資　　　料

細菌検査で選択する感受性測定薬剤についての検討

鯉　渕　晴　美*1　渋　谷　泰　寛*2　久　保　信　彦*3
河　野　幹　彦*4　伊　東　紘　一*5　　　　　　　　　
　　　　　　　　　　　　　　　　　　　　　　
Selection of Appropriate Antimicrobial Agents to Test and Report
by Clinical Microbiology Laboratories

Harumi KOIBUCHI, MD*1, Yasuhiro SHIBUYA, MD*2, Nobuhiko KUBO, MD*3,
Mikihiko KAWANO, MD*4 and Kouichi ITOH, MD*5

Clinical microbiology laboratories in Japan have not yet established standards for selecting the most appropriate antimicrobial agents for testing and reporting antimicrobial susceptibility that are comparable to the performance standards of the National Committee for Clinical Laboratory Standards(NCCLS) in the United States of America.
Selection of the most appropriate antimicrobial agents for testing and reporting was discussed by a working group(WG) consisting of medical physicians, surgeons, pharmacists, medical technologists and medical microbiologists. The WG agreed on the following basic criteria for the selection of antimicrobial agents: 1) the agent should be useful when screening various resistant bacteria, 2) the agent should serve as a useful guide for physicians and residents when selecting antimicrobial agents, and 3) the agent should be useful for controlling nosocomial infections and resistant bacteria. Clinically isolated microorganisms were classified into 7 groups based on susceptibility to antimicrobial agents. These groups were Staphylococcus spp. or Enterococcus spp., Streptococcus spp. or Haemophilus spp., enterobacteriae, glucose non-fermenting gram positive rods(NFRs), anaerobic bacteria, fungi and mycobacterium.
After considering clinical and bacteriological evidence, the WG decided on several antimicrobial agents for testing in clinical microbiology laboratories in Jichi Medical School Hospital. For the NFR group, these were Piperacillin(PIPC), ceftazidime(CAZ), cefepime, imipenem, amikacin and levofloxacin(LVFX). For the enterobacteriae group, these were Ampicillin(ABPC), PIPC, aztreonam, CAZ and LVFX. For the Staphylococcus spp. or Enterococcus spp. group, these were oxacillin, ABPC, vancomycin and gentamicin.
We concluded that the most appropriate antimicrobial agent for testing and reporting must be economical and agreed upon at the hospital level, although the ultimate selection must be based on the available clinical and bacteriological evidence.
[Rinsho Byori 50 : 992〜999, 2002]

*1Department of Clinical Laboratory Medicine, Jichi Medical School, Kawachi-gun,Tochigi 329-0498

【Key Words】antimicrobial agents(抗菌剤)，susceptibility testing(薬剤感受性検査)，drug resistant bacte-ria(耐性菌)，evidence-based laboratory medicine(根拠に基づく臨床検査医学)

受付2002年4月22日・受理2002年9月20日
*1〜5自治医科大学臨床検査医学教室(〒329-0498 栃木県河内郡南河内町薬師寺3311-1)

E-mail :koichan@jichi.ac.jp