第43回薬剤耐性菌研究会

プログラム・抄録集

平成26年10月31日（金）・11月１日（土）石川県加賀市　片山津温泉　加賀観光ホテル

43

26 10 31 12:55

26 11 1 11:35

QUEEN ELIZABETH 922-0412 41

TEL: 0761-74-1101 FAX: 0761-74-1105

http://www.kagakankoh-hotel.co.jp/

TEL: 027-220-7992 FAX: 027-220-7996

26

http://yakutai.dept.med.gunma-u.ac.jp/society/index.html

JR 10

JR 3

11:40 12:10 12:40

JR

12:13 12:21 12:46 13:15 13:19 13:45

11:53 12:22 12:24 12:30 12:54 13:22

行き先

名古屋

10 31 12:00

17,000 1,000 6,000 10,000

10

12

Dsub-15

USB

PC windows8.1, PowerPoint2013

Macintosh PC

COI

ICD ICD

2

43 26 10 31

10 5 13:00~14:00

ESBL/AmpC

( )

－ 1 －

1 2 1,2 1 2

14:45 15:15

Acinetobacter spp. - - (IMP-2) -

－ 2 －

CRE)

－ 3 －

2 26 11 1

10 5

ESBL

MRSA

MRSA 1,2 1 2 2 3 3

1 2 3

－ 4 －

10:30 11:30

Regional

Infection Control Support System; RICSS

Modified Hodge Test

1,2 1,2 1,2 1,2 1

1,2 1 2

－ 5 －

10 31 15:30 17:30

CRE)

CRE

CTX-MExtended Spectrum beta Lactamase ESBL

CRE

CREESBL

KPC

CREIMP-6 IMP-34 MBL IPM

Acinetobacter MBL TMB-1CRE

IMP-7NDM-1 CRE

OXA-181 CRE OXA-181 CREOXA-181

CRE

CRECRE

in vivo

－ 9 －

－ 10 －

26 9 926 9 19

2011 2013 3 [ ] 1 1

MIC 2 g/ml (KB)22mm

( ) MIC 2 g/ml (KB)

22mm ( ) MIC 64 g/ml

(KB) 12mm [ ]

E.coli 2011 2013 MEPM 0.08% 0.06% 0.09% IPM/CS 0.14%0.07% 0.05%CMZ 0.46% 0.41% 0.5% C.freundii MEPM 0.0% 0.28%0.0% IPM/CS 3.17% 1.8% 1.1%CMZ 14.2% 16.3% 16.8% K.oxytoca MEPM 0.0% 0.0% 0.0% IPM/CS 0.5% 0.35% 0.43%CMZ 0.37%0.12% 0.33% K.pneumoniae MEPM 0.0% 0.04% 0.03% IPM/CS 0.16%0.09% 0.08%CMZ 0.96% 0.47% 0.31% E.aerogenes MEPM 0.0% 0.0%0.2% IPM/CS 9.2% 11.4% 8.4%CMZ 81.9% 84.0% 84.0% E.cloacaeMEPM 0.5% 0.7% 0.87% IPM/CS 2.75% 2.4% 2.2%CMZ 80.8%81.4% 81.6% S.marcescens MEPM 0.0% 0.15% 0.0% IPM/CS 2.5%1.5% 1.35%CMZ 8.2% 10.4% 8.6% P.mirabilis MEPM 0.0% 0.0%0.0% IPM/CS 12.1% 12.4% 13.5%CMZ 0.5% 0.2% 0.45% P.vulgarisMEPM 0.0% 0.0% 0.0% IPM/CS 16.5% 14.1% 19.9%CMZ 0.58%1.5% 1.71% P.rettgeri MEPM 0.0% 0.0% 0.0% IPM/CS 3.6% 6.8%3.9%CMZ 2.6% 1.2% 1.0% P.stuartii MEPM 0.0% 0.0% 0.0% IPM/CS

7.4% 7.5% 7.0%CMZ 4.0% 2.9% 3.4% M.morganii MEPM 0.0%0.0% 0.0% IPM/CS 20.9% 25.2% 26.5%CMZ 1.5% 1.6% 1.5%

－ 11 －

CRE CRE

1970 19801990

2000

(CRE)

CRE

KPC CRE

2 ceftolozone/tazobactam ceftazidime/avibactam FDACRE

CREeravacycline plazomicin Ph 3

Ph 1 Ph 2

CRE

ICAAC

－ 12 －

1,2,3, 2, 2,3, 4, 5

1 2

3 4

5

26 9(CRE) CRE

CRE ,

OXA-48 Klebsiella pneumoniae, Escherichia coli 3MIC ,

OXA-48 , TAZ/PIPC MHTNDM-1 , NDM-1

E. coli SMA MHTNDM-1, OXA-181 K. pneumoniae MHT

DHA-1 K. pneumoniae

MIC , MHT MEPMKPC DHA-1 KPC

MIC

IMP-1 Citrobacter freundiiMIC MicroScan, Phoenix, Vitek 2 , Vitek 2

IPM MEPM MIC 16 g/ml , MicroScan IPM 1 g/ml, MEPM 0.5 g/ml , hidden carbapenemase

, MicroScan Vitek 2 MIC

IMP-1 MBL K. pneumoniae IPMMIC 1~ 16 g/ml

CRE -, ,

－ 13 －

ESBL/AmpC

- extended-spectrum -lactamases : ESBL

AmpC -

ESBL/AmpC ESBL/AmpC

ESBL/AmpC ESBL

ESBL

2013 3100 4 78 4 6

1 89 ABPC( ) CTX() CAZ( ) 1 µg/ml

CAZ CTX CFX MICESBL AmpC

PCR ESBL

ESBL 100 64 64.0 89 3842.7

AmpC 100 14 14.0 89 2528.1

ESBL 77 50 SHVTEM 10 CTX-M 46.8%

68 CTX-M TEM 44.2%

22 CTX-M PCR1 2 AmpC

14 14 25 29CIT

－ 17 －

IMP-type - -aminoglycoside-acetyltransferase AAC(6’)-Iae

2011 2013646 2011 169 2012 186 2013 291

IMP-type - -AAC(6’)-Iae AAC(6’)-IbIMP IMP

2011 2013 646 2011169 IMP 107 63.3% AAC(6’)-Iae 84 (49.7%)

AAC(6’)-Ib 34 (20.1%) 2012 186 IMP128 68.8% AAC(6’)-Iae 100 (53.8%) AAC(6’)-Ib 42 (22.6%)2013 291 IMP 170 58.4% AAC(6’)-Iae

129 (44.3%) AAC(6’)-Ib 90 (30.9%) IMP IMP

2011 IMP 107 IMP-1: 66 IMP-6: 2 IMP-7: 12IMP-10: 21 IMP-43: 5 IMP-44: 1 2012 IMP128 IMP-1: 70 IMP-6: 13 IMP-7: 17 IMP-10: 20

IMP-34: 3 IMP-41: 1 IMP-43: 4 2013 IMP170 IMP-1: 82 IMP-6: 14 IMP-7: 38 IMP-10: 26 IMP-34: 2 IMP-41: 2 IMP-43: 5

AAC(6’)-Iae AAC(6’)-IbIMP-34 IMP-41 IMP-43 IMP-44

IMP - -

－ 18 －

- A

( )

AGroup A Streptococcus; GAS -

GAS B Streptococcus agalactiaepenicillin G -

GAS -GAS 256 -

256

1 B penicillin G, oxacillin, ceftizoxime, ceftibuten, cefaclor 5 -

minimum inhibitory concentration; MIC Clinical and Laboratory Standards Institute CLSI

2 MIC GAS 8 penicillin binding protein(PBP)PCR

16S rRNA

1. 256 CLSI penicillin G

breakpoint 0.12 g/ml penicillinMIC MIC

2. MIC 8 3 Streptococcus pyogenes 5 Streptococcus

dysgalactiae subsp. equisimillis (SDSE) 16S rRNA8 -

PBP MIC MIC

8 - PBP- A

MIC8 5 C G SDSE A

SDSE - MIC

- A

－ 19 －

JANIS CRE

2014 9 19

CRE 5

CRE JANIS CRE

MIC Disk CRE

2013 1 2 JANIS CRE IPM

and/or MEPM CMZ (MIC ) E. coli K. pneumoniae IPM 2

g/mL CMZ 64 g/mL MEPM 2 g/mL CRE CRE

CRE E. coli IPM CMZ 21 /34,185 0.06 MEPM

170 /23,474 0.72 K. pneumoniae IPM CMZ 34 /12,879 0.26

MEPM 78 /8,561 0.91 IPM CMZ MEPM 3

E. coli 16,487 IPM+CMZ CRE 10 MEPM

CRE 150 IPM+CMZ MEPM CRE

4 3 K. pneumoniae 8,561

IPM+CMZ 7 MEPM 78 CRE IPM+CMZ MEPM CRE

0 CRE W/A 50

CRE 2 g/mL IPM 15 MEPM

25% MIC Disk CRE

W/A IPM MEPM 4 g/mL CMZ 64 g/mL VITEK IPM 4 g/mL MEPM

16 g/mL CMZ 64 g/mL IPM MEPM 2 g/mL CMZ 64

g/mL CRE Disk KB IPM 25mm

MEPM 26mm E- IPM 0.5 g/mL MEPM 0.25 g/mL

CRE

CRE 0.1% 2

IPM+CMZ MEPM

CRE CRE

1

MIC Disk CRE

－ 20 －

Acinetobacter

1 2 1,2

1 2

AcinetobacerAcinetobacer MDRA

Acinetobacter

2013 12 Acinetobacter 102MIC PCR PFGE MLST DNA

MIC PFGE 1 102Acinetobacer OXA-51-like A. baumannii MDRA 3

1 4 GA-7 GA-29 GA-67 GA-69MLST GA-29 ST291 GA-7 67 69 ST208

CC92 GA-29 GA-29OXA-51-like 7 bp ISAba OXA-51-like OXA-80

1 aacA4 catB8 aadA116S rRNA arm PCR gyrA QRDR

83 S L parC QRDR 80 S L

MDRA

CC92

－ 21 －

－ 22 －

－ 23 －

Acinetobacter spp. -β- (IMP-2)

1 2 2 2 - 3

2 4 5 4 5

2

1 2

3 4 5

IMP-2 IMP-1 B1 -β- (MBL)

Zn(II) β- IMP-2 IMP-1

36 10

26 mature IMP-1

26 4 (Ser68, Gln198, Asp227, Ser261) 9Å

Acinetobacter spp.

IMP-2 X IMP-1

IMP-2 hanging drop 20C 1

X Rigaku Micro Max007 & R-AXIS VII IMP-1 (PDB code,

1DD6) search model

IMP-2 ( 1) MBLs αβ/βα

2 Zn(II)

IMP-1 1 ( 2)

－ 24 －

1 3 3 2,3 1 1 ,

2 3

β-

O157Cpx

O157 Tor

TorTrimethylamine-N-oxide (TMAO) O157

TMAO TorTMAO

TrimethylamineO157 Tor

Tor

Tor TMAOTMAO O157

－ 25 －

ESBL

, , , , , ,

, , ,

,

, ,

ESBL

(FOM) ESBL

FOM

FOM

ESBL 192 FOM MIC

FOM

FOM

ESBL 192 FOM

(MIC, 128 µg/ml) 7 3 FOM

( -S- FOM-GST)

FOM-GST phosphonoformate(PPF) PPF

FOM-GST FOM FOM

PPF 1mg

FOM-GST PPF

FOM-GST

ESBL FOM FOM-GST

PPF

FOM-GST

Nakamura et al., Journal of Clinical Microbiology, 52(9):3175-9, 2014.

Wachino et al., Journal of Clinical Microbiology, 52(10):3827-8, 2014.

－ 26 －

－ 27 －

MRSA

1,2 1 2 2 3 3

1 2 3

PFGE

NGS

(MRSA)

NGS

clonal complex (CC) 5 SCCmec type II MRSA

PCR-based ORF typing POT 14

20 CC1 SCCmec type IV MRSA

5 10 49

NGS Illumina MiSeq NGS

Abyss contig MUMmer SNP

N315 Genomic island

SNP

RAxML MEGA6

1 CC5 14

2

SNP 1 17 CC1

SNP 25 79

SNP

NGS

－ 28 －

Regional Infection Control Support System; RICSS

1), 2), 3), 4), 2), 5) ,6), 6)

1) , 2) , 3) , 4) , 5) , 6)

24 3

2410 24 40 1 2

1 21

1 2

16,550,000

－ 29 －

Modified Hodge Test

1) 1) 2) 1) 3)

1)

2)

3)

modified Hodge test (MHT) (ertapenem, ERT)

MHT

100 ERT, , (meropenem,

MEPM) 93%, 82%, 83% , 3 ERT

ERT , Pseudomonas 27 3

Acinetobacter 19 2 , OXA-23 4 1

VIM-1 1 , NDM-1

β- , 2

, 45

(extended-spectrum β-lactamase 20 , Pseudomonas 20 , Enterobacter

cloacae 5 ) , MEPM (43/45 , 95.6%) ERT

(40/45 , 88.9%) , , β-

5 1 MHT

, ,

3 , ERT

, 2

,

MHT ERT

, ERT

β- MHT

－ 30 －

ESBL

1 1 2 3 A. Yan4 1 1

1) 2)

3) 4) The University of Hong Kong

ESBL

(DSTM)

Polydimethylsiloxane (PDMS, TORAY) UV

4 5

(CTX CAZ AZT PIPC ) -lactamase CVA TAZ

CMZ FMOX MEPM CVA metallo- -lactamase

DPA ESBL 9 8

MH-broth (OD 0.1)

10 L 37 2

-lactamase

DSTM -lactam

2 ESBL

CTX CAZ AZT

CVA

ESBL CMZ FMOX MEPM DPA class B

-lactamase class B AZT CVA TAZ

class B ESBL AZT CVA

class C -lactamase

DSTM

-lactam 2

ESBL class

B -lactamase 2

－ 31 －

MALDI-TOF MS ESBL ST131 ST405

1,2 1,2 1,2 1,2 1 1,2 1 2

ESBL extended-spectrum beta-lactamase (ESBL) sequence type 131 (ST131) ST405

STMatrix Assisted Laser Desorption Ionization

Time-of-Flight Mass Spectrometry (MALDI-TOF MS) ESBL ST131 ST405

7 2001 2010ESBL 581 ST

ST131-O25b 41 ST131-O16 26 ST405 41 ST(OST) 41

Microflex LT (Bruker)(1) MALDI Biotyper MSP

(2) ClinProTools Biotyper ClinProTools

Biotyper ST131 (ST131-O25b+ST131-O16 / 98.5%/93.9%ClinProTools Biotyper ST131-25b

ST405 90% MALDI-TOF MS ST131 ST405

Biotyper ClinProTools

(%) (%) (%) (%) ST131-O25b+O16 98.5 93.9 94.0 92.7 ST131-O25b 75.6 96.3 95.1 98.2 ST131-O16 88.5 89.4 80.8 95.1 ST405 22.0 100.0 90.2 96.3 OST 87.8 69.4 92.7 96.2

－ 32 －

メ　モ

メ　モ

メ　モ

http://yakutai.dept.med.gunma-u.ac.jp/project/index.html

43

26 10 31 12:55

26 11 1 11:35

QUEEN ELIZABETH 922-0412 41

TEL: 0761-74-1101 FAX: 0761-74-1105

http://www.kagakankoh-hotel.co.jp/

TEL: 027-220-7992 FAX: 027-220-7996

26

http://yakutai.dept.med.gunma-u.ac.jp/society/index.html

第43回薬剤耐性菌研究会

プログラム・抄録集

平成26年10月31日（金）・11月１日（土）石川県加賀市　片山津温泉　加賀観光ホテル