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No. 3
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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
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0.25
2
8
2
8
0.25
1
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0.25
0.25
0.25
2
8
8
0.25
0.25
0.25
0.25
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0.5
8
8
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0.25
0.25
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8
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1
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2
4
4
8
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2
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2
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8
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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
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4
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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
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16
16
16
16
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5
6
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16
16
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16
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0.25
0.25
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8
4
8
8
8
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2
2
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2
1
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2
4
2
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8
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1
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8
8
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1
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1
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1
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16
8
8
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8
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26 %h/0i*j¹º» Vol. 21
21)
No. 3
2011.
7)
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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
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2005. Performance standards for antimicrobial
susceptibility testing: 15th informational supplement. M100-S15. Clinical and Laboratory
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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.
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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.
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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
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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)
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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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