« 膠原病?? | メイン | 耐性菌UpDate »

嫌気性菌

嫌気性菌

臓器で菌決まる →抗菌薬決まる
 胃より下なら Bacteroides 。これを含むか含まないか
 横隔膜より上か下か
   上なら、 ペプトストレプトコッカス、フソバクテリウム
   下なら、 バクテロイデス

「嫌気性菌にCLDM」??

ポイント
●混合感染
●培養で出ないことあり
  酸素が混じることも
  技術的にも難しい
 →臨床診断。感染臓器はどこ???
  培養陰性でも、可能性のある病原体を叩く
  感受性検査も難しい… できないことあり
  グラム染色がひとつの手がかり
    培養ででなくてもでることも

検体ごとの感受性よりも、診断から予測される病原体の感受性傾向が大切

De-escalationを無理にすすめられない

   ◆ではどの抗生剤つかうの??

・ルーチンの血液培養は必要???
  岩田先生が書いていた

逆に、抗菌薬から嫌気性菌を考えてみる

・PCG
  口腔内嫌気性菌にはよく効く
  ペニシリナーゼ産生菌にはだめ
    …バクテロイデスとか
・セファロスポリン
  セファマイシンにくらべると弱い
  口腔内には効くかもしれないけれど… →ペニシリンと比べると、いみない
・セファマイシン
  セフメタゾール、セフォペラゾンなど、
  大腸癌の予防投与に好まれる
  バクテロイデスは、 5〜10%耐性を持っている
・CLDM
   オールマイティではない
  バクテロイデスは10〜20%耐性
  クロストリジウムには効かない
  骨移行性はいい
  膿瘍移行性がいいかもしれない(古川先生の経験から)
・なんでも効くやつ
  ペネム・βラクタマーゼ阻害薬との合剤
   …ただ、メタロβラクタマーゼ産生、だと、どっちも効かない…
  メトロニダゾール   …点滴がほしい
  クロラムフェニコール …副作用強いから使いにくい
   …ほとんど感受性があるのでどれも使える!!!!

 ポイント
  セファマイシン・クリンダマイシンは感受性が微妙(10%は効かない)


他のポイント

●脳膿瘍
口腔、鼻腔から直接いく
腸内細菌が血行性に飛ぶ

●肺膿瘍、肺化膿症
口腔内常在菌が落ち込む
腸内細菌の誤嚥も多い


抗菌薬が効かない嫌気性菌感染症はどうするか
・変更? 併用? (eg チエナム・CLDM
  まちがえている)
・高圧酸素??
  有効ではない

→ドレナージ! 薬では治らないと伝える


★ポイント
・感染臓器!!!!
・培養生えない!!!!
・CLDM 万能ではない
・ドレナージ


(おまけ)
セファマイシン
 基本は使わない

トラックバック

このエントリーのトラックバックURL:
http://dream-hosp.net/cgi/mt/mt-tb.cgi/2662

コメント

What a lovely day for a 2353061! SCK was here

What a lovely day for a 1997613! SCK was here

Great write-up, I am regular visitor of one窶冱 website, maintain up the nice operate, and It is going to be a regular visitor for a long time.

You made certain nice points there. I did a search on the topic and found the majority of persons will go along with with your blog.

What a lovely day for a 3382318! SCK was here

aesthetic value are sometimes attained. Pretty much all that is

Guten Tag! Schテカner Weblog! magst

Wow, fantastic blog layout! How long have you been blogging for? you made blogging look easy. The overall look of your site is wonderful, let alone the content!

I used to be very happy to seek out this net-site.I needed to thanks in your time for this excellent learn!! I undoubtedly enjoying each little bit of it and I've you bookmarked to take a look at new stuff you weblog post.

Yes, i am glad that your asking us to know our opinion.

We are a group of volunteers and opening a new scheme in our community. Your site offered us with valuable info to work on. You have done a formidable job and our whole community will be thankful to you.

yes definitely

Hello there! I could have sworn I窶况e been to this website before but after browsing through some of the post I realized it窶冱 new to me. Anyhow, I窶冦 definitely happy I found it and I窶冤l be book-marking and checking back often!

What a lovely day for a 429345! SCK was here

Great article, I窶况e bookmarked this page and have a feeling I窶冤l be returning to it often.

Simply want to say your article is as tonishing. The clearness in your post is simply spectacular and i can assume you are an expert on this subject. Well with your permission allow me to grab your rss feed to keep up to date with forthcoming post. Thanks a million and please keep up the gratifying work.

Congratulations for posting such a useful blog. Your blog isn't only informative but also extremely artistic too. There usually are extremely couple of individuals who can write not so easy articles that creatively. Keep up the good writing !!

Thanks a bunch for sharing this with all of us you actually know what you're talking about! Bookmarked. Please also visit my site =). We could have a link exchange contract between us!

Gracias por compartir su maestrテュa en esta テ。rea. Hay mucho Info inテコtil en esto que flota alrededor y aprecio su trabajo duro.

What窶冱 Happening i am new to this, I stumbled upon this I've found It absolutely useful and it has helped me out loads. I hope to contribute & aid other users like its aided me. Great job.

What a lovely day for a 3178201! SCK was here

Great beat ! I would like to apprentice while you amend your site, how could i subscribe for a blog web site? The account helped me a acceptable deal. I had been tiny bit acquainted of this your broadcast offered bright clear concept

Need to shed fat? Finally a diet supplement that works and it's a TOP RATED PRODUCT by LANCE ARMSTRONG'S FOUNDATION LIVESTRONG! Boost metabolism, increase energy levels, supress appetite, aid digestion, fight free radicals, and maximize your ability to burn calories with FUSION 5. CLICK HERE and get your sample bottle today!

Need to shed weight? Finally a diet supplement that works and it's a TOP RATED PRODUCT by LANCE ARMSTRONG'S FOUNDATION LIVESTRONG! Boost metabolism, increase energy levels, supress appetite, aid digestion, fight free radicals, and maximize your ability to burn calories with FUSION 5. CLICK HERE and get your sample bottle today!

It窶冱 exhausting to seek out knowledgeable folks on this topic, however you sound like you understand what you窶决e speaking about! Thanks

After examine just a few of the weblog posts on your website now, and I truly like your means of blogging. I bookmarked it to my bookmark web site listing and will probably be checking again soon. Pls take a look at my website online as well and let me know what you think.

Nice Blog! I am getting tired of reading mindless web sites so I appreciate your well thought out conversation. I just wish there were more educated responses. Thanks again!

I discovered your blog web site on google and check a number of of your early posts. Proceed to keep up the very good operate. I simply extra up your RSS feed to my MSN News Reader. Seeking forward to reading extra from you afterward!窶ヲ

Really, thanks for posting this. Appreciated!

I found your blog on the search engines. I believed most websites were hard to rank. You must have some Google wizardry in here some place. Many thanks for the posting.

Just want to say your article is as astounding. The clarity in your post is just cool and i could assume you are an expert on this subject. Fine with your permission allow me to grab your feed to keep up to date with forthcoming post. Thanks a million and please continue the rewarding work.

Great. I like it!

Nice submit. I was checking continuously this blogging site and I am impressed! Very useful info specially the last part :) I care for such info much. I was seeking this particular info for a long time. Thanks and good luck.

Its like you look at my mind! You seem to know so much about this, like you wrote the book in it or something. I believe that you can do with a few pics to drive the message home a bit, but instead of that, that is excellent blog site. An excellent browse. I'll certainly be back again.

Nice post. I learn something more challenging on different blogs everyday. It will always be stimulating to read content from other writers and practice a little something from their store. I窶囘 prefer to use some with the content on my blog whether you don窶冲 mind. Natually I窶冤l give you a link on your web blog. Thanks for sharing.

Hands down, Apple's app store wins by a mile. It's a huge selection of all sorts of apps vs a rather sad selection of a handful for Zune. Microsoft has plans, especially in the realm of games, but I'm not sure I'd want to bet on the future if this aspect is important to you. The iPod is a much better choice in that case.

Wow! This can be one particular of the most helpful blogs We have ever arrive across on this subject. Basically Fantastic. I'm also a specialist in this topic so I can understand your hard work.

That is a remarkably amazing powerful resource that you窶决e offering and you just provide it away cost-free!! I really like discovering websites ones see the particular importance of offering you an excellent learning resource for zero cost. We truly dearly loved examining this blog. Enjoy it!

Hi, i believe that i saw you visited my site so i came to 窶徨eturn the favor窶.I am trying to acquire things to improve my site!I suppose its ok to use a few of your ideas!!

Hello! This is my 1st comment here so I just wanted to give a quick shout out and tell you I really enjoy reading through your blog posts. Can you suggest any other blogs/websites/forums that deal with the same topics? Thanks a lot!

magnificent post, very informative. I wonder why the other experts of this sector don't notice this. You must continue your writing. I'm confident, you have a great readers' base already!

Hey, I think your really on track with this, I can't say I am completely on the same page, but its not really that big of a deal .

Thanks for making the honest effort to speak about this. I feel very sturdy about it and want to read more. If it's OK, as you achieve extra extensive wisdom, might you thoughts including more articles similar to this one with additional info? It would be extraordinarily useful and helpful for me and my friends.

I've been absent for some time, but now I remember why I used to love this website. Thank you, I will try and check back more frequently. How frequently you update your web site?

היי האם אתם יודעים שמומלץ להזמין מאמנת כושר אישי, מאמן כושר אישי, מגיע/ה אליך 3 פעמים בשבוע. כדאי לפעילות גופנית, בונה לך תוכנית כושר אישית שמתאימה לך למטרה שלך

היי רציתי ךהודיע על אתר אינטרנט בנושא קידום אתרים בגוגל. באתר ניתןלצפות באינפורמציה בתחום קידום אתרים בגוגל.

With havin so much written content do you ever run into any issues of plagorism or copyright violation? My website has a lot of exclusive content I've either written myself or outsourced but it seems a lot of it is popping it up all over the web without my authorization. Do you know any methods to help reduce content from being ripped off? I'd certainly appreciate it.

Major thanks for the article post. Will read on窶ヲ

We're a group of volunteers and starting a new scheme in our community. Your web site offered us with valuable information to work on. You have done an impressive job and our whole community will be grateful to you.

You made some nice points there. I did a search on the subject and found most persons will consent with your blog.

Wow that was unusual. I just wrote an extremely long comment but after I clicked submit my comment didn't appear. Grrrr... well I'm not writing all that over again. Regardless, just wanted to say wonderful blog!

You really make it seem so easy with your presentation but I find this topic to be actually something that I think I would never understand. It seems too complex and very broad for me. I'm looking forward for your next post, I will try to get the hang of it!

A person generally help to make seriously posts I would state. This is actually very first time I visited your web page and thus far? I amazed with the research you made to make this amazing post wonderful. Amazing job!

Beach front residences are genuinely well-known in the vicinity, so even despite the fact that the men and women previously mentioned are certainly not conclusively saying yes with just what I presume, they still do carry about rather excellent factors with regards to property at this point.

Nice read, I just passed this onto a friend who was doing a little research on that. And he just bought me lunch since I found it for him smile So let me rephrase that: Thanks for lunch!

Aw, this was a really nice post. In thought I want to put in writing like this additionally 窶 taking time and precise effort to make an excellent article窶ヲ but what can I say窶ヲ I procrastinate alot and not at all appear to get something done.

Hi there this is kind of of off topic but I was wanting to know if blogs use WYSIWYG editors or if you have to manually code with HTML. I'm starting a blog soon but have no coding know-how so I wanted to get advice from someone with experience. Any help would be greatly appreciated!

Great goods from you, man. I have understand your stuff previous to and you are just too fantastic. I really like what you have acquired here, really like what you're saying and the way in which you say it. You make it entertaining and you still take care of to keep it smart. I can not wait to read much more from you. This is actually a tremendous website.

Peculiar this post is totaly unrelated to what I was looking google for, but it used to be listed on the first page. I assume your doing something proper if Google likes you enough to place you at the first web page of a non comparable search.

It窶冱 really a great and helpful piece of info. I am glad that you shared this useful information with us. Please keep us informed like this. Thanks for sharing.

Do you have a spam problem on this blog; I also am a blogger, and I was wanting to know your situation; many of us have developed some nice procedures and we are looking to swap techniques with other folks, be sure to shoot me an email if interested.

As i got to express which the writing is usually remarkable which will make us discovered a great deal of matters news. I many strategy in my mind today. Nice one for this method. I think you will is able to keep intending together with bear portion brand-new advice that thought but.

Thanks for another great post. Where else could anybody get that kind of information in such a perfect way of writing? I have a presentation next week, and I'm on the look for such information.

I was just looking for this info for a while. After six hours of continuous Googleing, finally I got it in your web site. I wonder what's the lack of Google strategy that do not rank this type of informative websites in top of the list. Normally the top websites are full of garbage.

I really liked reading your post!. Quallity content. With such a valuable blog i believe you deserve to be ranking even higher in the search engines.

Yes, you are right.

Your blog is GREAT! I found it in google.

Remarkable submit, stunning weblog with remarkable informational content. This is actually a definitely intriguing and helpful submit.

There are some interesting time limits on this article but I don窶冲 know if I see all of them heart to heart. There is some validity but I'll take hold opinion until I look into it further. Good article , thanks and we wish more! Added to FeedBurner as well

コメントを投稿