Urosepsis症例の臨床的特徴と治療成績: 市中感染例と病院感染例の比較/CLINICAL FEATURES AND TREATMENTS OF PATIENTS WITH UROSEPSIS: COMPARISON OF COMMUNITY -ACQUIRED AND HOSPITAL-ACQUIRED INFECTIONS

摘要

We reviewed the clinical features and treatments of 45 patients with urosepsis who were admitted to Kanagawa Prefectural Shiomidai Hospital from 2000 through 2007. Urosepsis was defined as a sepsis syndrome due to urinary tract infection. Cases satisfied the criteria for systemic inflammatory response syndrome and were confirmed bacteriologically. Urosepsis developed in 30 patients with community-acquired infections and in 15 patients with hospital-acquired infections. More than 80% of patients were older than 65 years. Most patients had underlying diseases, such as chronic renal failure, neurological diseases, diabetes mellitus, and orthopedic diseases. Indwelling urinary catheters had been present in 1 patient (3.3%) with a community-acquired infection but in 9 patients (60.0%) with hospital-acquired infections. When elderly patients or patients with underlying diseases have community-acquired urinary tract infections, even if they don't have an indwelling urinary catheter, we believe that the infection is likely to progress to urosepsis. Escherichia coli was the most common causative organism. All examples of Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus were isolated from patients who had indwelling urinary catheters and had previously been treated with antimicrobial agents. Quinolone-resistant E. coli was isolated from 3 of 38 patients (7.9%). For the patients with community-acquired urosepsis, 14 of 23 patients (60.9%) with sepsis were treated with a first- or second-generation cephem, and 3 of 7 patients (42.9%) with septic shock were treated with a carbapenem. Various antimicrobial agents were used to treat hospital-acquired infections. The efficacy rate of initial treatment was 40.0% (12 patients) for community-acquired infections and 66.7% (10 patients) for hospital-acquired infections. The patients for whom initial treatment failed were often those who had been treated with a first- or second-generation cephem or a carbapenem or those with septic shock due to a community-acquired infection. Dosages and durations of treatment were inadequate in most patients for whom initial treatment failed. Three patients (6.7%) died. Initial treatment had failed for all patients who died, and all had septic shock. Our findings suggest that adequate dosages and appropriate durations of treatment are important for the initial antimicrobial therapy of urosepsis.%高齢者や基礎疾患を有する患者の尿路感染症では市中感染の尿道カテーテル留置がない例でも尿 路感染症が重症化し，urosepSisになる可能性を念頭に置くべきである．urosepsisの初期治療では十分な用量の抗菌薬を適切な回数で投与することが重要である．