腎移植における細菌感染症の化学療法 付 : 最近の抗菌薬

Abstract

Intraoperative wound infection and postoperative pulmonary and urinary tract infections are the major problems that face the transplant surgeon today. These infections are the major cause of the mortality after renal transplantation. Almost any microorganism could be causative. But, in this paper, only bacterial infections will be discussed. Prophylaxis of intraoperative infection is the same as that used for general surgery. In addition, one of the major defects in the recipient is defective renal function, resulting in general weakness. The use of broad-spectrum antibacterial agents (eg, cefmetazole etc.), effective against many different bacteria from gram-positive cocci to gram negative rods, administered to these patients will produce dramatic results. Aminoglycosides are nephrotoxic and should not be given to the patients having renal failure. Piperacillin or the third generational cephems (ceftizoxime, latamoxef , cefotaxime, cefmenoxime, ceftriaxon and ceftazidime) are the drugs of choice for postoperative infections, especially for urinary tract infections. Pseudomonas aeruginosa should be treated with cefsulodin, cefoperazone, or cefpiramide by the intravenous route. After chemotherapeutic and antibiotic therapy sterilizes the urine, this should be followed by suppressive therapy with quinolone- carboxylic acid (pipemidic acid, norfloxacin, enoxacin and DL-8280), combinations of sulfamethoxazole and trimethoprim, sulfonamides, or fosfomycin for many weeks or months. In chronic antimicrobial suppression treatment, half-doses should be given at bedtime.