前立腺術後の尿路感染症に対するPivmecillinamの予防と治療効果に対する検討

Abstract

前立腺術後の感染防止に各種の抗生剤を使用後, PMPCを尿感染を指標に投与し感染治療効果と感染防止効果を検討した.術後の感染防止に使用した抗生剤と術後に検出した菌につき関連を検討した.1)前立腺摘除術後の67例でのPMPCの感染治療効果は53.7%であった.2)前立腺摘除術後化学療法で菌を検出しなかった34例でPMPCの感染防止効果は64.7%であった.3)前立腺摘除術(TUR-Pと被膜下摘出術)の術式によるPMPCの治療効果にほとんど差はなかった.4)術後の感染防止としCEPRあるいは単独または併用投与が主流をなしているためか, Serratia, Pseudomonasの検出頻度が高く, 感染防止に用いる抗生剤の組合わせにひとつの示唆を与えた.5)術前カテーテル非留置例でPMPCはすぐれた治療と感染防止効果を示した

Patients received pivmecillinam (PMPC) after prophylactic use of various antimicrobial chemotherapeutic agents following prostatectomy, and their clinical responses were assessed for effectiveness in the treatment and prevention of postoperative infection. The data were also analyzed to explore the relationship between bacterial isolates obtained during the postoperative course and the antimicrobial agents administered prophylactically against postoperative infection. Therapeutic effect of PMPC: Treatment of postoperative infections with PMPC was effective in 36 (53.7%) out of 67 patients who had undergone prostatectomy. Prophylactic effect of PMPC: The use of PMPC provided effective prevention of infection in 22 (64.7%) out of 34 patients from whom no bacterial pathogen had been isolated before postoperative antimicrobial chemotherapy. Therapeutic responses to PMPC, compared between different types of operative procedure: There was little or no difference in therapeutic effectiveness of PMPC against postoperative infection when compared between two types of operative procedure, transurethral prostatectomy and subcapsular removal of the prostate. Incidence and types of bacterial isolates following prophylactic chemotherapy with various agents after prostatectomy: Possibly because cephapirin (CEPR) and ticarcillin (TIPC) were mainly administered, alone or in combination, for prophylaxis against postoperative infection, Serratia and Pseudomonas were most frequently isolated. The findings offer suggestions as to the appropriate combination of antimicrobial agents to be used for prophylactic purposes. Effectiveness of PMPC in the presence or absence of a preoperative indwelling urethral catheter: The use of PMPC was more effective both in the treatment and prevention of postoperative infection in cases without preoperative indwelling urethral catheterization than in those with it.