- PDF 無料ダウンロード

Size: px

Start display at page:

Download ""

いちえいあさま
5 years ago
Views:

18 (5): 420, ) Schweich, A. et al.: Staphylococcal Septicemia with recurrent spontaneous Pneumothorax, Ann. Int. Med. 50 (3), 819, ) Hassal, J. E. et al.: Staphylococcal Septicemia, Lancet I.: 213, to Coagulase-Positive Staphylococcus Auneus, Ann. Int. Med. 52(3): 643, ) P. N.: Antibiotics and Host Resistance, Swift, Brit. Med. Journ. 1: 129, ) Rogers, D. E.: The Current Probrem of Staphylococcal Infections, Ann. Int. Med. 54 (5): 748, ) Beason, P. B. et al.: Bacteremia, A Consideration of some experimental and clinical As- pects, Yale J. Biol. Med. 26: 241, ) Rogers, D. E.: Studies on Bacteremia, J. Exper. Med., 103: 713, ) Spink, W. W.: Staphylococcal Infections and the Problem of An- tibiotic-resistant Staphylococci, Arch. Int Med., 45: 748, ) Smith, I. M.: Natural History of 338 treated and untreated Patients with Staphylococcal Septicemia ( ), Lancet

19 Septicemia in These Days Gyoichi KOYA, Tsunenori HASEGAWA, Yoko SHINODA Department of Internal Medicine, First National Hospital, Tokyo and Nozomu KOSAKAI Department of Clinical pathology, Juntendo University School of Medicine, Tokyo Fifty-three patients with septicemia admitted to the First National Hospital of Tokyo during the past eight years were investigated by the authors in order to find out modern tendency of the infection. Mircoorganisms isolated from the blood stream were staphylococci in twenty-two cases, Gram-negative bacilli in eleven, and streptococci in twenty. Sensitivity tests of these microorganisms were performed against chloramphenicol, tetracycline, erythromycin, streptomycin, penicillin and sulfa preparation by the disk method. Twenty one cases acquired the infection during the course of underlying disesses within the hospital. The majority of streptococcal infections (subacute bacterial endocarditis) developed the illness outside the hospital, whereas almost all of the septicemia cases due to Gram-negative bacilli were hospital-acquired. The mortality rate excluding six cases with neoplasma or leucemia was 42.5%, the over-all being 40%. The portal of entry, age, sex, cause of hospital admission, history, physical and laboratory findings, sensitivity of causual microorganisms, and effect of chemotherapy in the 53 patients studied are presented and discussed separately in three chapters. I Staphylococcal Septicemia Twenty-two patients having one or more blood cultures for Staphylococci form the basis of this report. The age ranged from 1,5 to 83 years. Male and female were half and half in number. The strains isolated from the blood stream included 20 Staph. aureus and 2 Staph. albus, and all of them showed a positive result for the coagulase test. Eleven patients, of which ten were hospital-acquired, developed the bacteremia during the course of underlying disease, such as leucemia (two), diabetes (two), duodenal cancer (1), skin disease (1), Bantis syndome (1), encephalomalacia (1), or condition after surgical operation (3). In four cases the septicemia occurred during the long-term treatment with corticosteroid or ACTH. Sensitivity tests revealed staphylococci of hospital-acquired cases to be more resistant than that of out-patients, particularly to tetracycline, streptomycin and penicillin. The majority of the strains were sensitive to chloramphenicol and erythromycin, and resistant to sulfa drug. To get a genuine clinical picture of staphylococcal septicemia, physical and laboratory findings were observed on the eleven primary cases and two of those relatively free from the underlying disease. Of these 13 cases, two showed a fulminating meningitis and severe hemorrhage, followed by death within 50 hours after admission. Meningitis was seen in another case which was followed by complete cure with intrathecal injection of antibiotics.

20 Bronchopneumonia occurred in nine cases, of which one (1.5 yrs) developed a bilateral spontaneous pneumothorax on the nineth day of the illness, followed by complete cure with adequate suction and chemotherapy. Endocarditis was diagnosed in three cases, of which one was confirmed by autopsy that revealed verrucous ulcerative lesions at the tricuspid valves and hemorrhagic infarcts in both lungs. Two cases developed the erythema in early stage of infection, and one had pustules on the fingertips and pinna, which contained staphylococci. Jaundice was noted in one case on the nineth day of the illness. One case, which developed multiple cavities in both lungs, was misdiagnosed as a pulmonary tuberculosis in early stage of the illness. Fever and leucocytosis patterns common to septicemia cases demonstrated different between two groups, with and without underlying disease as follows. The majority of the primary cases (without underlying disease) developed a fever over 40 Ž in maximum, whereas almost all the cases with underlying disease had a fever about or under 39.5 Ž in muximum and never exceded 40 Ž. About half of the primary cases showed a leucocytosis over 15,000 whereas the cases with underlying disease besides leucemia demonstrated a leucocytosis under 15,000. Eleven of 22 cases died, in which two leucemias and one malignant neoplasma were included. Patients in the older age groups had a higher mortality. Antibiotics to which the causative strains were sensitive were approximately 50% effective. Up to now, the combined chemotherapy of chloramphenicol and erythromycin must be first choice for staphylococcal septicemia according to sensitivity patterns of isolated strains.

CHEMOTHERAPY aureus 0.10, Enterococcus faecalis 3.13, Escherichia coli 0.20, Klebsiella pneumoniae, Enterobacter spp., Serratia marcescens 0.78, Prote

CHEMOTHERAPY aureus 0.10, Enterococcus faecalis 3.13, Escherichia coli 0.20, Klebsiella pneumoniae, Enterobacter spp., Serratia marcescens 0.78, Prote aureus 0.10, Enterococcus faecalis 3.13, Escherichia coli 0.20, Klebsiella pneumoniae, Enterobacter spp., Serratia marcescens 0.78, Proteus mirabilis 3.13, Proteus vulgaris 1.56, Citrobacter freundii 0.39,