???F????? S?? ???????G??? KAI S??? ??T???G??

1
???F????? S?? ???????G??? KAI S??? ??T???G??

• ?.?.G?aµa??????-?p???µp?????
• ?p??. ?a????t?? ?a??????a?
• ? ?a???????? ???????
• ?at???? S???? ?a?/µ??? ??????

2
?????????????? (Weed HG. Med Clin Nor Amer 2003,
87 59)

• ???a?? st?? ?st???a t?? ?e??????????
• lt 1950 ap?f??? epeµß?se?? ???? t?? ???d???? t??
  pe??e??e???t???? ???µ??e??

3
??? ?F????????? (Weed HG. Med Clin Nor Amer
2003, 87 59)

• ???-e??e???t???
• ???f??a?? ??a e?d??a?d?t?da
• ??????? ???µ??e?? se ??dete??pe??????

4
???? ?????????F?????S(Adamis G, et al. Int J
Antimicrob Agents 2004, 23 144)
Cmax
5
????O?? ??? ?G?????????? ??????(Surgical Site
Infection)(Smyth Emmerson. J Hosp Infect 2000,
45 173)

• ?p???d?p?te a?at?µ??? d?aµ???sµa µet? ta
  t????µata st? ?p??? ????a? ?e?????????? ?e???sµ??
• ???µ??? t?? e??e???t???? t?µ?? (incisional)
• ?p?p???? (d??µa ?p?d????)
• ?? t? ß??e? (µ?? pe??t???a)
• ???µ??? t?? ????? t?? sp??????? t?? ?e??????????
  ped??? (organ/space)

6
??????????G??-??????????S??S(Astagneau et al. J
Hosp Infect 2001, 48 267)

• ???t? a?t?? ??s???µe?a??? ???µ??e??
• 14-16 ??s???µe?a??? ???µ??e??
• ???e ???µ???
• ?a??tas? µ?s?? ?????? ??s??e?a? 7.3 ?µ??e?
• 3152-7500 d??????a
• ap??e?a e??at????? ep?d?µata ??????
  ep?ß????s?

7
??????T?S???? ????G????S (Pessaux P, et al. Arch
Surg 2003, 138 314)

• ?e??st?? pa??sa???a, S?2, de??t?? ASAgt2, ??????
  f??e?a S. aureus
• ?e????????? ep?µßas? d?e????e?a ????st?µ?a?,
  ßa??t?ta t?? t?a?µat??, µeta???se??, eµpe???a
  ?e????????, µe???? d????e?a

8
???G?S S???? (1) F?S????G??? ??O????(Brook I.
J Antimicrob Chemother 2002, 50 S805)

• 104 cfu/g

• 108 cfu/g

• 1011 cfu/g

• ?e??ß?a/a?ae??ß?a 1/1000

• S.aureus S.epidermidis

9
???G?S S???? (2) TO ANTIBIOTIKO(Zelenitsky SA,
et al. Antimicrob Agents Chemother 2002, 46 3026)
100 80 60 40 20 0
???a??t?ta ???µ????
0 0.5 1.0 1.5 2.0
2.5 3.0 3.5
Ge?taµ????? ???? ?at? t? s????e?s? t?? ?st??
(µg/ml)
10
?????????? ????T?S? (TRANSLOCATION)(Koutelidakis
I, et al. J Surg Res 2003, 113 243)
??????
????
NO
?????????? ????????????
???????????S S?????? ???????S?
11
??? ?????? S?S????S? ?? ?? ???????? ??S
??? (Koratzanis G, et al. Int J Antimicrob Agents
2002, 20 457)
12
????G????????? ?????????S?? (Nichols RL. Emerg
Infect Dis 2001, 7 220)

• ??e???? ep?p?d?? ????????
• ?p?µe??? ?a?a??sµ?? µe sap???? ?a? ?e?? t??
  pa?aµ???
• ?pa???? ???????s? t?? ?st?? t?? ped???

• ???a???? p??et??µas?a pa???? e?t???? de? ?fe?e?
• Zmora O, et al. Ann Surg 2002, 237 363 (380
  as?e?e??)
• Ram E, et al. Arch Surg 2005, 140 285 (329
  as?e?e??)

13
???? ??????S?O? (1) (Jimenez Wilson. Surg
Infect 2003, 4 273)
?a??de??µa ???d???? ???µ????
?a?a??? ????? d??????? ?????? sp??????? ???e?, µaste?t?µ? lt5
????t??? µ???sµ??e? d??????? ?????? sp??????? ????? d?asp??? ßa?t????? Gste??t?µ?, ???e?t?µ? 10
14
???? ??????S?O? (2) (Jimenez Wilson. Surg
Infect 2003, 4 273)
?a??de??µa ???d???? ???µ????
????sµ??e? ?st?? µe e????a f?e?µ???? ????? p?? ? d??????? ?????? sp??????? µe µe???? d?asp??? µ???????a??sµ?? ???t??s? 20
??pa??? ?a???s?a p??? ?e??t???t?da 40-50
15
??????? ???S???? ????G?S?S (Andersen BR, et al.
Cochrane Rev 2006, 4 1)
1 d?s? vs placebo (? 2191) 1 d?s? vs placebo (? 2191) Te?ape?a vs placebo (? 851) Te?ape?a vs placebo (? 851)
S? S?
??a?µa 19 0.34 10 0.34
?p?st?µa 3 0.34 3 0.38
??????e?a ??s??e?a? 1 0.40
16
????G????????? ?????????F????? (1) (Aufenacker
TJ, et al. Ann Surg 2004, 240 955 Weed HG. Med
Clin Nor Amer 2003, 87 59)

• ??? st?? ?a?a??? e?t?? ?a? a? t?p??ete?ta? ????
  s?µa ? ep? d?aß?t???? as?e????
• ?????????? st?? d???t??? µ???sµ??e?
• Kat? t?? e?sa???? st?? a?a?s??s?a
• ??? d?s? ?efa??sp?????? ß ?e?e?? iv
  (µet????da???? ??a epeµß?se?? ??t??e? t??
  d?af???µat??)
• ?pa?????? t?? d?s?? a? ? d????e?a t?? ep?µßas??
  gt3 ??e? ? ep? µe????? a?µ???a??a?

17
????G????????? ?????????F????? S?? ??????S??????
??????S??????? (Higgins A, et al. Arch Surg 1999,
134 611 Uchiyama K, et al. Dig Sis Sci 2003, 48
1955)
?efa??sp????? ß??e?e??/ aµp????????-s???µpa?t?µ? Placebo
????µ. ?s?e??? 445 331
???µ??? (a???µ.) 15 35
18
????G????????? ?????????F????? (2) (Burke JP.
Clin Infect Dis 2001, 33 Suppl 2 S78 Periti P,
et al. Eur J Clin Microbiol Infect Dis 1999, 18
113)

• Se t?p???t?s? ????? s?µat?? 1g ßa???µ??????
  d?e??e???t??? ?a? 1g µet? 12 ??e?
• Se a??t??? µ?s?e?µa pa??????a µe t? ßa???µ?????
  ?a? µ?a ?efa??sp????? ß ?e?e??

S.O.S St?? µ???sµ??e? ?a? ??pa??? epeµß?se?? ?
??????s? a?t?µ????ß?a??? ??e? ?a?a?t??a ?e?ape?a?
19
?????????F????? ??? ????TOS? ????S (Augenacker
TJ, et al. Br J Surg 2006, 93 5 Terzi C. J Hosp
Infect 2006, 62 427)

• ?te?????e?a ???????? µe?et??
• ?eta-a????s?
• 1230 ??? vs 1277 placebo
• ?aµ?? d?af???

??? a? t?p??ete?ta? p???µa
20
?????????F????? G????????G???S ??????S??S
(Cormio G, et al. Acta Obstet Scand 2003, 82
1130)

• ?a?sa???? e? ?e?µ?, p?????t? ap?ß???, ap??es?
  µ?t?a?, ?ste?e?t?µ?
• ?efa??sp????? ß??e?e?? µet????da????
• ?µp????????/s???µpa?t?µ?

21
?????????F????? ??????G???S ??????S??S (Weed
HG. Med Clin Nor Amer 2003, 87 59)

• ???state?t?µ?/t?p???t?s? pig-tail
• ?a??????e?a ?????

• S?????
• ?efa??sp????? ß??e?e??

• T?????
• Te?ape?a ß?se? a?t?ß?????µµat??
• 5-7 ?µ??e?

22
?????????F????? S?? ???????G??? S??????S????

• St?? d???t??? µ???sµ??e? epeµß?se??
• ??e??e???t???
• ?efa??sp????? ß??e?e?? ( µet????da???? ??a
  epeµß?se?? ??t??e? t?? d?af???µat??)

23
????O???S ???ST????O? ??????O?(Karchmer
Longworth. Infect Dis Clin Nor Amer 2002, Jun)

• ????µ?lt12 µ??e? µete??e???t???
• ???µ?gt12 µ??e? µete??e???t???
• CNS, S.aureus, d?f?e??e?d?, Candida spp
• 70 a? de? ?e??????????? ap?ß???e?

24
???? ?????????? ?????????F?????? (Khurana M, et
al. Br J Orth 1999, 26 295)

• ?????? ???d????
• ???s?et???? ßa?ß?de?
• ?st????? e?d??a?d?t?da?
• ??a??t???? ?a?d??p??e?e?
• Shunts
• ??t???? ???d????
• ???pt?s? µ?t??e?d??? µe a?ep???e?a
• ?e?µat??? ßa?ß?d?p??e?a
• ?pe?t??f??? µ???a?d??p??e?a

25
???? ?????????? ?????????F??????

• ?d??t?at????? e??as?e? (e?a????, ?e?ape?a
  pe???d??t?t?da?, ?a?a??sµ??)
• ??ap?e?st??? (ß?????s??p?s?, aµ??da?e?t?µ?)
• G?S (s??????e?ape?a, ERCP, ??????s??p?s?)
• ????p????e???t??? (p??state?t?µ?, ??ste?s??p?s?)

26
??? ??? ??O????? ???????? ??? ???????S?????(Hiro
ta WK, et al. Gast Endosc 2003, 58 482)

• ?µ?????????? 2g p?? (im)
• ???e???a ????daµ????? ? a?????µ?????/??a?????µ???
  ?? (iv ßa???µ?????)

27
??? ??? ???O????? ???????? ???
????????G?????????(Danchin N, et al. Heart 2005,
91 715)

• ?????? ???d????
• iv/im aµp???????? 2g ?e?taµ????? 1.5mg/kg 30min
  p?? aµp???????? 1g 6h µet?
• ??t???? ???d????
• iv/im aµp???????? 2g 30min p??

28
??? ??? ?????????????O? ?ST??O?(de Pauw B. J
Antimicrob Chemother 2004, 53 130)

• ?a?t???a?? pa?????a µ???te?
• ????? d?asaf???sµ??e? ap??e??
• ?????? µe??te? µe s?et??? µ?????? a???µ???
  as?e???
• ???µa ?a? ? µeta-a????s? de? µp??e? ?a ??se? ta
  e??t?µata ??at? ?? µe??te? ????? ete?????e?a

29
??? G?? S?S???????? ???HT??S?(Comely OA, et al.
Blood 2003, 101 3365)

• ?a ste???? Candida ap???????? t? G?S
• ??? ???? ??a s?st?µat??? ?a?t??t?as?
• ???t??e???/de?te???e???
• F??????a???? 400 mg/?µ??a s?????a ???? se
  as?e?e?? p?? ?p?ß?????ta? se µetaµ?s?e?s?
• ?e?te???e???
• ??? ??a C. kruzei, C. glabrata, Aspergillus spp

30
??? G?? BAKTH?????S ????O???S (1)(van de
Watering MD, et al. Eur J Cancer 2005, 41 1372)

• 330 µe??te?
• ???????????a? 37
• TMP/SMX vs placebo (n 10)
• ???????e? vs placebo (n 8)
• TMP/SMX vs ???????e? (n 4)

31
??? G?? BAKTH?????S ????O???S (2)(van de
Watering MD, et al. Eur J Cancer 2005, 41 1372)

• Kaµ?? ap? t?? µeµ???µ??e? µe??te? de? a?ade????e?
  ?fe???
• ? ?e?ape?a µe??se t?? ???d??? ßa?t???a?µ?a?
• ?e? µe??se t?? ???d??? ?a??t??

32
??? S??? ??T???G?? S??????S????

• G?a as?e?e?? ?????? ?a? µ?t???? ???d???? ??a
  e?d??a?d?t?da p?? epeµß?se??
• ?pa?t???ta? µe??te? µe µe?a??te?? a???µ? a???st??
  ??a ?a d?ap?st??e? ? ??s? t?? ??a t???
  ??dete??pe?????? as?e?e??.