Piperacillinの泌尿器科領域における臨床的検討

Abstract

泌尿器科入院患者中尿路感染症より分離した原因菌249株につきDisc法による各種抗生剤に対する感受性を検査した.手術後感染予防18例, 複雑性尿路感染症治療5例にPIPCを使用した.1)入院時の分離菌はStreptococcus sp., Proteus sp., E. coliの順に多く, Pseudomonas aeruginosa, Klebsiellasp.もいくらか認めた.手術後と長期入院群ではPseudomonas aeruginosa, NF-GNB, Streptococcus sp.が多かった.2) PIPCに対する感受性はE. coli, Proteus sp., Streptococcus sp., Pseudomonas aeruginosaが80%以上, NF-GNBも50%以上であった.3)泌尿器科手術感染予防目的でPIPCを使用し, 18症例中著効14例, 有効4例であった.4)複雑性尿路感染症5例にPIPCを使用した.UTI薬効評価基準では有効2例, 無効3例であったが細菌学的効果は全例に認めた.5) PIPCは泌尿器科手術後の感染予防に非常に適した抗生剤で, 複雑性尿路感染症の治療にも充分有用である.副作用の面でも従来のペニシリン系抗生剤と同様比較的安全に使用できる

The sensitivity of 249 etiological bacterial strains causing inflammation isolated from patients with infections of the urogenital tract who were under treatment on an in-patient basis in our Department was examined by the Disc (3 concentration) assay method. Piperacillin (PIPC) was employed for prophylactic treatment in 18 patients against postoperative infections and for therapeutic treatment in 3 patients against complicated infections of urogenital tracts. The results of these studies are reported along with some discussion on the utility of PIPC in the urological field. The frequency of detection of bacteria isolated from the patients on their admission into our hospital was in the decreasing order of Streptococcus Sp., Proteus Sp. and E. coli Pseudomonas aeruginosa and Klebsiella Sp. also were noted in some of the patients. Pseudomonas aeruginosa, nonfermentative Gram's-negative bacilli (NF- GNB ), and Streptococcus Sp. were detected in many of the patients who had had an operation or who had been in hospital for a long time. The sensitivity of E. coli, Proteus Sp., Streptococcus Sp. and Pseudomonas aeruginosa was invariably more than 80%, while that of NF- GNB was more than 50%. PIPC was used for prophylactic treatment of patients against infections at the postoperative stage in the urogenital field. Out of 18 cases, it proved to be markedly effective in 14 cases and moderately effective in 4 cases. There was no poorly effective case. PIPC was employed for treatment in 5 cases complicated infections of urogenital tracts. There was no markedly effective case, and 2 moderately effective and 3 poorly effective cases resulted according to the UTI efficacy evaluation standards However, its bacteriological efficacy could be identified in all the treated cases. Therefore, PIPC is a valuable prophylactic antibiotic agent against infections after an operation in the urological field. It may also prove valuable in the therapeutic treatment of complicated infections in the urogenital tracts. PIPC has a relatively large margin of safety in terms of side effects as in the case of conventional penicillin group antibiotics.