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1950

1960

1970

1980

1990

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2010

PCG peniciilinaseST E. coli'S. aureus

methicillinmethicillin-resistant S. aureus (MRSA)

GM-resistant S. aureus

GM

SM-resistant MTB, Meningococcus

SM

VCMKM

VCM-resistant Enterococcus

KM-resistant MTB

ABKUVWX

ABK-resistant P. aeruginpsa(RmtA)

ABK-resistant S. aureus

ABKUYZX

ESBLSTK. pneuminiae, E. coli

MDR-TB

XDR-TB

IPM/CSUYZX

IMP-1STSerratia

CIP-resistant K. pneumoniae

CIPCIP-resistant P. aeruginosa

CIP-resistant E. coli

LZD

LZD-resistant S. aureusQnr-producing E. coli VanA-producing S. aureus

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450

500

550

600

650

700

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IMP VGn�Ãop

D°¯ßûG¯åæSTkq#Ö3/rÒÓÔ�70eÁst

ûuG�n��+×#�ë0� ¡elmd-�ÕJR�7ÕÃ0v-w˨Õec#d�*+Àxy

2. MDRz{ç#eY|}eE3!U~�� ¡'ØÙ/ËX

�� UMDRP*()*+xw�ͽ'zªT%½ÒÓ-/03'Y|%��eT�À�ìÕÃ0��1�Õ½v���/�Z%¼0X

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3. ç#+q�� ¡e�l�e��+

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eï�k�

�+#3*+#�ñ´

ICAAC(2010Ñ9�)%���7�NDM-1�+[e��e»­�

2010Ñ10�18G�N�� ��ç#ò ­�¡¢£¤'¥¦§¨'©ª«¬

d)��+±²³«¬êeÒÓ§

­®[ ¯°[K. pneumoniae E. coli

0.5

1.5

MICµg/ml

ESBLUij=.+klm!-nopqrsXST#�1980Ñõ�'?@%TEM-, SHV-mESBL3gh��8�2000ÑAB'CTX-M-mESBL3ôCD�E3!FF¼08

MBLUtp^- !-nopqrsXST#�GH%1991Ñ��n_y~��+eMBL(IMP-1)ÀIJ�ÿeK'VIM-m'GIM-1'SPM-1'SIM-1'NDM-1/Ë3VW�708

KPC-m�����qrsST#�1990ÑõKL�'MNNYÐO%'KPC-1, KPC-2, KPC-3Ö3VW�708

OXA-m�����qrsST#�1990Ñõë!'Acinetobacter baumannii/Ë%IJ8�OXA-51-like'OXA-23-like, OXA-24-like'OXA-58-likeePQR3¸¹8�SÐ'OXA-483?@%E3!'ÒÓ-/ìÕÃ08

AmpC-m[\]^_`aírsST#�CMY-m/˽'[\]qvwb�&*+

ªT� 1UêÒÓ-/0�n��+()*+#

KPC-type carbapenemase

�Klebsiella pneumoniae%S�IJ�7���������������carbapnemase

�ESBL-!Åeon_A�'º0[abm!-nopqrs�

�������eÆ/6Ƕwb�&*+ÀÈ]º08�

� K. pneumoniaeeKPCST[½()*+ɳÀʺ8�������������(ST258/Ë)

()*+Àxy��Klebsiella pneumoniae

KPC-1ÀSTº0������*+[��1990ÑõKL�'MNezr_�^nvbí@ezª%öË��K�'KPC-2-!"%¼0¾-3�@

KPC-2ÀSTº0������*+[��1998Ñ-1999Ñ�MNezª%öË

KPC-3ÀSTº0������*+[��2000-2001Ñ�MNeNY Medical Center%öË��OmpK35eÌÍ'OmpK36egh��S&E3ìÕÃ0KPC-2m"-nopqrs

KPC-m"-nopqrs-�Õ½'KPC-112%ÎÏ

KPC-m"-nopqrsST[-�Õ½'MLST¿Ðe�Û��ST258(USA, Fin, Nor, Pol, Swe)3(Ã

���Of four antibiotics with minimal activity against the KPC-Kp

test strain (MIC > 16 µg/ml), those that suppressed total

anaerobes and bacteroides (i.e., clindamycin and piperacillin-

tazobactam) promoted colonization by KPC-Kp (P < 0.001),

whereas agents that did not suppress total anaerobes or

bacteroides (i.e., ciprofloxacin and cefepime) did not (P "

0.35).

KPCSTK. pneumoniae ±²[�1�'SnVÑYÒÓ¸(MIC)3'> 16 µg/ml%¼0P$ýec#de

|%'¨ÕeÔÕ+#-�oÖ^v×_ÀØÙº0'oabÚqvwb*Û�nwab-p¶�op�½' KPCSTK. pneumoniae ±²[e¦ÜÀÝÞ(P < 0.001)��3

'¨ÕeÔÕ+#-�oÖ^v×_ÀØÙ�/Ã'w�^\^��wb*[\ßÛ�½'¦ÜÀÝÞ�/Áì�(P =0.35) 8

IáâáàG`3Gá$G:á3GGCC"G55)G,585ß3G,âûû

µf§

�!"&)*+&""(,-.$/-0(�&¶wb·¸*+[3¸¹º08ú¯E"3G¹,5ºGµ»¼½æX

�¾76½'ÈFåæ*¿I"ßm�����qrs%½/1' ù}+e¿ûmú¿À#Ámü!ßnopqrseÂÃST[%¼08

ESBLUij=.+klm!-nopqrsXST#�1980Ñõ�'?@%TEM-, SHV-mESBL3gh��8�2000ÑAB'CTX-M-mESBL3ôCD�E3!FF¼08

MBLUtp^- !-nopqrsXST#�GH%1991Ñ��n_y~��+eMBL(IMP-1)ÀIJ�ÿeK'VIM-m'GIM-1'SPM-1'SIM-1'NDM-1/Ë3VW�708

KPC-m�����qrsST#�1990ÑõKL�'MNNYÐO%'KPC-1, KPC-2, KPC-3Ö3VW�708

OXA-m�����qrsST#�1990Ñõë!'Acinetobacter baumannii/Ë%IJ8�OXA-51-like'OXA-23-like, OXA-24-like'OXA-58-likeePQR3¸¹8�SÐ'OXA-483?@%E3!'ÒÓ-/ìÕÃ08

AmpC-m[\]^_`aírsST#�CMY-m/˽'[\]qvwb�&*+

ªT� 1UêÒÓ-/0�n��+()*+#

�2001Ñö÷�

��øùezª%�()*+xw�Í�opr�3E30sss

()*+Àxy��Acinetobacter baumannii

������*+�����OXA-51, 23, -58, -66/Ëe�����qrseST�����blaOXA-51eêí�IS(ISAba1Ö)3î©�7OXA-513ST�����Efflux system + AmpCUADCmXeÂÃST/Ë�����plasmid��+eIMP-1, VIM-2/ËeMBLeST

\�ï^�z^b*+�����Efflux system (AdeABC: RND family)

11111GyrA/ParCeQRDRðñeñ.

xyz{|}*+�����xyz{ò}óôQ��õ�UAAC, APH, AADX�����16S rRNA tÉÊr_(ArmA)eST�����Efflux system (AdeABC: RND family)

��M,Ö ]!

M,Ö

!"«��

Ý@«�]

TMs

TMs«�e

TMs«:i���

�ed�

EH9�m£¤

!"Ï/Í

plasmid

Chromosomal

DNA

TMs«�ewVE��

Hardly blocked

� 1«#C

Altered TMs

}'q

Porins

EH9�m£¤

½31«01^_^ (:i��^_^)

i�1«01^_^

q>01«ð6�]^¡¢

TMs: J-]^

TMs

£�1«#C

EH9�m£¤

DE(FGHIJKL;./M:LNOP8Q%RS

NT�-ä0()*+[eéê

AMKn=169

(1.52%)

IPM/MEPMn=134

(1.2%)

LVFX/CIPn=1,025

(9.21%)

n=31

(0.28%)n=179

(1.61%)

n=69

(0.62%)

n=31

(0.28%)

Acinetobacter 属 n=11,133

JANIS×rpG(2007Ñ10�ë2008Ñ9�)

ìQR*+[eéê½'!"#$%%¼!'NT%½v-

wËöË�7/Ã8

ã3N�-ä0åA. baumanniiæe=ç

GèD/ij«¬%A. calcoaceticus-baumannii-!¦�7�[e1/33' A. baumannii

Acinetobacter calcoaceticus-baumannii complexeîïD\ú

A. pittii

A. nosocomialis

Sequence-based typing methods of Acinetobacter baumannii

gene No. of ST HP References

A. baumannii

sequence

typing

(3LST)

ompA

csuE

blaOXA-51-like

7 group http://www.hpa-

bioinformatics.org.

uk/AB/

Clin Microbiol Infect

(2007) 13:807-815

J Antimicrob

Chemother (2009)

63:828-830

MLST gltA, gyrB,

gdhB,

recA,

cpn60, gpi,

rpoD

135 ST

(253

isolates)

http://pubmlst.org/

abaumannii/

J Clin Microbiol

(2005) 43: 4382-

4390

MLST

(Pasteur)

cpn60,

fusA, gltA,

pyrG, recA,

rplB, rpoB

84 ST http://www.pasteur

.fr/recherche/geno

pole/PF8/mlst/Aba

umannii.html

!"#$%&'()"&%*+(),-)$$##+&'()*+,-.()

!"#$%"&!#'(")*&+,

/0#12*

345/64*35784+9*:#;:!<=546>+=?#12<=546>+=@A

B>64CD*3E</6D*F5G+6D*HI=>G64<6D*3J+KE*G+8IL4<KD*(86</D*M+G76/CD*N5G>IO64D*)E6<46/PD*-FD

-(HD*Q686/

European clone II

European clone I

ûRef:Emerg Infect Dis (2010)16:35-40Ý

CC92

CC109

Acinetobacter spp.

A.

baumannii

A.

calcoaceticus-

baumannii

complex

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O

NH

O

OO

R

R

OO

R

HO

HO

O

O P O

OH

O

O

NH

O

OO

R

R

O

O

R

O

O

O

R

X

X= H or OH

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O

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P

O

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O

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K_Kupzr�xyb

K_Kupzr�xyb

Lipid A

Lipid A}eK_Kupzr�xybe�ê�ë0Îa_Éb*+

Phosphoethanolamine Modification of Lipid A in Colistin-Resistant Variants of Acinetobacter baumannii

Mediated by the pmrAB Two-Component Regulatory System.

Beceiro A, Llobet E, Aranda J, Bengoechea JA, Doumith M, Hornsey M, Dhanji H, Chart H, Bou G, Livermore

DM, Woodford N. Antimicrob Agents Chemother. 2011 Jul;55(7):3370-9.

`ay�wbQd�Lc+*MN*+Àʺç#

Serratia maecescens1(colistin MIC, >256 µg/mle[&(ÃX

Enterobacter spp.

Proteus spp.

Providencia spp.

Stenotrophomonas maltophilia

Burkholderia cepacia

Flavobacterium spp.

(Chryseobacterium meningosepticumVElizabethkingia meningoseptica)

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çÑèéêÕ;KL¤01�ëì�|êÕ;KLGM× (AAC, (¤)

íÑ=>01<-IJEKLM

îÑ!"#$%&'()*ïÚ+"#%),&)-Ú~ðñ|ÜàäæòåÜàá01 (Lancet, 2001)

óÑ.%/0±1«123-4,(5()*#ÞÛÛô (Lancet, 2001; JAC, 2005)

õÑvanA�ö�÷øùú5ûøùú9 (MMWR, 2002; Lancet 2003)

üÑ16S rRNA tÉÊr_STGNR*UrmtA/ËX(Lancet, AAC, 2003)

ýÑqo^nv~/ÌÍnv~*+qvÎ�nÏq (AAC, 2004)

10ÑPlasmidþÿ1FQ!"Ï/Í(QepA) (AAC, 2007)

11��-./#$%1B���&'(PRGBS)(AAC, 2008)

12ÑNDM-1Ød=>01D½l'(AAC, 2009; Lancet 2010)

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