結石にともなう尿路感染症 2. 結石内細菌に対する抗菌剤の効果について

Abstract

結石をともなった尿路感染症において結石内の細菌に対する抗菌剤の効果を検討した.1)感染結石では抗生剤CMZがある程度効果がみられたが, 代謝結石では効果は不明であった.2)結石内細菌に対する抗菌剤のMICと尿中排泄および結石内浸透性より考え, より効果があってしかるべきと思われたが, 実際はそうではなく, 種々の要因が推察された.3)結石を除去し抗菌剤を使用すれば尿路感染は高率に治癒した

We investigated the effect of antimicrobial agents against bacteria within infected stones. Cefmetazole (CMZ) was found to have equally strong activities against gram-positive and gram-negative bacteria isolated from the stones. In addition, CMZ was excreted in the urine from the affected kidney in high concentrations and was penetrated into the stone to some extent in vitro. However, preoperative administration of CMZ did not so significantly eradicate bacteria within the stones. Stones may function as a sanctuary for organisms and may attenuate the effects of antibiotics against them. Therefore, to treat urinary tract infection associated with urinary calculi, complete extirpation is necessary. In recent years, ultrasonic and other types of stone crushing methods are in wide use. CMZ or other effective antibiotics may become useful for the perioperative management of infected urinary stones.