6. ANTIBIOTIC RESISTANCE THREATS
in the United States, 2013
耐性菌への感染者
2,000,000人/年
Antibiotic Resistant Threats in the United States, 2013
7. ANTIBIOTIC RESISTANCE THREATS
in the United States, 2013
耐性菌による死亡
Antibiotic Resistant Threats in the United States, 2013
23,000人/年
8. ANTIBIOTIC RESISTANCE THREATS
in the United States, 2013
耐性菌への追加コスト
Antibiotic Resistant Threats in the United States, 2013
20,000,000,000㌦/年
200億㌦≒2兆円
15. TACKLING DRUG-RESISTANT
INFECTIONS GLOBALLY:
FINAL REPORT AND
RECOMMENDATIONS
THE REVIEW ON
ANTIMICROBIAL RESISTANCE
CHAIRED BY JIM O’NEILL
MAY 2016
http://amr-review.org/
Jim O’Neill氏による報告書 2016年5月に最終報告
インターネットで閲覧可能(日本語あり)
23. ANTIBIOTIC RESISTANCE
from the farm to the table
RESISTANCE Animals can carry harmful bacteria in their intestines
When antibiotics are given to animals...
Antibiotics kill
most bacteria
But resistant bacteria
can survive and multiply
SPREAD Resistant bacteria can spread to...
animal products
produce through
contaminated water or soil
prepared food through
contaminated surfaces the environment when animals poop
家畜への抗菌薬
耐性菌の選択と増加
http://www.cdc.gov/foodsafety/pdfs/ar-infographic-508c.pdf 改編
人の場合と同じように、抗菌薬の継続利用は
動物の消化管内での耐性菌の選択圧を高め、その増殖を促してしまう。
24. 耐性菌の拡散
When antibiotics are given to animals...
Antibiotics kill
most bacteria
But resistant bacteria
can survive and multiply
SPREAD Resistant bacteria can spread to...
animal products
produce through
contaminated water or soil
prepared food through
contaminated surfaces the environment when animals poop
EXPOSURE People can get sick with resistant infections from...
contaminated food contaminated environment
Antibiotics kill
most bacteria
But resistant bacteria
can survive and multiply
spread to...
repared food through
ontaminated surfaces the environment when animals poop
ck with resistant infections from...
contaminated environment
When antibiotics are given to animals...
Ant
mo
SPREAD Resistant bacteria can spread to...
animal products
produce through
contaminated water or soil
prepared food through
contaminated surfaces
EXPOSURE People can get sick with resistant inf
contaminated foodhttp://www.cdc.gov/foodsafety/pdfs/ar-infographic-508c.pdf 改編
食肉の汚染、そして糞便から周囲の土壌/水資源等の環境が汚染される。
これによる作物表面への耐性菌の付着も確認されている。
食肉と環境の汚染
25. SPREAD Resistant bacteria can spread to...
animal products
produce through
contaminated water or soil
prepared food through
contaminated surfaces the environment when animals poop
EXPOSURE People can get sick with resistant infections from...
contaminated food contaminated environment
IMPACT Some resistant infections cause...
mild illness severe illness and may lead to death
Learn 4 steps to prevent food poisoning at www.foodsafety.gov
About 1 in 5 resistant
infections are caused by germs
from food and animals.
Source: Antibiotic Resistant Threats in the United States, 2013
ヒトへの暴露
http://www.cdc.gov/foodsafety/pdfs/ar-infographic-508c.pdf 改編
耐性菌に汚染された食肉/作物の摂取でヒトの腸管内へ取り込まれる。
また農業に従事するヒトの手からの感染も報告されている。
耐性菌感染症の20%は食品/家畜関連
26. 環境の汚染
• 3世代セフェム耐性 大腸菌
9.1% vs 3.1%
➾ 約3倍 (p=0.040)
• ESBL産生 大腸菌
6.3% vs 1.5%
➾ 約4倍 (p=0.046)
英国のサーファーの腸内に耐性菌!
Leonard AFC, Environ Int. 2018; Article in Press
141. 適切な抗菌薬の供給は
小さな命を救う
Figure 1: Estimated pneumonia deaths avertable in under-5 populations with improved antibiotic access
Countries with less than 100 deaths averted are not labelled. Data on under-5 population with suspected pneumonia receiving antibiotics are from 1990 to 2013;
0 20 40 60 80
Trendline weighted by
the under-5 population
of each country
100
0
1
2
3
4
5
6
Pneumoniadeaths(duetoStreptococcuspneumoniaeandHaemophilus
influenzaetypeb)per1000childrenagedyoungerthan5years
Under-5 population with suspected pneumonia receiving antibiotics (%)
India
Nigeria
DR Congo
Pakistan
China
Ethiopia
Afghanistan
Sudan
Indonesia
Somalia
Mali
Niger
Uganda
Chad
Tanzania
Burkina Faso
Kenya
Yemen
Mozambique
Cameroon
Myanmar
Philippines
Côte d’Ivoire
Bangladesh
Guinea
Iraq
Madagascar
Nepal
Malawi
Ghana
Burundi
Benin
Sierra Leone
Uzbekistan
Zambia
Egypt
Haiti
Senegal
Iran
Central African Republic
Togo
Vietnam
Morocco
Brazil
Rwanda Zimbabwe
Mauritania
Cambodia
Tajikistan
Algeria
Congo (Brazzaville)
Guinea−Bissau
Bolivia
ColombiaTurkey
Thailand
North KoreaLaos
Argentina
KazakhstanPeru
Timor−Leste
Dominican Republic
Equatorial Guinea
Kyrgyzstan Syria
Gambia
Comoros Swaziland
Honduras
Paraguay
Ukraine
India (169760)
Nigeria (49407)
Nepal (2434)
Hypothetical under-5 pneumonia deaths
averted with universal antibiotic access
Laxminarayan R, Lancet. 2016; 387: 168
151. 蕁麻疹と皮疹
The new engl and jour nal of medicine
A B
DC
蕁麻疹 斑状丘疹性皮疹
画像 蕁麻疹:www.allergyuk.org, 斑状丘疹性皮疹:Stern RS, N Engl J Med. 2012; 366: 2492
蚊に刺されたような感じ 融合して大きくなる
169. 医療チームでの情報伝達
• I : 薬剤師の佐野です。ICUのAさんのことで。
• S : OPE帰室から痛みが強くて、頻脈になっています。
• B : 外傷のOPE後でセレコックスのみの指示です。
• A : 現在、頓用の指示もなく、セレコックスでは疼痛コン
トロールが不良と考えます。
• R : 医師で術後の疼痛で間違いないか確認してください。
アセリオの6時間毎もしくは疼痛時の投与を提案します。
例えば…