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Title: 全国多施設での院内肺炎の実態と初期治療におけるmeropenemの位置づけ
Other Titles: Nationwide multicenter survey on the pathophysiology of hospital-acquired pneumonia and the use of first-line antibiotics in Japan: Evaluation of clinical position of meropenem in the initial therapy of hospital-acquired pneumonia
Authors: 河野, 茂 / 渡辺, 彰 / 松島, 敏春 / 院内肺炎研究会
Authors (alternative): Kohno, Shigeru / Watanabe, Akira / Matsushima, Toshiharu / HAP Study Group
Issue Date: Sep-2006
Publisher: 日本化学療法学会 / Japanese Society of Chemotherapy
Citation: 日本化学療法学会雑誌, 54(5), pp.453-464; 2006
Abstract: 日本呼吸器学会(JRS)「呼吸器感染症に関するガイドライン―成人院内肺炎診療の基本的考え方―」に基づき,院内肺炎の病態と初期治療の実態を調査し,メロペネム(MEPM)の院内肺炎初期治療における位置づけを検討した。2002年6月~2004年5月を調査期間として,連続登録方式により院内肺炎症例をプロスペクティブに調査対象とし,全国254施設より院内肺炎症例計1,460例を収集し1,356例を解析対象とした。初期治療におけるMEPM使用例は661例であり,そのうち506例(76.6%)が単剤使用であった。他薬剤併用例では,重症例を中心にクリンダマイシン,テトラサイクリン系薬,アミノ配糖体系薬の順に多く使用された。また,MEPMは重症例やJRS院内肺炎ガイドラインで規定された危険因子の多い症例に多く使用され,病型別でも中等症で危険因子あり,または重症の肺炎[III群:タイプC]や特殊病態下の肺炎[IV群:タイプD~H]といった重篤な病態の症例が91.7%(606/661)を占めたが,MEPM初期治療使用例の有効率は54.4%(349/641)であり,カルバペネム系薬非使用例の有効率(47.2%:238/504)に比較して有意に高値であった。また,初期治療におけるMEPM投与量は,90%以上の症例が常用量(0.25~0.5 g×2回/日)であり,1日3回投与や承認上限用量である1日2 g投与が行われた症例は少なかった。院内肺炎の原因菌が緑膿菌等の抗菌薬に低感受性の細菌が主体であることも考慮すると,次回ガイドライン改訂時にはPK/PD理論に基づいた抗菌薬投与量設定の重要性について言及する必要があるものと考えられた。安全性について,MEPM投与症例での主な副作用は肝機能障害であり,添付文書の「使用上の注意」から予測できない重篤な副作用は認められなかった。以上の結果より,MEPMは院内肺炎の初期治療において重要な位置づけを占める薬剤であることが示唆された。 / Through a nationwide, collaborative, multicenter survey to investigate the pathophysiological profile of hospital-acquired pneumonia (HAP) and the use of first-line antibiotics, we evaluated the clinical position of meropenem (MEPM) in the initial therapy of HAP. A prospective survey was conducted of consecutively-enrolled patients with HAP in the period from June 2002 to May 2004. Data were collected for a total of 1,460 patients from 254 institutions across Japan. Among the cases analyzed for patient profiles (1,356 patients), 661 cases were treated with MEPM among the first-line antibiotic. Of the MEPM-treated cases, monotherapy accounted for 76.6%. Among cases treated with MEPM combination therapy, clindamycin was used in 24.5%, followed in descending order by tetracyclines and aminoglycosides. MEPM was preferably used for serious cases or cases having many risk factors defined in the Japanese Respiratory Society Guidelines for Management of HAP in Adults. As for the distribution of the disease type, moderate pneumonia with a risk factor or severe pneumonia [Group III: type C] and pneumonia with specific conditions [Group IV: type D?H] accounted for 91.7% of all cases. The response rate was 54.4% when MEPM was used as a first-line medication, and 47.2% when carbapenems were not used. Most of the MEPM-treated patients were the dosage which is normal in Japan (0.25?0.5 g×2/day). As the main causative organisms of HAP were antibiotic-resistant bacteria such as Pseudomonas aeruginosa, future revisions of the HAP guideline should incorporate consideration of antibiotics dosage based on the PK/PD theory. As for safety, main adverse drug reactions in MEPM-treated patients were hepatic function disorder. Unlabelled serious adverse drug reactions were not reported. In conclusion, the results from this study suggest that MEPM plays an important role in the initial therapy of HAP.
Keywords: hospital-acquired pneumonia / meropenem / guideline
URI: http://hdl.handle.net/10069/26669
ISSN: 13407007
Type: Journal Article
Text Version: publisher
Appears in Collections:Articles in academic journal

Citable URI : http://hdl.handle.net/10069/26669

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