046ｧ8 0402080ｸ70ｹ0 07020600060203086 506 02086ｦ00ｹ0 apple 030709080702000ｹ0 % AMP OX CL TET SXT RF FA MUP VA TEC GN CIP CoNS (28) (25/28) (5/28) 0 (3/28) (1/28) 0 (10/28) 0 0 0 (9/28) 0 89,28 17,85 3,57 35,71 32,14 E. faecalis (11) 0 ｨC ｨC (3/11)ｨC ｨC ｨC ｨC ｨC 0 0 (5/11) ｨC 27,3 45,45 E. faecium (3) (3/3) ｨC ｨC 0 ｨC ｨC ｨC ｨC 0 0 (2/3) ｨC 100 66,7 Corynebacterium spp (4) 0 ｨC 0 0 ｨC 0 ｨC ｨC 0 0 0 0 S. aureus (2) (1/2) 0 0 0 0 0 0 0 0 0 0 0 50 S. viridans (1) 0 ｨC 0 0 0 0 ｨC ｨC 0 0 0 ｨC Bacillus spp (4) (2/4) ｨC (2/4) 0 0 (1/4) ｨC ｨC 0 0 0 0 50 50 25 AMP: ampicillin, OX: oxacillin, CL: clindamycin, TET: tetracycline, SXT: sulfamethoxazole-trimethoprin, RF: rifampicin, FA: fusidique, MUP: mupirocin, VA: vancomycin, TEC: teicoplanin, CIP: ciprofloxacin, GN: gentamicin, ｨC: 0007 000100020704030902 07 53

13 ﾒ. ｦ ﾆ ﾞ036ﾑ8ｦ O08 ﾒ ﾞｦﾐ 6ｾ40803. 6ﾑ80303090706026ｧ8 03000803o03o096ｧ9 18, 2006 096ｧ907 02 0ｹ0 6. ﾞ070208046ｧ8 (%) 020ｷ307 apple080008070ｷ303 閨07020ｷ307 GramｨC 0307090206020607 6 5 020209036ｧ90ｷ307 0402080ｸ70ｹ0 07020600060203086 506 02086ｦ00ｹ0 apple 030709080702000ｹ0 02 0207 02 閨0209 2001ｨC2004 6ﾑ86ｧ9 080ｹ0 GramｨC 030709020602086ｦ0 6 5 020209036ｧ9080ｸ7 (n=22) ﾞ070208046ｧ8 0402080ｸ70ｹ0 07020600060203086 506 02086ｦ00ｹ0 apple 030709080702000ｹ0 % AMP CXM CRO CAZ FEP AZT TZP TCC AMC SXT AK GN TB NT CIP IMP P. aeruginosa (3) ｨC ｨC ｨC 0 0 0 0 0 ｨC ｨC 0 0 0 0 0 0 Enterobacter cloacae (1) (1/1) (1/1) 0 0 0 0 0 0 0 (1/1) 0 0 0 0 0 0 100 100 100 E. coli (3) (1/3) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 33,3 Proteus mirabilis (4) (3/4) 0 0 0 0 0 0 0 0 (2/4) 0 0 0 0 0 0 75 50 Pseudomonas stutzeri (1) ｨC ｨC 0 0 0 0 0 0 0 ｨC 0 0 0 0 0 0 P. fluorescens/putida (2) ｨC ｨC 0 0 0 0 0 0 0 ｨC 0 0 0 0 0 0 Citrobacter koseri (1) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Acinetobacter baumanii (2) (2/2) (2/2) (2/2) (2/2) (2/2) (2/2) (2/2) (2/2) (2/2) (2/2) (2/2) (2/2) (2/2) (2/2) (2/2) 0 100 100 100 100 100 100 50 100 100 100 100 100 100 100 100 Acinetobacter lwoffii (1) (1/1) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 100 S. maltophilia (2) (2/2) (2/2) (1/2) (1/2) (1/2) (1/2) (1/2) 0 (2/2) 0 (1/2) (1/2) (2/2) 0 (1/2) (2/2) 100 100 50 50 50 50 50 100 50 50 100 50 100 E. agglomerans (1) (1/1) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 100 Clostridium histolyticum (1) 0 ｨC ｨC ｨC ｨC ｨC 0 0 0 ｨC ｨC ｨC ｨC ｨC ｨC 0 AMP: ampicillin, CXM: cefuroxime, CAZ: ceftazidime, CRO: ceftriaxone, FEP: cefepime, AZT: aztreonam, TZP: piperacillinｨctazobactam, TCC: ticarcillinｨcclavulanate, AMC: amoxicillinｨcclavulanate, CIP: ciprofloxacin, AK; amikacin, GN: gentamicin, NT: netilmicin, TB: tobramycin, IMP: imipenem, ｨC: 0007 000100020704030902 07 54

136ﾑ80303090706026ｧ8 03000803080308096ｧ9 18, 2006 096ﾑ806ｦﾐｦ O03ｦﾐｦ ｦﾐ04 ﾞ 6ｾ46ﾑ8 ﾞ6ｾ4056ﾑ8036ﾑ8ｦﾐ6ｾ4 0809O 6ｾ408036ﾑ801 ﾇ 02O06 ﾇｦ ﾇ 096ﾑ806ｦﾐｦ O03 ﾞ07 ﾒ ﾇ ﾒ ﾞ05 ﾞ066ｾ4 ﾇ (2001-2004) 02 閨070203080ｸ74. ｦ 08 6 5 0202090306 02fi 6ｧ9020608 02090ｹ0 apple0003060208076ｧ90206 0ｹ0 0402080ｸ70ｹ0 04030007006ｧ90ｹ0 0ｸ7applefi 6ｾ40209 ﾒ, 000202fi0ｹ0 applefi 6ｦ008 apple000306apple02060400060ｹ0 000ｸ702000308apple 03086ｦ00ｹ0 apple0003060208076ｧ90206 0ｹ0, 0ｸ7apple6ｧ8030100 閨07, 0000 apple0308- 閨03000ｸ70409 0209 04030ｷ3036ｧ9 02080ｸ7 閨0300 02080ｹ0 6ｧ8 02080ｸ7 000702 閨03080ｸ7. ｦ apple080408040207 020ｷ307 Gram-03000206020607 (68,92%) 02 06 Gram- 0307090206020607 (25,68 %) 02090ｹ0 000003 閨02090ｹ0 00 0ｹ0 020ｸ700 6ｧ907080702 06 00 閨04 040208 006ｦ003080ｹ0 020ｷ307 apple08040804020607 apple080ｸ7 07 08 閨03080702 06 applefi 070303000ｹ0 000003 閨02000ｹ05-7. 6ｾ402060ｹ0 000003 閨02000ｹ0 0ｸ702 閨0ｹ0, 000706 0208 apple0608 040ｸ70407fi 6ｧ9020608 006ｧ907 06 0806 CoNS, 0208 006ｦ002000308 6ｧ9020608 apple080ｸ7 020803080ｸ703006ｧ9 006ｧ907 06 08 S. aureus. 0307 07 閨08 0906 0208 06-02fi 00 0ｹ0 02 閨07020308 006ｦ0030900, apple080ｸ7 閨040006 000009070309 040900 046ｧ9 0906 020907 00apple060308096ｧ8 02080ｸ7 03040602086ｦ0 0000apple0006030602086ｦ0 04046ｧ800 02080ｹ0, 006ｧ907 06 fi0206 0208 040ｸ70407fi02000308 6ｧ9020608 apple0003060208076ｧ90206 0ｹ0 00000207 02080ｸ70ｹ0 CoNS 006ｧ907 06 0806 0007020003fi020802020806, 06 6ｧ90ｷ30ｹ0 08 E. faecalis. O06 0007020003fi020802020806 apple08020003086ｦ007 00 閨03080ｹ0 02090ｹ0 04030ｷ3036ｧ9 0ｹ0 02080ｸ7 000702 閨03080ｸ7 02 06 006ｧ90407080ｸ707 00fi030ｸ7070409 0000 02fiapple03 07. 090603 0707, 0806 02fi02020806 000604 閨0304080702 06 040208 apple00030602fi- 07 0608 06 00 閨04080ｸ7 02080ｸ7 02 閨03 06080ｸ7 020806040600 02080ｹ0 02080ｸ7 000702-03080ｸ7. ﾇ apple0003060208076ｧ90206 applefi S. aureus, 09 08apple086ｧ9 006ｧ907 06 0006 04086 5 036ｧ8 03086ｧ9000ｷ30109 0000 0002 0903060400060ｹ0 0002020002 00 閨07080ｸ7 0208060306 02086ｦ0 applefi07080ｸ7, 0ｸ7applefi02 04090ｹ0 02fi00 02 06 apple036ｧ803080ｸ70ｹ0 shock, 006ｧ907 06 04apple070706 0400 04030007006ｧ90ｹ0 02080ｸ7 02006ｧ800 02fi0ｹ0 00 0ｹ0 (2,7%). 07040ｷ30ｹ0 09 apple03080309apple0206026ｧ8 0008 030008096ｧ8 mupirocin (bactroban) 040208 040900006ｧ908 0001fi 080ｸ7 02080ｸ7 02 0300026ｧ803 000109-09006ｧ9 0208 apple08036ｦ0 04 000903fi apple0804080402fi 03086ｧ9000ｷ301090ｹ0 applefi S. aureus 8. 6ｾ40ｸ7076ｧ8030ｷ30ｹ0 09 apple0003060208076ｧ90206 040400026ｧ9ｨB0002 06 0000 030806-00060100060ｹ0 02080ｸ7 02 0300026ｧ803 (040900006ｧ908 0001fi 080ｸ7 02080ｸ7 02 0300026ｧ803 6ｧ8 0ｸ7apple08 fi0306 046ｧ803 0909 ) 02 06 04apple070706 0400 00fi030ｸ7070409 0001 00apple 086ｧ80ｹ0. ﾞapplefi 02060ｹ0 6ｦ008 apple000306apple02060400060ｹ0, 09 006ｧ9 040ｸ707 00fi02 07 0000 03086ｧ9000ｷ30109 02080ｸ7 040900006ｧ9080ｸ7 0001fi 080ｸ7 02080ｸ7 02 0300026ｧ803. 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136ﾑ80303090706026ｧ8 03000803080308096ｧ9 18, 2006 096ﾑ806ｦﾐｦ O03ｦﾐｦ ｦﾐ04 ﾞ 6ｾ46ﾑ8 ﾞ6ｾ4056ﾑ8036ﾑ8ｦﾐ6ｾ4 0809O 6ｾ408036ﾑ801 ﾇ 02O06 ﾇｦ ﾇ 096ﾑ806ｦﾐｦ O03 ﾞ07 ﾒ ﾇ ﾒ ﾞ05 ﾞ066ｾ4 ﾇ (2001-2004) 06026ｧ90ｷ307 02090ｹ0 apple0003060208076ｧ90206 0ｹ0 0400 04030007006ｧ90ｹ0 0ｸ7applefi 6ｾ40209 ﾒ 040208 03000803080308090602fi ｦ 006ｧ800 02080ｸ7 03080408020800006ｧ9080ｸ7 00 0ｹ0. Summary K. Tzanetou, N. Afentakis, V. Antonopoulou, A. Kapogli, P. Vamvakari, G. Moustakas, G. Tsoufakis, P. Ziroyiannis, E. Malamou-Lada. Peritonitis in CAPD patients: incidence, microbiology and susceptibility patterns of the causative organisms in one center. ﾇellen Nephrol 2006; 18 (1): 49-58. Aim: a) To study the causative organisms of peritonitis in CAPD patients, the frequency of isolation and the susceptibility patterns to antimicrobial agents. b) To select the most appropriate initial empirical antibiotic treatment and c) ｦ o evaluate the incidence of peritonitis (episodes per patient per year). PatientsｨCMethods: We retrospectively evaluated all the cases of CAPD peritonitis from January 2001 throughout December 2004. All the cloudy peritoneal fluids with >100 leukocytes/00l were cultured for aerobic and anaerobic bacteria and fungi. The sediment obtained after centrifugation of 100 ml fluid was inoculated into BacTAlert (BacTAlert system, Bio Merieux, France) or BacTec (Becton Dickinson, Meylan Cedex, France) bottles and on solid culture media. The isolates were identified by API 20 E, API 20 NE, API STAPH, API STREP, Coryne API and VITEK-2 (bio Merieux Vitek two, France). Antibiotic susceptibility testing was performed by the disc diffusion technique on Mueller-Hinton agar, the VITEK-2 system and the Etest (AB Biodisk, Solna, Sweden). Results: During the study period, 92 episodes of peritonitis, 74 (80.43%) culture-positive and 18 (19.57%) culture-negative occurred in 42 patients. The noninfectious eosinophilic peritonitis (peritoneal fluid eosinophilia) was excluded from the culturenegative CAPD peritonitis. Among the 74 episodes, as a single cause of peritonitis, Gram-positive, Gramnegative bacteria, and Candida spp were isolated in 51 (68.92%), 19 (25.68%), and 2 (2.70%) cases respectively. Two (2.70%) episodes of mixed infection with more than one enteric pathogens (Enterococcus, E. coli) were caused from intestinal perforation. The coagulase-negative staphylococci (CoNS) and Enterococci were isolated in 28 (37.84%) and 11 (16.21%) cases respectively. Other Gram-positive bacteria Corynebacterium spp, Bacillus spp, and S. aureus were isolated in small proportions 5.41%, 5.41% and 2.70% respectively. Only one episode (1.35%) of anaerobic peritonitis from Clostridium histolyticum was identified. Proteus mirabilis (5.41%) and Pseudomonas aeruginosa (4.05%) were identified as the most common single cause of peritonitis from Gram-negative bacteria. The annual peritonitis rate (episodes/ patient-year) ranged from 1.3 to 1.7. The susceptibility testing showed a low resistance rate (17.85%) of CoNS to methicillin (MRS) and susceptibility of all Enterococci to vancomycin. A high proportion (50%) of Enterococci was highly resistant to gentamicin. All Gram-negative bacteria were multi-susceptible except for 2 nosocomial isolates of Acinetobacter baumannii. Conclusions: a) Gram-positive bacteria as causative agents of CAPD peritonitis occur 2.5 times more often than Gram-negative. b) CoNS followed by Enterococci are the most common causes of CAPD peritonitis. c) The isolation of more than one enteric pathogen is a strong evidence of secondary peritonitis in CAPD patients. d) Despite the culture of a large volume of peritoneal fluid the rate of culture-negative peritonitis remains high. e) The empirical use of vancomycin+ceftazidime, based on the frequency of the bacteria species isolation and their susceptibility to antibiotics, effectively cover all the range of the causative organisms in our Nephrology department. f) Selection of empiric therapy should be center specific and adapted to the local CAPD epidemiology. Key words: continuous ambulatory peritoneal dialysis, culture of peritoneal fluid, eosinophilic peritonitis, peritonitis. ｦﾌ066 50306080903 086ｧ9 1. Males BM, Walshe JJ, Amsterdam D. Laboratory indices of clinical peritonitis: total leukocyte count, microscopy, and microbiologic culture of peritoneal dialysis effluent. J Clin Microbiol 1987; 25: 2367-71. 2. Ejaz AA, Fitzpatrick PM, Durkin AJ, et al. Pathophysiology of peritoneal fluid eosinophilia in peritoneal dialysis patients. Nephron 1999; 81: 125-130. 3. Isenberg HD. Culture of continuous ambulatory peritoneal dialysis fluid. In: Isenberg HD, ed. Essential Pro- -cedures for Clinical Microbiology. Washington DC: ASM Press; 1998: 672-677. 4. Van Biesen W, Vanholder R, Vogelaers D, et al. The need for a center-tailored treatment protocol for peritonitis. Perit Dial Int 1998; 18: 274-281. 5. Von Graevenitz A, Amsterdam D. Microbiological aspects of peritonitis associated with continuous ambulatory peritoneal dialysis. Clin Microbiol Rev 1992; 5: 36-48. 6. Gloor HJ, Pandolfi S, Rｨｹttimann S. 20 years of peritoneal dialysis in a mid-sized Swiss hospital. Swiss Med Wkly 2003; 133: 619-624. 7. Zelenitsky S, Barns L, Findlay I, et al. Analysis of microbiological trends in peritoneal dialysis-related peritonitis from 1991 to 1998. Am J Kidney Dis 2000; 36: 1009-1013. 8. Tacconelli E, Carmeli Y, Aizer A, et al. Mupirocin prophylaxis to prevent Staphylococcus aureus infection in patients undergoing dialysis: a meta-analysis. Clin 57

13 ﾒ. ｦ ﾆ ﾞ036ﾑ8ｦ O08 ﾒ ﾞｦﾐ 6ｾ40803. 6ﾑ80303090706026ｧ8 03000803o03o096ｧ9 18, 2006 Infect Dis 2003; 37: 1629-1638. 9. Sewell DL, Golper TA, Hulman PB, et al. Comparison of large volume culture to other methods for isolation of microorganisms from dialysate. Perit Dial Int 1990; 10: 49-52. 10. Alfa MJ, Degagne P, Olson N, et al. Improved detection of bacterial growth in continuous ambulatory peritoneal dialysis effluent by use of BacT/Alert FAN bottles. J Clin Microbiol 1997; 35:862-866. 11. Piraino B, Bailie GR, Bernardini J, et al. ISPD Ad Hoc Advisory Committee. Peritoneal dialysis-related infections recommendations: 2005 update. Perit Dial Int. 2005; 25: 107-131. 12. Tzanetou K, Triantaphillis G, Tsoutsos D, et al. Stenotrophomonas maltophilia peritonitis in CAPD patients: susceptibility to antibiotics and treatment outcome: a report of five cases. Perit Dial Int 2004; 24: 401-404. 13. Keane WF, Alexander SR, Bailie GR, et al. Peritoneal dialysis-related peritonitis treatment recommendations: 1996 update. Perit Dial Int 1996; 16: 557-573. 14. Keane WF, Bailie GR, Boeschoten E, et al. International Society for Peritoneal Dialysis. Adult peritoneal dialysis-related peritonitis treatment recommendations: 2000 update. Perit Dial Int 2000; 20: 396-411. 15. Ariano RE, Franczuk C, Fine A, et al. Challenging the current treatment paradigm for methicillin-resistant Staphylococcus epidermidis peritonitis in peritoneal dialysis patients. Perit Dial Int 2002; 22: 335-338. 16. Baker RJ, Senior H, Clemenger M, Brown EA. Empirical aminoglycosides for peritonitis do not affect residual renal function. Am J Kidney Dis 2003; 41: 670-675. A03030903o0903 086ｧ9 : ﾒ. ｦ ｨB 07 閨02080ｸ7 09060203086 506080308090602fi 6ﾑ80309 04026ｧ8030608 縺03 ﾞ 00. 縺0007070900 02070ｹ003 156 69, ﾞ036ｧ807 T0903: 210 7768482, 3 Fax: 210 7788185 E-mail: ktzane@otenet.gr 58