第41回研究会のプログラム（pdf版） - 群馬大学大学院医学系研究科附属
Contents
1.2. 1 1 2 3 4 5 6 1 1 2 3 4 5 6
3. PpyA MexAB OprM OprM AOprM E OprM AOprM w4 oprM PAM01 0 5 mM
4. JANIS CLSI Paeruginosa EE co77 P _aeruginosa
5. JANIS 2010 1 12 1 JANIS aeruginosa MIC S LR 126 542 25 180 101 362 582 64 319 S LR CLSI 2008 M100 S18
6. C glabrata 4US7 40S7 C glabrata
7. 8 SMB 1 1 pp MBL VAP MBL MEP1071
8. IMP type B aminoglycoside acetyltransferase AAC 6 Iae 2009 2011 878 200354000 217 2011 161 IMP type 6 AAC 6 Iae AAOC 6 Tb 0 MIC B
9. 91 gyr4 parC 4cinetobacter baumannii 9 CTX M
10. 4 S7 40S7 OSH4 TIR3 40S7 I De C glabrata
11. gt alert matrix 12 15 12 20 B B 1 2 Ou 9 1 2 5 B
12. IMP 1 6 IMP 1 0 23 uM 2 0 19 uM 3 1 2 uM IMP 1 3 1 4 IMP 1 50 uM 2 4 0 1 mL
13. B 4 H L Invitrogen 1 Health B NDM 1 B IMP H B IMP VIM NDM 1 MBL KPC B E
14. CLSI Clinical and Laboratory Standards Institute 2008 PB lactam BP 2010 M100 S20 CEZ CTX CTRX CAZ BP 8g gmL 1 g mL 2012 M100 822 P aeruginosa PIPC BP 64 16 rp gmL IPM MEPM BP 4 2 g mL BP co7 aeruginosa JANIS 2009 2011 6 8 coli aeruginosa coli CEZ CTX CTRX CAZ BP BP 1 3 aeruginosa
15. lt MAX MIN 14 7 JANIS AMK 3 1 18 4
16. VRE VanA VanB VanC VanD VanE VanG VanL VanM VanN 9 VanN VRE 2011 10 1 VanN VRE 2011 2 5 90 45 85 102 322 VRE PCR PFGE PCR 322 129 VanC1 849 VanC2 17 5 871 VRE VCM MIC6 12 pw g ml
17. 10 23 12 00 1F 14 00 17 000 1 000 6 000 10 000 12 3 1 12 USB PC windows7 PowerPoint2010 Macintosh PC COI ICD ICD
18. cut off Hi E T ATCC goat anti rabbit igG EF IMP B VIM B 18 20 B 3 KPC 1 NDM 1 2 MacFarland No 0 5 10 uu
19. B Fosfomycin FOM 40 A 2 E 1 FOM 2010 FOM FOM 6s43 fpsC2 H E CTX M CTX M E coli fos4 1 8 HH
20. MIC yaz Enterococcus faecium 3 VRE van B MIC 4ug ml 8ug ml x7erococcs jaecium 2007 20114 25 VREIH VRE 3 25 VRE VRE VRE VRE EY E VRE
21. EE Wh EF HH 1 EN 8 AUD 2003 2011
22. pYM101 pDS132 5000 1 2 10000 MIC 4 1 4 cop5 opz apC MIC 2 0RF MIC ORF PA01 MIC
23. E 5 MDRP B lactamase 4 E MDRP 3 lt MIC
24. 4cze opgc7er baumannii MDRAB MDRAB 20 MDRAB1 70 MDRAB strain 1 strain 1 MDRAB strain 2 2 80 MDRAB laoxa blaapc 16S rRNA PCR
25. ABK 1 aac 6 aph 2 TB beads SAP NALC NaOH SAP NALC NaOH
26. _
27. E 8 17 VRE 4 VRE E HH HH 13 VanN VRE
28. 2009 2010 217 IMP 174 80 2 AAC 6 Iae 145 66 8 AAC 6 Tb 21 9 7 2011 161 IMP 101 62 8 VIM 1 AAC 6 1ae 80 49 6 AAC 6 Tb 35 2 1 7 2010 2011 IMP AAC Iae AAC 6 Ib AAOC 6 Tb 66 PFGE 60 5 50 30 60 0 IMP 7 B NCGM1588 aminoglycoside acetyltransferase AAC 6 Iaj aac 67 7a7 aac 6 7a7 integron DNA AAC TIaj AAC 6 Ia
29. 3 4 2 3 IMP 1 8 SMB 1 Serratia marcescens MBL SMB 1 X
30. H PP gt AUD 2003 ME Total AUD MBPM AUD 2011 13 12 2011 1 gX3 AUD 2004 PM 480 2007 488 2009 E HC Total AUD ME M MEPM DR
31. 4 40 0 22 27 0 34 6 25 0 431ogisCFU ml P lt 0 05 P lt 0 05 BIPM T gt MIC 0 10 3 ME1071 BIPM BIPM x BIPM ME1071 MBL VAP ME1071 MBL hy
32. R 4erogoas hydrophila Chris S del Castillo Ho Bin Jang 3 Tae Sung Jung Aquatic Biotechnology Center of WCU Project Gyeongsang National University L000 10 00 11 30 3 ESBL 2 5
33. rRNA rRNA erm methyltransferase Erm 23S rRNA domain V A2058 Telithromycin TEL Erm A2058 A2058 23S rRNA domain Il A752 TEL 23S rRNA domain I G748 methyltransferase mA
34. 2 gt alert 1 1 2 gt alert matrix 2 P MDA Medlas SHIPL Standardized Hospital Infection Primary Lookout 614 413 259 3 VRE 2 1 4 7 P MDA P MDA gt alert matrix gt alert 0 500 0 100 500
35. 2008 8 2012 MRSA 1 000 2 fF F 7 patient da 9 TDM 2 3 11 6 19 MRSA 3 E 5 2 3 2 2DCM bh
36. 1 5 ciprofloxacin CPFX amikacm AMK imipenem IPM ceftazidime CAZ piperacillm PIPC 37 3 3 3
37. coli BL21 DE3 pLysS pET30a X Photon Factory SMB 1 1 6 A SMB 1 MBL B3MBL SMB 1 B3MBL AIM 1 L1 BJP 1 N 2 1 2 SMB 1 N B3MBL 1 57
38. 4 B MBL KPC
39. 415 14 30 14 30 lt 15 00 15 00 16 00 IPM 8 Enterobacteriacea ee 0 a dm
40. 3 ESBL 93 91 68 72 13 PCR 7 PFGE ESBL 74 64 54 36 50 3 6 20 8
41. 1 matrix 12 alert gt alert matrix
42. 2 CA MRSA tL HA MRSA HA MRSA CA MRSA HA MRSA CA MRSA MRSA 1 1 3 3 JANIS 2011 1 309 993 210 382
43. E 6 H 2 MDRP E 18 3 E Polydumethylsiloxane PDMS TORAY 100C 30min RIE 10NR Samco 6
44. pv 1 0 tst 62 3 552 MRSA PFGE 299 PFGE 4 PFGE MRSA MRSA MRSA POT MRSA o
45. MDRP 10 RND AcrB MexY MexB GBDD 2002 AcrB membrane vacuum cleanery 1
46. 4 baumannii PFGE 37 ATCC 2 39 EU clone II Bartual Pasteur Multilocus sequence typing MLST 4 baumannii poxA sik EU clone I 4 baumannii 39 Bartual MLST Clonal complex 92 CC92 21 Pasteur MLST Sequence Type 2 ST2 21 EU clone II oxA_sidik zoxA se blaoxA 82 DlaoxA 83 18 EU clone II blaoxa s1 ke 7 goxA sidik EU clone II nt106 108 4 baumannii 39
47. p Enterococcus faecium VanN VRE 2 Candida glabrata
48. 17 2 10 plex 9 plex PCR 2 ORF 1 0 genomic islet POT1 B POT2 10 POT POT 415 multilocus sequence typing MLST PFGE POT 107 410 8 20 646 8 24 PFGE 410 8 79 646 8 94 Ya OD te OD et BA et et a LI 82 ST ST eBURST 6 clonal complex CC 59 singleton 49 ST CC 108 POT1 ST
49. MIC MIC MIC es mexS mexT nfxC mexT
50. Antimicrobial Stewardship MRSA 3 y MRSA NOR RN ER CDN 3 CL 2009 8 HH R E CD 1 E 2 3 c0 0
51. MRSA MRSA 4 MRSA Infection Control Network MRSA 2009 4 584 MRSA MIC SCCmec typing PCR Pulsed field gel electrophoresis PFGE Sal DNA MRSA 8SCC ectype type II type 1V V MRSA
52. PRGBS 2001 2008 PSGBS38 ST ST 1 19 10 153 12 573 23 25 4 4 1 1 1 2 66 11 11 3 3 3 5 PSGBS38 PRGBS ST1 ST23 ST1 66 PRGBS ST PSGBS eBURST ST PSGBS ST10 ST19 ST1 ST PRGBS ST1 group ST1 ST1 allele profile ST PRGBS ST1 ST 6 PSGBS PCG MIC 0 03 0 06ug mD 38 GBS Penicillin susceptible GBS PSGBS ST
53. Na CA MRSA USA300 POT1 106 HA MRSA POT1 93 64 24 CFU Na 24 CA MRSA CFU HA MRSA 100mM CFU Na 200mM 48 CA MRSA CFU HA MRSA CFU Na 48 CA MRSA USA300 80mM CFU 0100mM 4 POT1 106 60mM CFU 80mM CFU HA MRSA 40mM CFU 60mM CFU HA MRSA CA MRSA CA MRSA Na
54. 8 30 9 45 exS ex7 1
55. B 2 QS OQS MIC MexS MexS MexT QS MexEF OprN MexS nfxC mex MexEF OprN MIC PAO1 mexs MexS MexEF OprN MexEE OprN Me
56. aureus 16 1 114 933 MRSA aureus 54 6 MRSA MRSA JANIS aureus 394 2003 aureus 201 595 MIC MRSA VCM TEIC LZD ABK ABK MIC Phage open reading frame typing POT ABK
57. 0 0001 MRSA 12 01 7 23 IRSA MRSA I JANIS CLSI aeruginosa E coli O
58. FOM 6s43 fosC2 ESBL Inc type Carattoli A et al 2005 J Microbiol Methods 6 2 3 6 77192 CTX M E coli 145 FOM MIC 128ug ml lt 9 4 8 8 16 Lee SY et al 2012 J Antimicrob Chemother 3 76s43 7sC2 type Imc N type 1 IncF type 2 5 1 IncIl type 2 Inc 7acrx uw CTX M FOM EE
59. TIPM p arwp e p7arwp 1 7arwp 6 7arwp s4 91 D gyr4 parC gyr4 parC gyr4 parC
60. aac 6 aph 2 595 VCM TEIC LZD 0 84 5 ABK MIC 16 ug ml 2003 2 201 1 0 2010 3 394 0 76 POT ABK MIC PCR aac 6 aph 2 14 ABK MIC 4 256 pg ml PCR 595 MRSA ABRK
61. kspM ompT PAI D PFGE FQ CEP FQ CEP v D O1 8ST648 FQ 8ST648 O
62. 5 faecium PFGE D Ala peptide ligase PCR PCR ligase Inverse PCR VanN 1 1 8S1 Nuclease PFGE ligase VanN VRE E faecium i D Ala4 D Ser5 ligase VCM VRE ecium
63. 2 2 CCE TB Beads 10 2 dd De Rod MI TB Beads 1 4 1 2 3 4 5 Graed P2 P1 M1 P3 P1 2 1 1 MGIT MGIT TB M avium TB TB Tad CCE 31 3 44 3 37 1 Man Beads 37 8 41 8 47 0 CCE 536 465 1022 Beads 817 512 1731 RE CCE 8 42 11 42 12 48 Beads Xpert CCE 13 7 18 4 25 5 Beads 18 6 21 2 23 7 Taq Man Ct TRC sec LAMP min Gene Xpert Ct 2 TRC Beads CCE 16 0 16 0 6 6 16 6 22 3 1 n 12 3 2 MGIT n 10 Beads Beads 5
64. Aquatic Biotechnology Center of WCU Project Gyeongsang National University Aeromonas hydrophila 4 hydrophila R pR148 pR148 165 906 bp DNA 147 pNDM 1 Doll IncA C pR148 Tn27 IV ac aoi aa947 su7 7 1 tetA tetR Tn1721 cat
65. 12 5 3 12 2 3 3 3 3 1 2 3 5 F 24 4 lt 3 12 6 50 9 ESBL ESBL opaczer freundii 3 Citrobacter amalonaticus 1 Enterobacter ae7ogenes 1 Enterobacter agglomerans 1 Serratia marcescens 1 Klebsiella pneumoniae 1 Escherichia co 1 ESBL CTX M 1 group ESBL 8
66. DNA GyrA IV ParC MLST Bartual Institut Pasteur B 4 gentamicm amikacin arbekacin sain 2 3 IS4pz p zoxA 5 IS45a7 5 D L DiaoxA23 strain 1 MDRAB 34 bp swam 2 7 bp 27 bp zoxAeo strain 1 IS4bal blaoxace strain 2 blaoxa66 IS4ba7 blaoxa s2 OXA 82 OXA 66 1 sain 1
67. Alexa Fluor 488 ji mmageJ National Institutes of H 1 000 TKPC ImageJ Acinetobacter baumannii 4cinetobacter baumannii European clone II EU clone II EU clone I 2000 2011
68. 14 8 vs 8 7 23 5 vs 6 1 CTX M 1 group ESBL lt E 1 4 3 1 4
69. 70 aac 6 Iaj MIC AAC 6 Tae IPM 8 Enterobacteriacea 29 9 9 9 7 9 2008 Extended Spectrum beta Lactamase ESBL K pneumoniae imipenem IPM
70. VAP MBL MRE1071 3 2 2 12 2 12 2 2 2 2 2 8 MBL MBL ME1071 MBL MBL vitro ME1071 MBL MBL VAP ME1071 ddY SPF 6 MBL 5mm
71. Elution Buffer PBS 2012 7 8 SAP NALC NaOH CCE Taq Man TRC LAMP Gene Xpert Cephied 4 5 TRC 17 22 12 MGIT 10 1 4 2 2 TRC 3 2 1 TB Beads LAMP TRC 2 1006 E CCE 553 3 9 2 TB Beads 664 6 11 1 0 903 83 3 MGIT 100
72. AZT CP MIC OprM OprM AOprM AZT 0 25 ngmD CP 2 ng m MIC AZT 4 ug ml CP 32 pg ml PAM01 AZT CP MIC 0 25 ug ml 4 pg ml 2 ng ml 16 ug ml v4 opzzM OprM OprM OpM
73. 3Fr 1 5 X107CFU ml 50u VAP BIPM 100mg kg BIPM 100mg kg ME1071 100mg kg 1 2 12h 7 7 80h IL 1B IL 6 TNE o BIPM ME1071 RS MIC BIPM 256ug ml BIPM ME1071 8ug ml BIPM P lt 0 05 30h
74. BP BP PIPC 87 76 IPM 78 60 MEPM 79 64 11 15 BP aeruginosa PIPC 11 15 BP BP BP BP aeruginosa
75. MRSA Methicillin resistant Staphylococcus aureus CA HA MRSA POT Phage Open reading frame Typing CA HA MRSA POT HA MRSA CA MRSA Na Na USA300 CA POT1 106 CA POT1 93 64 HA CA MRSA HA MRSA 2 co culture 37 24 48 CFU Na 40mM 60mM 80mM 100mM Na 20mM 50mM 100mM 200mM
76. D 5 3 F D 6 6 E FQ CEP E A 5 8 B1 5 3 B2 2 5 D PFGE 4 1 lt IV TQ FQ CEP I II CEP Susceptible III IV 10 FQ FQ CEP D O1 ST64 D FQ CEP DR 8 D 1 01 ST648 2 I Ia Ib Ice Ta 5
77. 8 Q157 SMB 1 AIM 1 B8MBL 157 7 MIC MIC 157 SMB 1 MBL MBL SMB 1 8B MBL
78. PSGBS ST PRGBS MLST 7 adhP pheS atr glnA sdhA glcK tkt allele allele profile ST ST464 1 4 ST12 1 3 ST153 1 3 ST10 BO 4 11 80 70 60 50 50 40 30 10 10 1 0 0 PSGBS 38 PRGBS 28 ST1 ST23 PRGBS ST458 PSGBS ST458 PRGBS ST ST458 ST1 tkt allele tkt GBS pbp2X pbp2X 2 tkt 8ST1 PSGBS ST458 PRGBS ST1 PSGBS ST1 PRGBS serotypeV1 50 ST458 PRGBS 80 serotypeVI ST458 PRGBS serotypeV
79. 7 6 11 5 4rr is 22 6 PFGE 2 809 amp rris 22 FIB 120kbp 7 amp r_rs R 4erooas hydrophila R Chris S Tae Sung Jung del Castillo 2 Ho Bin Jang
80. a a 70 KJ K TB Beads TB Beads TB Beads Elution Buffer
81. VanN VanN VanN 2 VanN VRE VanN VRE Candida glabrata Candida glabrata
82. CAZ PIPC CAZ 3 8 H PIPC 1 10 PIPC PIPC B lactamase 1 10 gt a 3 4
83. D 91 DNA gyr4 pg7C sequence minimal inhibitory concentration MIC 91 7096 ciprofloxacim 4 gyr4 Ser 91 Phe Ser 91 Ile Asp 95 Gly parC Ser 88 Pro 3 ciprofloxacin levofloxacin gatifloxacin MIC gyr4 Ser 91 Phe Ser 91 Ile Asp 95 Gly parC Ser 88 Pro 4cjzeozc7gr baumannii
84. b PRGBS2 PSGBS1 9 4 CTB PSGBS PRGBS PBP2X 2B 1A MLST 7 adhP pheS atr gln4 sdhA glcK Smal DNA PFGE CCL MIC PSGBS 1 2 ugm1 CTBTPSGBS PRGBS 8 16 ugmD CZX MIC PSGBS 0 064 0 19 ug ml PRGBS gt 32 ug mD CTB PSGBS 0 75 1 5 ug ml CTB PSGBS PCG ABPC CTB PSGBS6 PBP 2X T394A PBP 2B TS67I PBP 2X G429S 3 PBP 1A T145A 3 PRGBS2 PBP 2X A400V V405SA QS557E PBP 2B TS67I PBP 2B CTB PSGBS PFGE
85. JANIS alert matrix
86. 3 4 Probability based Microbial Dissemination Alert P MDA gt alert
87. MexEF OprN MexAB OprM Quorum sensing QS B lactam MexT mexEF oprN K Poole MexEF OprN 4 zexS mex7 zC QS PAO1 mexs mexs nfrxC 7xC MexS QS MexAB OprM
88. meropenem MEPM Klebsiella pneumoniae ISMRK 1mipenem susceptible meropenem resistant KK pneumoniae TISMRK 47 2Kb pKPI 6 8 MBL blarmr 6 ESBL blacTx M 2 IPM MEPM arwp e pKPI 6 co7 ISMRE Imipenem susceptible meropenemr resistant co IPM ISMRK IPM MBL 26 20 ISMRK E 1 arwp K pneumoniae 5 IMP MBL 7arvr s4 blarmP 34 80kbp IMP 34 IMP 1 1 87 Glu Gly
89. ABC 2006 2 3 3 2 2011 2 2
90. NTC 63 nM CER 4 72 uM IMP 1 0 1 mL Tris 2 8 mL 3 0 mL 30 C 10 0 1 mL SS 3 4 me NTC 0 10 50 uM EN CER 0 50 100 200 uM NTC 1 2 3 4 uM CER 5 10 20 40 uM J T J 10 uM J 0 uM oo T T T 17 wIE 104 mir1 NM T 1 5 6 D a 200 nM 100 nM 50 uM 1 WE 7 103 min LineweaverBurk 4 8 0 1 E 1 Fig 1 Plots of 1 v E against 4 AM OR IMP 1 NTC of4 mercaptobutyric acid CER IMP 1 4 D 44 uM 37 uM
91. 0 D 2 41 24 10 25 13 00 18 10 12 55 13 00 12 3 13 00 14 15 B B B
92. PvdS PAM01 PAM02 PAM01 PAM02 AOprM PAM02 AZT CP MIC 0 5 ug ml 4 pg ml AOprM PAMO1 B E B lactamase
93. fosfomycin 7os4 16 00 16 30 1 Pi to 16 30 16 45 16 45 17 15
94. 1actamase Acinetobacter baumannii 17 15 17 20 40 10 17 20 lt 18 10 2 24 10 26 8 00 12 20 12 3 8 00 8 30
95. arm4 GyrA Ser83Leu ParC Ser80Leu MLST Bartual ST135 strain 1 strain 2 clonal complex 92 ST 92 ST 189 Institut Pasteur ST1 strain 1 2 ST2 Bartual CC 92 Institut Pasteur ST European clone IL Imstitut Pasteur ST1 European clone 1 MDRAB MDRAB CTX M fosfomycimn fos4 J
96. 4 EU clone II 4 baumannii EU clone II EE Rb MDRP RND MexB MexY
97. MRSA POT MRSA G MRSA 11 30 12 15 TB beads
98. 5 E 10 FQ CEP E PFGE MLST E FQ 22 FQ CEP D E FQ CEP FQ CEP ptible group B1 34 83 B2 40 0 FQ 50 0 CEP 40 0 FQ CEP 59 1 D TFQ FQ CEP 0 98 CEP 0 58 B2 8 9
99. 41 24 10 25 26 41 24 10 25 13 00 24 10 26 12 20 509 2207 190 1 TEL 0576 25 2048 FAX 0576 25 2390 http www bosenkan co jp index htm TEL 027 220 7992 FAX 027 220 7996 41 T ww PFER be ww ww ww JR 20 JR 2 12 30 12 45
100. Group B streptococcus GBS 1 SR Multilocus sequence typing MLST ST1 group ST23 group B 2 GBS B ES PRGBS PRGBS 2 4 PRGBS ST19 PRGBS28 ST1 group n 23 ST458 n 11 PRGBS PRGBS ST
101. TEL TEL G748 N1 rimA TEL nmA N1 rRNA BN 3 E VRE E VRE 3 Enterococcus faecium VRE
102. 7 5s43 acrx u E E Escherichia coli FOM CTX M FOM CTX M coli 145 FOM MIC CLSI M7 A8 Wachino Wachino J et al 2010 7 4ntimicrob Chemother primer set PCR Shibata N et al 2006 Antimicrob Agents Chemother
103. CTB PSGBS PRGBS CTB PSGBSe PRGBS MLST ST1 EUCAST PCG B CTB CCL GBS CTBFPSGBS PCG GBS PBP B MIC PBP B 2
104. gt 8B OprD apC Pseudomonas aeruginosa PAO1 pTnMod OGm DH5c pRK2013 PAO1 PAO1
105. 2 0 7 10 0 0 10 CCE CCE 0 4 0 4 0 0 0 0 0 0 1 1 0 0 0 0 5 6 1 12 10 0 0 10 PFGR PCR PCR based ORF typing POT ne 10 ORF 5 IMP VIM 17 ORF
106. CC 1 1 26 ST 33 POT POT1 POT2 23 POT1 12 POT1 2 3 ST genomic islet genomic islet MLST clonal complex CO POT gt alert matrix 1 2
107. A2 sz 7 ImcU pRA3 pAr 32 PD ao aag47 Acinetobacter baumannii AYE 100 pR148 IncA C E 8 ESBL
108. AcrB MexB PP MexY PP MexY MexY References 1 Murakami et al Nature 419 587 593 2002 2 Murakami et al Nature 443 173 179 2006 3 Nakashima et al Nature 480 565 569 2011 4 Nakashima et al Nature under review 2012
109. I ST1 PSGBS serotypeVl DD PSGBS ST PRGBS PSGBS ST B 2 CTB B GBS B PRGBS PSGBS CTB GBS CTB XPSGBS 2011 2012 1 CTBFPSGBSS6
110. PM PM MEPM DRPM EPM DRPM gt 2003 17 55 2010 MEPM AUD 2010 3 DRPM MEPM DRPM Total AUD 2010 MEPM 468 E 9 73 M 7U 470 MEPM 2004 83 2010 94 MEPM AUD 0 859 p lt 0 005 MEPM DRPM 0 074 p 0 849 EPM DRPM E
111. xT MexEF OprN BE MexS CEP 1 2 1 2 EQ 3 1 FQ CEP FQ CEP 14 Susceptibl O Susce vv B1 3 9 A 3 3 1 CEP e 35 Ea
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