Key words: septic shock, Klebsiella pneumoniae, corticosteroid
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1 Key words: septic shock, Klebsiella pneumoniae, corticosteroid
2 馬 場 ます み 他 490 Table 1 Laboratory findings Fig. 1 on admission The circle Fig. 2 Table 2 血 球 減 少,血 Laboratory findings connects Chest Hemodynamic the normal values data shown in ()' X-ray film on admission ( ) on admission 清 補 体 価 の 低 下 が 認 め ら れ た.GOT, γ-gtp,bun,ク レ ア チ ニ ン の 上 昇 よ り,肝 機 能 障 害 が 示 唆 さ れ た.低 酸 素 血 症,代 ド ー シ ス を 認 め,Swan-Ganz 行 動 態 検 査 で は,心 シ ョ ッ ク(hyperdynamic 謝性 ア シ Catheterに 係 数,肺 血 管 抵 抗 低 値 を 示 し,重 腎 よる血 血 管 抵 抗 高 値,全 身 篤 な肺 炎 に よ る敗 血 症 性 state)と 考 え ら れ た. (PEEP10clnH2O),乳 輸 液,ア 酸 加 リン ゲ ル を 中 心 とし た シ ドー シ ス の 補 正,ド ド ブ タ ミ ン(DOB)投 性 で,鏡 ー パ ミ ン(DOA), 与 を 行 っ た.喀 疾 は粘稠膿 検 に て グ ラ ム 陰 性 桿 菌 を 認 め た.ま た, 腹 部 超 音 波検 査 で は慢 性 肝 炎 の パ タ ー ン が認 め ら 飼 っ て い た イ ン コ の 咬 傷 の 存 在 か ら オ ウ ム 病 も否 れ た. 定 で き ず,Piperacillin(PIPC)6g/日,Latamoxef 入 院 時 胸 部x線 写 真(Fig.2):左 上葉 を 中心 に 比 較 的 濃 厚 均 一 な 浸 潤 影 を 認 め た. 入 院 後 経 過(Fig.3):機 械 的 人 工 呼 吸 (LMOX)4g/日 mg/日 に 加 え,Minocycline(MINO)200 を 点 滴 静 注 し た.気 Klebsiella pneumoniaeが 管 支 肺 胞 洗 浄 液 よ り 同 定 さ れ た 後,Ceft. 感 染 症 学雑 誌 第63巻 第5号
3 Fig. 3 Clinical course Fig. 4 Effect of methylpredonisolone (MP) on whole blood chemiluminescence induced by K. pneumoniae (n= 5)
4 4) Fainstein, V.: New antimicrobial agents in the immunocompromised cancer patient. Zb. R. Bakt. Suppl., 13: , ) Schumer, W.: Steroid in the treatment of clinical septic shock. Am. Surg., 184: , ) Bone, R. C., et al.: A controlled clinical trial of high-dose methylpredonisolone in the treatment of severe sepsis and septic shock. N. Engl. J. Med., 317: , ) Baltch, A.L., et al.: Comparison of the effect of three adrenal corticosteroids on human granulocyte function against Pseudomonas aer- J. Trauma, 26: , uginosa. 9) Olds, J. W., et al.: Corticosteroids, serum and phagocytosis: In vitro and in vivo studies. Infect. Immun., 9: , ) Fuenfer, M.M., et al.: Effect of various corticosteroids upon the phagocytic bactericidal activity of neutrophil. Surgery, 78: 27-33, 1975.
5 A Case of Septic Shock due to Pneumonia caused by Klebsiella pneumoniae Masumi BABA, Yasuo ONO, Yuichirou UEDA, Toshiaki HAGA, Norio NOZUE, Hajime NISHIYA & Otohiko KUNII The Second Department of Internal Medicine, Teikyo University School of Medicine A 51-year-old male, who had a history of excessive drinking and chronic hepatitis, was admitted to our hospital because of high fever and shock. Physical examinations, chest X-ray films and hemodynamic data revealed that he had progressed to septic shock due to pneumonia. Combination chemotherapy of latamoxef plus piperacillin was immediately started. After Klebsiella pneumoniae was isolated from bronchoalveolar lavage fluid, the antibiotics were changed to ceftizoxime plus amikacin. Furthermore human gamma globulin preparations and frozen fractional plasma were administered because of granulocytopenia and a decrease in complement. Gabexate mesylate, methylpredonisolone (MP) and branched chain amino acids were given to prevent disseminated intravascular coagulation and/or multiple organ failure. With this intensive care, he recovered from shock and pneumonia. The effects of MP on the whole blood chemiluminescence (CL) were examined. Incubation of whole blood with 25, 50 or 100,ag/ml of MP for 10 to 60 minutes had no effects on the CL response. This indicates that MP does not affect the production of reactive oxygen species from phagocytic cells at concentrations comparable to those used in drug therapy.
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