Study on rational antimicrobial use through activities of a medical relief team after the Indian Ocean Tsunami

印度洋海啸后医疗救援队活动中合理使用抗菌药物的研究

• 批准号: 18614002
• 负责人: OKUMURA Junko
• 金额: $ 2.58万
• 依托单位: Kanazawa University
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (C)
• 财政年份: 2006
• 资助国家: 日本
• 起止时间: 2006 至 2007
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-18614002/
• 关键词: Wound Infection; Antimicrobilas; International medical relief; Natural disaster; Tsunami; Aquatic environment; Gram-negative bacilli; 創部感染; 感染症; 抗生物質

Further analyses of the 1st year results and reviews of the previous studies on traumatic wound infection were done. According to a report by Indonesia University (2004), one of commonly isolated bacteria from infected wounds in Jakarta was Staphylococcus aureus (14%). Japan Disaster Relief (JDR) medical team selected beta-lactam penicillins as 1st line antimicrobials under an assumption that the causative bacteria of wound infections were mainly S. aureus. On the contrary, there were several studies reported that traumatic wound cases submerged in water were infected with Aeromonads. However, Aeromonads are rarely considered as one of infectious agents when Japanese doctors start empirical therapy for such cases. Major reasons for the difficulty in such practice are: wound infections caused by Aeromonas spp. Are similar to those by S. aureus, and most of Aeromonads are resistant to beta-lactam penicillins. Therefore, by making Gram staining available, it will be possible to provide appropriate antimicrobial therapy at early timing. Further, the result of analyses of water samples collected from aquatic environment and qualitative data obtained from tsunami survivors at Banda Aceh suggested that the survivors been repeatedly exposed to pathogens, Aeromonas spp., Klebsiela spp., Vibrio spp. When they were bathing at shelters.Through this study researchers recommend a empirical therapy, i.e., where clinical microbiological are not available: the initial use of beta-lactam penicillins for 3 days for S. aureus, followed by new quinolones if the first antimicrobial is not effective under an assumption that the etiological agents are Gram-negative bacilli or beta-lactam penicillins resistant bacteria. Finally it is highly recommended that medical relief team such as JDR should equip for Gram staining and keep enough amounts of new quinolones.

对第1年结果进行了进一步分析，并对创伤性伤口感染的既往研究进行了回顾。根据印度尼西亚大学（2004年）的一份报告，雅加达感染伤口中常见的分离细菌之一是金黄色葡萄球菌（14%）。日本灾难救援（JDR）医疗小组选择β-内酰胺青霉素作为一线抗菌剂，假设伤口感染的致病菌主要是S。金黄色。相反，有几项研究报道，浸泡在水中的创伤性伤口病例感染了气单胞菌。然而，当日本医生开始对此类病例进行经验性治疗时，很少将气单胞菌视为感染源之一。造成这种实践困难的主要原因是：由气单胞菌属引起的伤口感染。类似于S。大多数气单胞菌对β-内酰胺青霉素耐药。因此，通过使革兰氏染色可用，将有可能在早期提供适当的抗菌治疗。此外，从水生环境中收集的水样分析结果和从班达亚齐海啸幸存者中获得的定性数据表明，幸存者反复接触病原体，气单胞菌属，克雷伯氏菌属，弧菌属当他们在避难所洗澡时。通过这项研究，研究人员推荐了一种经验疗法，即，在临床微生物不可用的情况下：对于S.金黄色葡萄球菌，如果第一种抗菌剂无效，则在假设病原体是革兰氏阴性杆菌或β-内酰胺青霉素耐药菌的情况下，使用新的喹诺酮类。最后，强烈建议医疗救援队，如JDR，应配备革兰氏染色和保持足够的新喹诺酮类药物。

项目成果

津波による受傷者に対する抗生剤の使用のあり方について - Banda Acehにおける環境中細菌の薬剤耐性レベル調査の結果から -

海啸灾民应如何使用抗生素 - 基于班达亚齐环境细菌耐药性水平调查结果 -

• 发表时间: 2006
• 期刊: 日本集団災害医学会誌 11(2)
• 作者: Junko;Okumura;Kazuko;Kimura;Tatsuro;Kai;Hayati;Zinatul;Karmil;Fadrial;Yasuhiro;Yamamoto;奥村 順子;奥村順子
• 通讯作者: 奥村順子

Anti-microbial resistant Gram negative bacilli in water in Banda Aceh: For rational antibiotic use for traumatic wound caused by tsunami

班达亚齐水中的抗微生物耐药革兰氏阴性杆菌：海啸造成的创伤性伤口的合理使用抗生素

• 发表时间: 2007
• 期刊: Prehospital and Disaster Medicine 22 Suppl.1
• 作者: MC. Shin;BII. Min;CJ. Kim;K. Shoudai;S. Ogawa;N. Akaike;奥村順子
• 通讯作者: 奥村順子

Anti-microbial resistant Gram negative Bacilli in water in Banda Aceh : For rational antibiotic use for traumatic Wound caused by tsunami

班达亚齐水中的抗微生物耐药革兰氏阴性杆菌：合理使用抗生素治疗海啸造成的创伤

• 发表时间: 2007
• 期刊: Prehospital and Disaster Medicine 22
• 作者: Junko;Okumura;Kazuko;Kimura;Tatsuro;Kai;Hayati;Zinatul;Karmil;Fadrial;Yasuhiro;Yamamoto
• 通讯作者: Yamamoto

Anti・microbial resistant Gram negative bacilli in water in Banda Aceh: For rational antibiotic use for traumatic wound caused by tsunami

班达亚齐水中的抗微生物革兰氏阴性杆菌：海啸造成的创伤的合理使用抗生素

• 发表时间: 2007
• 期刊: Prehospital and Disaster Medicine 22Suppl.1
• 作者: Junko;Okumura;Kazuko;Kimura;Tatsuro;Kai;Hayati;Zinatul;Karmil;Fadrial;Yasuhiro;Yamamoto;奥村 順子
• 通讯作者: 奥村 順子