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- 1. メチシリン耐性黄色ブドウ球菌およびバンコマイシン耐性腸球菌の治療のための抗菌薬の
薬理 pharmacology of antimicrobial agents for treatment of methicillin resistant staphylococcus aureus and vancomycin resistant enterococcus
- 2. 腸球菌感染症の治療 treatment of enterococcal infections
- 3. 腸球菌における抗菌薬耐性の機構 mechanisms of antibiotic resistance in enterococci
- 4. 小児における侵襲的メチシリン耐性黄色ブドウ球菌感染の治療 treatment of invasive methicillin resistant staphylococcus aureus infection in children
- 5. 成人における侵襲性メチシリン耐性黄色ブドウ球菌感染症の治療 treatment of invasive methicillin resistant staphylococcus aureus infections in adults
- Treatment of infections due to resistant Staphylococcus aureus.
- Anstead GM, Cadena J, Javeri H.Author information Medicine Service, South Texas Veterans Health Care System, San Antonio, TX, USA.AbstractThis chapter reviews data on the treatment of infections caused by drug-resistant Staphylococcus aureus, particularly methicillin-resistant S. aureus (MRSA). This review covers findings reported in the English language medical literature up to January of 2013. Despite the emergence of resistant and multidrug-resistant S. aureus, we have seven effective drugs in clinical use for which little resistance has been observed: vancomycin, quinupristin-dalfopristin, linezolid, tigecycline, telavancin, ceftaroline, and daptomycin. However, vancomycin is less effective for infections with MRSA isolates that have a higher MIC within the susceptible range. Linezolid is probably the drug of choice for the treatment of complicated MRSA skin and soft tissue infections (SSTIs); whether it is drug of choice in pneumonia remains debatable. Daptomycin has shown to be non-inferior to either vancomycin or β-lactams in the treatment of staphylococcal SSTIs, bacteremia, and right-sided endocarditis. Tigecycline was also non-inferior to comparator drugs in the treatment of SSTIs, but there is controversy about whether it is less effective than other therapeutic options in the treatment of more serious infections. Telavancin has been shown to be non-inferior to vancomycin in the treatment of SSTIs and pneumonia, but has greater nephrotoxicity. Ceftaroline is a broad-spectrum cephalosporin with activity against MRSA; it is non-inferior to vancomycin in the treatment of SSTIs. Clindamycin, trimethoprim-sulfamethoxazole, doxycycline, rifampin, moxifloxacin, and minocycline are oral anti-staphylococcal agents that may have utility in the treatment of SSTIs and osteomyelitis, but the clinical data for their efficacy is limited. There are also several drugs with broad-spectrum activity against Gm-positive organisms that have reached the phase II and III stages of clinical testing that will hopefully be approved for clinical use in the upcoming years: oritavancin, dalbavancin, omadacycline, tedizolid, delafloxacin, and JNJ-Q2. Thus, there are currently many effective drugs to treat resistant S. aureus infections and many promising agents in the pipeline. Nevertheless, S. aureus remains a formidable adversary, and despite our deep bullpen of potential therapies, there are still frequent treatment failures and unfortunate clinical outcomes. The following discussion summarizes the clinical challenges presented by MRSA, the clinical experience with our current anti-MRSA antibiotics, and the gaps in our knowledge on how to use these agents to most effectively combat MRSA infections.
- Methods in molecular biology (Clifton, N.J.).Methods Mol Biol.2014;1085:259-309. doi: 10.1007/978-1-62703-664-1_16.
- This chapter reviews data on the treatment of infections caused by drug-resistant Staphylococcus aureus, particularly methicillin-resistant S. aureus (MRSA). This review covers findings reported in the English language medical literature up to January of 2013. Despite the emergence of resistant and
- PMID 24085702
- Linezolid resistance in Enterococcus faecium isolated in Ontario, Canada.
- Patel SN, Memari N, Shahinas D, Toye B, Jamieson FB, Farrell DJ.Author information Public Health Ontario, Public Health Laboratory, Toronto, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada. Electronic address: Samir.Patel@oahpp.ca.AbstractRecent studies have described linezolid-resistant MRSA and vancomycin-resistant enterococci (VRE) occurring worldwide, including an outbreak of linezolid-resistant MRSA. The objective of this study was to determine if linezolid-resistant enterococci are present in clinical isolates in Ontario, Canada. From January 2010 to June 2012, all enterococcal isolates submitted to the Public Health Ontario Laboratory (PHOL) for confirmation of VRE and susceptibility testing were included in this study. Of 2829 enterococcal isolates tested, 12 Enterococcus faecium were found to be resistant to linezolid. All linezolid-resistant isolates were also resistant to ampicillin, ciprofloxacin, and vancomycin. In addition, 33% of isolates were non-susceptible to daptomycin, whereas 41% were resistant to quinupristin/dalfopristin. Molecular characterization of these isolates showed that 8/12 isolates (66.7%) contained the mutation G2576T in 23S rRNA, which has been associated with linezolid resistance. Amplification and sequencing of L3- and L4-coding genes did not reveal mutations associated with linezolid resistance. One isolate contained the cfr gene, which is associated with linezolid resistance, and has been found in staphylococcal species and E. faecalis. These data show that occurrence of linezolid resistance is still rare among enterococcal isolates referred to PHOL though detection of cfr in E. faecium is concerning as it has the potential to disseminate among other enterococci.
- Diagnostic microbiology and infectious disease.Diagn Microbiol Infect Dis.2013 Dec;77(4):350-3. doi: 10.1016/j.diagmicrobio.2013.08.012. Epub 2013 Oct 2.
- Recent studies have described linezolid-resistant MRSA and vancomycin-resistant enterococci (VRE) occurring worldwide, including an outbreak of linezolid-resistant MRSA. The objective of this study was to determine if linezolid-resistant enterococci are present in clinical isolates in Ontario, Canad
- PMID 24095643
- Diversity, distribution and antibiotic resistance of Enterococcus spp. recovered from tomatoes, leaves, water and soil on U.S. Mid-Atlantic farms.
- Micallef SA, Goldstein RE, George A, Ewing L, Tall BD, Boyer MS, Joseph SW, Sapkota AR.Author information Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, MD 20742, USA.AbstractAntibiotic-resistant enterococci are important opportunistic pathogens and have been recovered from retail tomatoes. However, it is unclear where and how tomatoes are contaminated along the farm-to-fork continuum. Specifically, the degree of pre-harvest contamination with enterococci is unknown. We evaluated the prevalence, diversity and antimicrobial susceptibilities of enterococci collected from tomato farms in the Mid-Atlantic United States. Tomatoes, leaves, groundwater, pond water, irrigation ditch water, and soil were sampled and tested for enterococci using standard methods. Antimicrobial susceptibility testing was performed using the Sensititre microbroth dilution system. Enterococcus faecalis isolates were characterized using amplified fragment length polymorphism to assess dispersal potential. Enterococci (n = 307) occurred in all habitats and colonization of tomatoes was common. Seven species were identified: Enterococcus casseliflavus, E. faecalis, Enterococcus gallinarum, Enterococcus faecium, Enterococcus avis, Enterococcus hirae and Enterococcus raffinosus. E. casseliflavus predominated in soil and on tomatoes and leaves, and E. faecalis predominated in pond water. On plants, distance from the ground influenced presence of enterococci. E. faecalis from samples within a farm were more closely related than those from samples between farms. Resistance to rifampicin, quinupristin/dalfopristin, ciprofloxacin and levofloxacin was prevalent. Consumption of raw tomatoes as a potential exposure risk for antibiotic-resistant Enterococcus spp. deserves further attention.
- Food microbiology.Food Microbiol.2013 Dec;36(2):465-74. doi: 10.1016/j.fm.2013.04.016. Epub 2013 May 9.
- Antibiotic-resistant enterococci are important opportunistic pathogens and have been recovered from retail tomatoes. However, it is unclear where and how tomatoes are contaminated along the farm-to-fork continuum. Specifically, the degree of pre-harvest contamination with enterococci is unknown. We
- PMID 24010630
- first aid step 1 2006 p.165
- first aid step 1 2006 p.165
|Mechanism of action||Drugs|
|1||Block cell wall synthesis by inhibition of peptidoglycan cross-linking||penicillin, ampicillin, ticarcillin, piperacillin, imipenem, aztreonam, cephalosporins|
|2||Block peptidoglycan synthesis||bacitracin, vancomycin, cycloserine|
|3||Disrupt bacterial/fungal cell membranes||polymyxins|
|4||Disrupt fungal cell membranes||amphotericin B, nystatin, fluconazole/azoles|
|5||Block nucleotide synthesis||sulfonamides, trimethoprim|
|6||Block DNA topoisomerases||quinolones|
|7||Block mRNA synthesis||rifampin|
|8||Block protein synthesis at 50S ribosomal subunit||chloramphenicol, erythromycin/macrolides, lincomycin, clindamycin, streptogramins (quinupristin, dalfopristin), linezolid|
|9||Block protein synthesis at 30S ribosomal subunit||aminoglycosides, tetracyclines, spectinomycin|
ATuSi → あつし
- 尾内一信 ; 第 39 回日本小児感染症学会教育講演 2 小児感染症の抗菌薬療法 -耐性菌時代の適正使用-
- 感染レジマニュ p.27
|肺||肺炎||肺炎球菌||7-10日 or 解熱後3日間|
- Antibiotics to avoid in pregnancy
- Fluoroquinolones––cartilage damage.
- Erythromycin––acute cholestatic hepatitis in mom
- (and clarithromycin––embryotoxic).
- Tetracyclines––discolored teeth, inhibition of bone growth.
- Ribavirin (antiviral)––teratogenic.
- Griseofulvin (antifungal)––teratogenic.
- Chloramphenicol––“gray baby.”
- SAFE Moms Take Really Good Care.