ῌ*$%0!» 2011 193 ῐ῍ ῌ῎ Escherichia coli b- ! !"#"$%#$& %'( 22 ) 12 & 20 *+,' '( 23 ) 5 & 30 *+-( ))' * ; +., -.' / b- /0120, 1342356789:' #14<=>5?6@A89BC5478DEF G' ,#1 9DH:IJ;?<=.K' >LMNOP?QR5STF ;CD' 2006 ) 1 & 2009 ) 9 &GD?" %744 %( 8 Escherichia coli 4@9?A B5A' UV b- /0120W #14<5; 7D?E[^F\] 4,211 9 E7F ; `a CAZ GH AZT J;XYZ[8 AF C\] E. coli 4#1 H 123 9 (2.9_) 124 WD MIC 4 2 mg/ml bG?cAWH 12 9 (9.8_) 13 W D' Extended spectrum b-lactamase (ESBL) 20W4 8 W (6.5_), Cephalosporinase (AmpC) 20W4 5 W (4.1_) DE7F dHeH' ESBL 20WH CTX-M9 e4 5 W5 CTX-M1 e4 2 WD' 1 WHIJ,W46B#fKgLDE7F Amp-C 20WDH 5 W e plasmidAmp-C (p-AmpC) 4#1F h ijkdH 2 W CIT replicon type H' l5mn 4 IncF (FIA,FIB) group D ESBL 20W 6 W' Amp-C 20W 4 WJoAF p,J;H' ESBL 20W#1 8 9 ' qrstu v %5 9( 5 flomoxef %1 9( DJ;XY4Mw' Amp-C 20W#1 2 9Hqrstu vDJ;XY4MwF bG M,4OyPz {0h3B4QDE:' C xY' ND |`64<?RGT#$} ~6$%MST6A4U8DEF Key words: ESBL, p-AmpC, Escherichia coli, V@' , ῏ ῑ ))' Escherichia coli 2004 )i J; k B7@V@ WX Surviving Sepsis Campaign | b=. UV b- 5678[F E. coli H Cephalospori- Guidelines (SSCG) 4YZ' 2008 ) 1 &[ nase ? \4YZF ; 0H£(pDE4' AmpR ¤q >L] D' p,J;9[8H' w:{ ?^A' Z[8,13_` p, w4a /0120 42356789:' J;< 0k AmpC ?lmnG¡a' ¢o2 tpuvw6[ wrs4 Dl5mn 6iq0A8[BC54bc8 5¢o20t4PT' y 3 z¥¦§ [F Ck ?cF G' dAJ;? wH' 9, 4<?6@A ¥¦§ v 5H66[F AA AmpR x¨4©ª h i A b- vGD /0120dH? ijkG«{A8[|¬Ht{v 89BC5478DEF 56F extended spectrum b-lactamase e]fgh (573῍1191) i!"jk 2῍3῍1 ! !"#"$%#$& TEL: 072῍804῍0101 FAX: 072῍804῍2959 E-mail: inuis@hirakata.kmu.ac.jp v9|±²³s (ESBL) 20dH?«{A8[5¥¦®¯i°{ v´GD?c A' )yzµpM¶PA8[1)F G' ·4¸9 [8M²³s v?}BlR¹8 b- A A ? « { A metallo b-lactamase (MBL) ?20 E. coli ~º4E2)F ))' *$%0!¼½ Vol. 21 No. 3 2011. 19 » 194 ¼C Cephalosporinase (AmpC) ½D ' Double Disk synergy test t ESBL DDST{5) r AmpC 3|}'M-6) Cephalosporinase (p-AmpC) * E. 4 MacFarland 0.5 $9b56 AMPC/CVA coli $ ' ()*+ 49, -./+ 35, wxP2 CAZ, cefotaxime (CTX), CFPM, cefpi- ! " # $ % & p-AmpC 44, 01 33,2%343)5 rome (CPR) $wxPc 20 mm < 678$ "9' :;<9= >+?$ " @ 9$CD2<5 E A B8< " FG<H$I" JGK8$'LMN*OPQ$RST U<2VW87 A ?$XYS ZJ ["$\]@62' Q^_+45 ?6+ `a FbK8B7 ZJ[" c= b-Pdefg Y2 i hijkl j%7 37 18 > 7K$wx P+P CAZ 2 CTX $wxPc 2 9 30 mm < j%7 ?7£7$ Z$:;$wxP 3-¤ ¥ ¦ § M 300 mg / disk < #$X 37 18 > 3-¤¥¦§Mj !mU] h /¡$ 83A87 ^$ AmpC PCR ESBL p- 3|}+'B7 2006 " 1 nK8 2009 " 9 nE+#oFb K8 E. coli B7 G $p2 %" c= b-Pdefg #jk AmpC ESBL #U PCR -* ESBL jk p-AmpC #$hi 5 rs 9=&'' BBL CRYSTAL t()uPvMwxO 5 5 ESBL $' Johann 8$;-7) CTX5 p-AmpC ¨U $' Pérez-Pérez 8$;-8) MOX(MOX-1, MOX-2, CMY-1, CMY-8©CMY-11), CIT (LAT-1©LAT-4, CMY-2© ZJ["|}' CLSI ~ - tfMfv (MIC) 2' c $rs M1, CTX-M2, CTX-M8, CTX-M9 $ yMzM{ * 92 5 AmpC 2. 83A8 5 M-' ff MvM4 MacFarland 0.5 $9b56 4. rs 2 E. coli U 5 q2$ M (CVA) /¡$ 77¢ ESBL 1. 5 DDST ' ffMvM +,b { ./01 Z$ MIC50 2 MIC90 5 2' Z' ampicillin (ABPC), piperacillin (PIPC), piperacillin/tazobactam (P/T), cefotiam CMY-7, BIL-1), DHA(DHA-1, DHA-2), ACC, EBC (MIR-1T, ACT-1), FOX (FOX-5b) $ rs 5. ¨U 5 !"#$ replicon type % $ replicon ' Carattoli 8$; (CTM), ceftazidime (CAZ), cefozopran (CZOP), ce- -9) 5 ==$e§ªOP PCR 2 3 == fepime (CFPM), flomoxef (FMOX), aztreonam $«M¬§ PCR HI1, HI2, I1-Ig, X, L/M, N, FIA, (AZT), sulbactam/cefoperazone (S/C), meropenem FIB, W, Y, P, FIC, A/C, T, FIIAs, F, K jk B/O $ (MEPM), biapenem (BIPM), doripenem (DRPM), 18 ==$ replicon type $rs amikacin (AMK), tobramycin (TOB), ciprofloxacin (CPFX), pazufloxacin (PZFX) +45 E # AmpC ESBL #U'9 amoxicillin/clavulanic acid (ACV), $ ceftibuten (CETB), tebipenempivoxil (TBPM), minocycline (MINO), sitafloxacin (STFX), levofloxacin (LVFX), fosfomycin (FOM), prim (ST) +^2' 3. sulfamethoxazole-trimetho5 CLSI $3|}$~4) CAZ E phic DNA(RAPD)ῌPCR '()* RAPDῌPCR ' Vila 8$;-10) ESBL #U 7. ®¯hirs b-!+,- No. 3 5 . E. coli /0123 45 CAZ E ' AZT $ MIC 2 mg/ml G U >°± 9 E+$?o²> @A9 ³G´µ tCRP, WBC, ' AZT 9 # U 20 ()l+ B¯¹º Vol. 21 5 ESBL & random amplified polymor- E. coli B7 ESBL AmpC $ MIC 2 mg / ml 6. 2011. ¶{ Q·¸<HU] 5 b-`STLG0 E. coli 1. replicon type 4211 E. coli 123 (2.9) 124 AZT MIC 2 mg/ml uvwxuy CAZ !"#$ ()*+, ESBL &'qrs CTX }% CTX-M9 2. } 5 / CTX-M1 } 2 1 % -./ 01234565 5 AmpC &' 5 2 CIT } p-AmpC 78 19 CIT } p-AmpC &' AmpC &'r CAZ / SBT/CPZ MIC ]_]"#$ ESBL &'% AmpC &'% :;0<= MIC50 / MIC90 >?"8 2 #$ F16 mg/ml G0+, % SBT/CPZ ~`z{| repli- con type % / IncF (FIA, FIB) group :;0 ESBL &' 6 % AmpC &' 4 $ % @ABCDE MIC50 / MIC90 4 mg/ml / H AmpC &'% @ABCDE "#$ N lQDEUts% STFX % PQRSTLEUVWX 1 YZIJKLE LVFX G0MO5:;0"#$ X 3 YZIJKLE[\G0"#$% X 4 CIT } 1 "tsO5 #$ Y Z I J K L E CZOP MIC90 2 mg / ml / Breakpoint ] " # $ ESBL RAPDῌPCR 4. " 1 #$ WX 1 YZIJKLEX 4 YZIJKLE TbD"#$ MIC50 /MIC90 /M_]"#$% "§t¨©5 b-`ST $ % I Case No. 1 / No. 4 % &'()*+ 5. MIC50 / MIC90 ^0.25 mg/ml / 1 mg/ml O uvwxuy 8 1. ª5 TbD"# ESBL &' 8 % AmpC ¡®"8 4 (/ E. coli 2006 2006 2007 2007 2008 2008 2009 1¯6 7¯12 1¯6 7¯12 1¯6 7¯12 1¯6 ®( 7±9 616 561 618 572 661 691 135 20.4 138 20 0( 7±9 0 79 83 16.9 128 20.8 120 21.4 142 23 128 22.4 E. coli ( 7±9 79 11 2.2 15 2.4 20 3.6 22 3.6 16 2.8 0 0 1 6.7 ESBL &' 0 0 3 AmpC &' 0 1 1 CAZ or AZT³2 mg/ml 7±9 E. coli ´h 79 E. coli ² 492 CAZ or AZT ³2 mg/ml ² ¤¥¦ &' 5 «¬ noR@pLEqrsUts 0.25 $ ¡¢£5 J i a j B D 7kl m I J K L9 E FMOX !"#$% ESBL & ' 7 t s RAPDῌPCR ESBL &'% @ABCDE% PQRSTLEUV abcdefgh SBT/CPZ M_]"#$ FOM M CFPM MIC50 / MIC90 ^0.25 mg/ml / 0.5 mg/ml O ts MIC ]My$ /% TBPM qrs 0.06 mg/ml IJKLE MIC50/MIC90 /M 0.5 mg/ml N/O UVW~`z{| replicon type /<=f:;0>?"8 3 #$ (9.8) 13 % ESBL & ' 8 ESBL &' 8 % AmpC &' 5 z{|} 12 (6.5), AmpC &' 5 (4.1) ESBL, p-AmpC 3. 2006 1 2009 6 N/O5:;0"#$ mg/ml 195 h° 4,211 874 20.8 18 2.7 21 3.0 123 2.9 2 12.5 2 13.3 1 4.8 12 9.8 2 2 1 0 8 (6.5) 1 0 1 1 5 (4.1) ¸«¹'º»¼½ Vol. 21 No. 3 4 20 2µ 9.1 ῍ 1 2 (ESBL &'/ AmpC &'¶·9 2011. 21 22 Vol. 21 No. 3 2011. 4 16 2 16 1 4 2 16 2 2 2 4 P/T 0.5 0.5 8 8 8 8 0.5 2 CTM 0.25 0.25 2 8 2 8 0.25 1 CAZ 0.25 0.25 0.25 2 8 8 0.25 0.25 0.25 0.25 0.25 0.5 8 8 0.25 0.25 0.25 0.25 4 8 0.25 1 0.25 0.25 CZOP CFPM FMOX 0.25 0.25 2 4 4 8 0.25 2 AZT 0.25 2 0.5 8 8 8 0.25 2 S/C MIC ( mg/ml) MIC50/MIC90 0.12 0.12 0.12 0.12 0.12 0.12 0.12 0.12 0.12 0.12 0.12 0.12 0.12 0.12 0.12 0.12 0.25 0.25 0.25 0.25 0.25 0.25 0.25 0.25 2 4 2 2 2 2 2 4 MEPM BIPM DRPM AMK 1 2 1 8 1 8 1 4 TOB 0.12 4 0.5 2 0.25 4 0.12 4 0.12 4 0.5 1 0.25 4 0.12 4 CPFX PZFX ABPC: ampicillin, PIPC: piperacillin, P/T: piperacillin/tazobactam, CTM: cefotiam, CAZ: ceftazidime, CZOP: cefozopran, CFPM: cefepime, FMOX: flomoxef, AZT: aztreonam, S/C: sulbactam/cefoperazone, MEPM: meropenem, BIPM: biapenem, DRPM: doripenem, AMK: amikacin, TOB: tobramycin, CPFX: ciprofloxacin, PZFX: pazufloxacin 50 90 111 8 16 16 16 50 90 16 16 16 16 AmpC 5 2 16 8 16 50 90 50 90 PIPC MIC 50/90 ABPC ESBL 8 124 E. coli 2. 196 CTX-M9 CTX-M1 CTX-M9 unknown 5 6 7 8 16 16 FIB 16 2 0.25 0.25 0.25 0.25 0.5 8 4 8 8 8 8 2 2 8 2 1 4 8 0.25 0.25 1 0.25 0.25 0.25 0.25 0.25 CFPM FMOX 2 2 2 4 2 8 4 4 4 8 8 2 8 AZT MIC (mg/ml) 0.5 0.5 0.5 2 8 8 8 8 8 8 8 8 2 S/C 0.12 0.12 0.12 0.12 0.12 0.12 0.12 0.12 0.12 0.12 0.12 0.12 0.12 2 2 2 2 2 2 1 2 2 2 2 2 2 0.5 1 0.5 0.12 2 4 0.12 0.25 4 4 0.25 0.25 4 0.06 0.06 2 0.06 0.12 0.06 0.06 0.06 0.25 0.06 16 16 4 0.06 0.25 0.06 4 16 MIC (mg/ml) 2 4 2 2 8 4 1 8 2 2 0.5 8 8 0.5 0.5 8 4 0.06 1 0.06 0.06 0.5 0.06 0.06 0.06 2 1 0.12 0.06 1 76/4 ST 1 19/1 1 19/1 128 76/4 1 19/1 1 19/1 1 19/1 1 76/4 4 19/1 1 76/4 1 TBPM MINO STFX LVFX FOM 0.25 0.06 2 CETB 16 16 16 8 8 4 8 8 4 ACV MIC MEPM AMK CPFX ESBL AmpC ABPC: ampicillin, PIPC: piperacillin, CAZ: ceftazidime, CFPM: cefepime, FMOX: flomoxef, AZT: aztreonam, S/C: sulbactam/cefoperazone, MEPM: meropenem, AMK: amikacin, CPFX: ciprofloxacin, ACV amoxicillin/clavulanic acid, CETB: ceftibuten, TBPM tebipenem pivoxil, MINO: minocycline, STFX: sitafloxacin, LVFX: levofloxacin, FOM: fosfomycin, ST: sulfamethoxazole-trimethoprim 13 8 FIA FIB 16 12 2 2 8 FIA FIB 16 11 I1-Ig 8 8 8 16 16 FIB unknown unknown FIB 1 16 16 16 FIB 1 8 2 16 FIA FIB 16 FIA 8 0.5 4 CAZ 16 16 16 CIT CTX-M9 4 16 16 10 CTX-M1 3 16 16 FIB Y 16 FIA FIB 16 CIT CTX-M9 2 PIPC p-AmpC Replicon ABPC 9 CTX-M9 ESBL 1 Case No. 3. b E. coli 197 Vol. 21 No. 3 2011. 23 ¹ 198 ´ 1. ESBL º»²¼½ ESBL 26 85 3 5 p-AmpC RAPDῌPCR tega }~11)GE s[ 65 76 1 1 AmpC E. coli 22 28 60 74 1 2 Case No. 4 No. 12 ESBL "# $%&! AJ uv! ' 55w(6 '%&X AJGy ' 1991 2007 G y 5 > ESBL 1() 85< E. coli *+c ! '() *+,-. 4 G E AJr$|| cx ' ,- . Case No. 1/5 2 01-2,3456 CV 7 2009 898:';345< = 8 > 5 ?Case 1011) : 18.812) 0 G ( b l No. 2/6@ AB ' -. C D ESBL 345< p-AmpC EF AmpC J ! G H! JKG 6 LM '()I4 A 8 > 6 QR SLM7:TUVWX 5 FMOX 1 AB ESBL MG<5 23.3</'c 5< { '345< NOP ESBL b'f345< Q 2 Gg< JGkD Jhiij A 6 G MEPM l domonas aeruginosa ' Pseu- 345< Case No. 6 mn!"oj *+.#Gpq4r$ rJs[J CIT t p-AmpC ^13)G<5 1 hG2|7:Ncaq/ 'c ¡3¢'£314) ¤¥ YZW[\]P^ cde345<D ESBL QGL Tumbarello D ESBL E. coli GE/' 29.4< }~ AB 874 > E. coli 123 (14) ESBL E. coli YZW_MGOP'`a4Lb 5 Case No. 5 AJGE/' 8.16 zU{| 123 > 8 (6.5), AmpC 123 > 5 (4.1) 6 Ortega '¦§4<D ~ AB 15) }~]P11)E6D 2000 G>¨ E. coli ESBL 5 10 15< 345© 'ª'a AmpC G<5 5 > 2 ?«¬WXl 13 > 2 15@ G CIT t (LAT-1/LAT-4, CMY-2/CMY-7, BIL-1) 2 DG7:TUVWX'S34 Q R AmpC ' 3 4 K ® ' °±6²t' ¯E6 8,Gy9:> ῍ AJ uv! 6 %&s[J 5wD(< %&s[J xvMwD(< E. coli 1991 2007 GyzU{| 24 <=>µ?@¶·¸ Vol. 21 No. 3 Or- 2011. p- '4 3456 E. coli G (<±6²t`a4 = >¨ ῌ } E. coli 716) ESBL ' 5.4 AmpC 3.36 ESBL ±6²tD CTX-M9 t';³G ±6² 345< replicon type IncF group Vol. 21 200739 200789 200949 12 13 200889 10 11 2006129 200829 8 9 200889 7 200789 4 200839 200739 3 6 200729 2 2007109 200719 1 5 Case No. 60 74 74 G : 76 G G 59 : 65 81 G : 85 74 G G 26 : 74 79 G G 66 : No. 3 W*N J ]^_+L `abc M@a+ 74 25 1 5 4 aL abcL b+ Nj 3 *L WCN* 3 1 z{|}~j ++ NL Nj 73 26 efWgL ghij ]^_+L `abc 29 17 HIJKL MNJKL OPQL RPQ UVWXYZ*NJ 66 ;<=>?*@ !" AMPC (8)A ABPC (8) PIPC (1) BIPM, CLDM SBT/CPZ (3) CLDM 18.1 11.7 8.1 10.6 26.8 14.8 20.8 MEPMACPFXcp SBT/CPZAMEPM 11.6 20.8 BIPMAPZFX, MCFG 27.7 IPM CMZAMEPM IPM, CLDM BIPM, CLDM MEPMAMEPM[ CPFX SBT/CPZAMEPM 8.3 CEZ, FMOXAMEPMA MEPM[MINOA MEPM[MINO[ FLCZAFMOXA PAPMACMZ 8 CEZ IPM (5) 13.2 24.9 CFPM PAPMADRPM VANC CPFX (7) VRCZ (7) CTMAFMOX 8 1.5 6.6 3.1 1.3 4.9 2.8 1.7 11.7 6.6 2.3 8.2 11.9 5 CRP (mg/dl) 5 #$%& ESBL AmpC 8 ! " 4. 92 68 133 338 96 139 137 35 188 68 218 11 16 8 122 27 58 57 84 72 182 154 27 59 73 69 5 WBC ('102/ml) 5 38.4 36.8 38.4 36.4 38.9 35.8 39.9 36.1 38.1 39.2 38.4 36.4 39 37.9 36.2 39.7 38.1 8 BT (() B2 B2 B2 B2 B2 B2 dST E.coli (ESBL) aST E. coli sss \ST E. coli (ESBL) b / lm lij" B2 rstuvST E.coli (ESBL) *wST x\y k2 / lm !)*+nopq" ! dST E. coli (ESBL) 3/20ope 3/26ope \ST E. coli (ESBL) CD1EF MST E. coli (ESBL) CD1EF 67 B2 B2 B2 B2 )*+,-./ 0123 !45" b- E. coli 199 2011. 25 ¼ 200 ½k7T QRS"()? _?c E. coli ! "#$% &' 8 2 4 2! 2!H" 5 2!T () U ESBL P*Q )56 ()* Surviving Sepsis Cam- paign Guidelines (SSCG) ! " + 1 ,-. /0() 12)"%3/0() 1 4. 5 %?>w ESBL P* VXY p-AmpC P* V¡ ;¢£=¤%VWr " )¥=XwV Wrv:c_ NK¦") 6 3787 9!"7:;<=># =Y§¨?d" ?)=©¨3 %?$% Z()*=ª«?d"[\o4a= () @&A BCD;EFGHIJ '(K)%LM17) 4NO ESBL P*Q!ERSTUVWXY Z[\]^GW!!_ AmpC P*Q! ª«]^!_ @! !¬V _)?`® ¯ a!r," real time PCR " CTX ERSTUVWXY+ 4 ,-Z[`VW =ª'(()56 °>"% V ±c !!_a.? /01bc ) 8²³4NO b´==|%µc ESBL P*Q2!ERSTUVW 1 2 =d¶% ) ©=efr·{ FMOX !*3.d AmpC P*Q2 !3Z()56"c]^gv¸!_ !ERSTUVW!*3.d? % % ERSTUVW() !ERSTU V8 ef_ V"-h() ESBL "j ῍ 34g!XYERSTU g!id FMOX 1) !_();Tk<Rl?dCD ;EFGH 56m no% pq"X ESBL P*Q"rZ[\]^GW 7s18) ! 2) 1 2!_ FMOX g!!*3.d? tu 89" X'(v:4>w xyzW";) ) 19) Ortega ! 1991 > 2007 > xyzc< "{=|11) -" 13} 28}"? 3) 4) ~% @!c CPFX,LVFX ! ESBL P*Q 8 Q 4 Q MIC 4 mg/ml .!_? ESBL P*) STFX p-AmpC P*)"% c MIC ABNO=&%? STFX DNA ^F;XY< ^ῌ"9! 5) r dual inhibitory activity =&rCxyzW 5q()!_ DxyzW())= ;)"% LVFX, CPFX GRNX 8E MFLX, 16 E()=% ? ESBL P* ;)"%c CPFX F% 32 E() =&%20) 6) G*"!>w ESBL P*Qtu /01b=|! H. I2! 2 -. H CV ER JH_ t!_? ESBL P*)NK ef%LH ERMN + 3 ,Z[`VW OPLM 26 %h/0i*j¹º» Vol. 21 21) No. 3 2011. 7) ῌ Paterson, D. L., R. A. Bonomo. 2005. Extendedspectrum betalactamases: A clinical update. Clin. Microbiol. Rev. 18: 657ῌ686. Shibata, N. Y. Doi, K. Yamane, et al. 2003. PCR typing of genetic determinants for metallo-blactamases and integrases carried by Gramnegative bacteria isolated in Japan, with focus on the class 3 integron. J. Clin. Microbiol. 41: 5407ῌ5413. Jacoby, G. A. 2009. AmpC b-lactamases. Clin. Microbiol. Rev. 22: 161ῌ182 Clinical and Laboratory Standards Institute. 2005. Performance standards for antimicrobial susceptibility testing: 15th informational supplement. M100-S15. Clinical and Laboratory Standards Institute,Wayne, Pa. Jarlier, V., M. H. Nicolas, G. Fournier, A. Philippon. 1988. Extended broad-spectrum betalactamases conferring transferable resistance to newer beta-lactam agents in Enterobacteriaceae: Hospital prevalence and susceptibility patterns. Rev. Infect. 10: 867ῌ878. Yagi, T., J. Wachino, H. Kurokawa, et al. 2005. Practical methods using boronic acid compounds for identification of class C betalactamase-producing Klebsiella pneumonia and Escherichia coli. J. Clin. Microbiol. 43: 2551ῌ 2558. Johann, D., D. Pitout, A. Hossain, D. N. Hanson. 2004. Phenotypic and molecular detection of CTX-M-b-lactamases produced by Escherichia !"# b-.34/ coli and Klebsiella spp. J. Clin. Microbiol. 42: 5715ῌ5721. 8) Pérez-Pérez, F. J., N. D. Hanson. 2002. Detection of plasmid-mediated AmpC b-lactamase genes in clinical isolates by using multiplex PCR. J. Clin. Microbiol. 40: 2153ῌ2162. 9) Carattoli, A., A. Bertini, L. Villa, et al. 2005. Identification of plasmids by PCR-based replicon typing. J. Microbiol. Methods 63: 219ῌ228. 10) Vila, J., M. A. Marcods, M. T. Jimenez de Anta. 1996. A comparative study of di#erent PCRbased DNA fingerprinting techniques for typing of the Acinetobacter calcoaceticusῌA. baurnannii complex. J. Med. Microbiol. 44: 482ῌ489. 11) Ortega, M., F. Marco, A. Soriano, et al. 2009. Analysis of 4758 Escherichia coli bacteraemia episodes: Predictive factors for isolation of an antibiotic-resistant strain and their impact on the outcome. J Antimicrob. Chemother. 63: 568ῌ574. 12) Serefhanoglu, K., H. Turan, F. E. Timurkaynak, et al. 2009. Bloodstream infections caused by ESBL-producing E. coli and K. pneumoniae: Risk factors for multidrug-resistance. The Brazilian Journal of Infectious Diseases 13: 403ῌ 407. 13) Tumbarello, M., M. Sali, E. M. Trecarichi, et al. 2008. Bloodstream infections caused by extended-spectrum beta-lactamase-producing Es- 51 E. coli :; 14) 15) 16) 17) 18) 19) 20) 21) 201 cherichia coli: Risk factors for inadequate initial antimicrobial therapy. Antimicrob. Agents Chemother. 52: 3244ῌ3252. 2008. Surviving Sepsis Campaign Guidelines 2008. De-escalation. 227: 788ῌ880. 2002. !"#$ %&'()*+,-./012 b-.34/ 516789:; <=> ?@AB 50: 777ῌ786. CDEF GHIJ K 2009. LM ESBL N)*+O3PQRS-TU1 <VWB 19: 230ῌ235. XYZ[ 2008. Surviving Sepsis Campaign Guidelines 2008. De-escalation. 227: 859ῌ864. \]^_ `ab cdefg K 2009. Extended-spectrum b-lactamase N Escherichia coli 6h9i jklmnohp qr67 89st <=> ?@AB 57: 502ῌ507. guvw 2005. xyzS{ |U}~51 } <=> ?@AB 53: 349ῌ 356. YFJ 2009. xyzS{ 4z xS Vqr <= AB 133: 43ῌ51. `ab =a 2009. ESBL N -./012 Vs 53: 1343ῌ1347. <=VWAB Vol. 21 No. 3 2011. 27 202 Studies on the Drug-Resistance of Escherichia coli Isolated from Cultured Blood to b-Lactam Antibiotics Sachiko Inui, Tatsuya Nakamura, Chihiro Koike, Kazuyuki Okuda, Makoto Sano, Chiyo Nakata, Hiroko Fujimoto, Hiroe Ohkura, Hakuo Takahashi Department of Clinical Laboratory, Kansai Medical University Hirakata Hospital In recent years, the drug resistance of Gram-negative bacilli particularly beta-lactamase-producing bacteria becomes the hot topic, and it is important to know the resistant mechanism and the epidemiological di#usion. Also, cases with the resistant bacteria detected from blood cultures makes initial treatment become di$cult and is thought to a#ect the prognosis. Therefore, the cases that Escherichia coli was isolated from blood cultures in this hospital by September, 2009 from January, 2006 were analyzed about the detection situation of various beta-lactamase-producing strains and the e#ect of treatment. Onehundred twenty four strains of E. coli were detected from 123 cases (2.9) out of 4,211 blood culture specimens. Among them, 13 strains in 12 cases (9.8) had MIC of 2 mg/ml for CAZ and AZT. Thereby, 8 strains (6.5) were producing extended spectrum b-lactamase (ESBL) and 5 strains (3.3) were Cephalosporinase (Amp-C) producers. The genotype of the ESBL producing E. coli showed to be a CTX-M9 type in 5 strains, and CTX-M1 type in 2 strains. CIT-type plasmid-Amp-C (p-AmpC) was detected in 2 of 5 strains with the Amp-C producer. The replicon type of the plasmid gene was mostly the IncF (FIA, FIB) group, and was presented in 6 ESBL producers and 4 Amp-C producers. The antibiotic therapy was e#ective in eight ESBL producers. Thereby, carbapenems was given in 5 cases and flomoxef in 1 case. Carbapenems were used in 2 Amp-C producers. These results indicate that the MIC creep with increasing antibiotic resistance for E. coli even in this country is evident, and the appropriate defense program not only for detection of microorganism but also for treatment in clinical setting is definitely necessary. 28 Vol. 21 No. 3 2011.
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