| 特集名 | 透析室の感染症へどう対応するか | |
|---|---|---|
| 題名 | グラム陽性球菌（MRSA，VRE，PRSP）への対策 | |
| 発刊年月 | 2018年 06月 | |
| 著者 | 原田 孝司 | 長崎腎病院 |
| 著者 | 佐々木 修 | 長崎腎病院 |
| 著者 | 一ノ瀬 浩 | 長崎腎病院 |
| 著者 | 澤瀬 健次 | 長崎腎病院 |
| 著者 | 橋口 純一郎 | 長崎腎病院 |
| 著者 | 舩越 哲 | 長崎腎病院 |
| 【 要旨 】 | MRSAの伝播予防策は接触予防策であり，とくに標準予防策としての手指衛生が重要である．携帯用乾燥式手指消毒薬の個人所有化は伝播予防に有用である．院外からの持ち込みへの対策としてアクティブサーベイランスの有用性が報告されている．各種抗MRSA薬は，それぞれ作用機序・作用様式・適応症が異なっている． グリコペプチド系抗菌薬の汎用によりバンコマイシン耐性黄色ブドウ球菌（VRE）の院内感染症や保菌者が増加している．VREの多くは多剤耐性であるが，オキサゾリジノン系薬は効果が期待できる． 肺炎球菌は，約50％がペニシリン耐性肺炎球菌（PRSP）であり，多剤耐性が多くなっている．予防として，透析患者に対する肺炎球菌ワクチン接種の効果が認められている．VRE，PRSPは感染者と診断した場合は，保健所に届け出が義務づけられている． |
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| Theme | Dealing with infections in hemodialysis facilities | |
|---|---|---|
| Title | Management of MRSA, VRE, and PRSP infections | |
| Author | Takashi Harada | Nagasaki Kidney Hospital |
| Author | Osamu Sasaki | Nagasaki Kidney Hospital |
| Author | Hiroshi Ichinose | Nagasaki Kidney Hospital |
| Author | Kenji Sawase | Nagasaki Kidney Hospital |
| Author | Junichiro Hashiguchi | Nagasaki Kidney Hospital |
| Author | Satoshi Funakoshi | Nagasaki Kidney Hospital |
| [ Summary ] | Methicillin-resistant Staphylococcus aureus (MRSA) transmission is preventable by minimizing contact, and hand hygiene is a particularly important standard precaution. The individual use of portable hand sanitizers is effective in preventing transmission. Previous studies showed that active surveillance is useful in preventing the transmission of MRSA from outside the hospital. Glycopeptide, aminoglycoside, oxazolidinone, and cyclic lipopeptide antibiotics are used in the treatment of MRSA infection. These agents vary in terms of their mechanism and mode of action; different types of anti-MRSA agents are indicated for different patients. The widespread use of glycopeptide antibiotics has led to an increase in the number of carriers and in the incidence of nosocomial infections caused by vancomycin-resistant enterococci (VRE). Although VREs are multidrug resistant, oxazolidinone antibiotics may be effective. A diagnosis of VRE infection must be reported to a local public health center within 7 days. Penicillin-resistant Streptococcus pneumoniae (PRSP) accounts for approximately 50 % of isolates from pneumococcal infections, including those exhibiting moderate resistance, and many of these organisms are multidrug resistant. A 23-valent polysaccharide vaccine and a 13-valent conjugated vaccine are available as pneumococcal vaccines, and vaccination against pneumococcus has been shown to be effective in patients undergoing dialysis. A diagnosis of PRSP infection must be reported to a local public health center within 7 days. |
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