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Vol.33 No.4 contents | Japanese/English |
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Full Text of PDF (312K) Article in Japanese |
Clinical Factors Influencing the Efficacy of the Treatment of Infections due to ESBL-producing Bacteria
Akitoshi TAKUMA1)～3), Masayuki MAEDA4), Ayumu KAWASHIMA1)5), Hirotaka WATANABE1)5), Hisako NAKAMURA2)6), Emi FUKUOKA2), Hiroko HASHIMOTO1)2), Satoshi KIMURA2)3)6) and Atsuko MINEMURA1)5)
1)Department of Pharmacy Services, Showa University Northern Yokohama Hospital, 2)Infection Control and Prevention Unit, Showa University Northern Yokohama Hospital, 3)Department of Laboratory Medicine, Showa University Northern Yokohama Hospital, 4)Division of Infection Control Sciences, Department of Clinical Pharmacy, School of Pharmacy, Showa University, 5)Department of Hospital Pharmaceutics, School of Pharmacy, Showa University, 6)Central Clinical Laboratory, Showa University Northern Yokohama Hospital
An important issue that is related to infection control is the spread of extended-spectrum β-lactamase (ESBL)-producing bacteria. Although, in addition to carbapenems, cefmetazole and flomoxef have been shown to be effective against the hydrolyzing activity of ESBL in vitro studies, the clinical studies that have evaluated their role against infection and pathogenicity caused by these organisms are few. Therefore, we evaluated the status of the isolation of ESBL-producing bacteria in Showa University Northern Yokohama Hospital and the factors associated with the efficacy of the treatment for the infections these organisms cause.
Between April 2008 and March 2016, ESBL-producing bacteria were isolated from 132 patients. A total of 128 patients were treated with antimicrobial agents for more than 3 days. No significant differences in the 30-day mortality rates were observed between the responsive group and the non-responsive group. On the one hand, in the responsive group, there were significantly more number of urinary tract infections and patients who used carbapenems. On the other hand, in the responsive group, the number of respiratory tract infection cases was significantly low. Multivariate analysis confirmed the use of carbapenems as being significantly associated with the efficacy of treatment (odds ratio, 3.73; 95% confidence interval, 1.34-10.35; P = 0.012).
Carbapenems are recognized as the first-line drug for infections with ESBL-producing bacteria. However, the usage of carbapenems should be well controlled. It is necessary to de-escalate their use when ESBL-producing bacteria are identified as non-causative pathogen.
Key words：extended-spectrum β-lactamase (ESBL), infection disease chemotherapy, carbapenem, clinical efficacy
e-mail: a-takuma＠cmed.showa-u.ac.jp
Received: October 20, 2017
Accepted: March 27, 2018
33 (4)：130─135,2018
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