尿管皮膚瘻患者の尿路感染症に対するImipenem/Cilastatin sodium (IMP/CS)の薬剤効果

Abstract

尿路感染症に対するIPM/CSの臨床効果を尿管皮膚瘻造設術を受けた19例の悪性腫瘍患者(膀胱腫瘍15例, 前立腺癌3例, 子宮癌1例)について観察した.IPM/CSの投与法は1回0.5 gを1日2回点滴静注し, 薬効評価は投与後5日目にUTI判定基準に従って行った.その結果, 総合臨床効果は著効4例(20.0%), 有効9例(45.0%), 無効7例(35.0%)で総合有効率は65.0%となった.疾患病態群別にみた効果は, G-3群(単独菌感染・上部尿路感染)が3例で有効率は33.0%, G-6群(複数菌感染・カテーテル非留置)が17例で有効率は70.6%であった.細菌学的効果としては, 分離菌38株中34株が本剤投与後に消失し, 消失率は89.5%であった

Clinical efficacy of IPM/CS against urinary tract infections (UTI) was evaluated on 19 patients with malignancies (bladder tumor: 15, prostate cancer: 3, uterus cancer: 1) and 1 patient with a benign disorder (ureter stenosis) who had undergone ureterocutaneostomy between January, 1988 and December, 1990. Their ages ranged from 42 to 79 years. Postoperatively, they had UTI with pyuria of greater than or equal to 5/hpf and bacteriuria of greater than or equal to 10(4)/ml. IPM/CS was administered at a dose of 0.5 g (0.25g/0.25 g) twice a day through intravenous drip infusion. Its efficacy was evaluated according to the UTI criteria for clinical evaluation as ruled by the Japanese Society of Chemotherapy. Overall clinical value was rated "excellent" in 4 (20%), "moderate" in 9 (45%) and "poor" in 7 (35%) cases for a total of 65%. The efficacy by types of infection was 33% and 70.6% in the group of single infection and in the group of mixed infection, respectively. As to bacteriological efficacy 34 of the 38 strains (89.5%) isolated were eradicated following its administration. The eradication rate was 84.6% for P. aeruginosa, and 84.6% for E. faecalis. Microbes which appeared after its dosing amounted to 6 classes of 17 strains, 6 NFB strains of which were identified. As a side effect, elevation of serum GPT (5%) was noted. Regardless of the underlying conditions (malignant diseases and ureterocutaneostomy), clinical efficacy of IPM/CS was appreciable. In addition, the MIC for (P. aeruginosa, E. faecalis) of IPM/CS was lower than that of PIPC.