脊髄捐傷患者における緑膿菌尿路感染症に関する臨床的,細菌学的検査成績およびその対策

Abstract

The chronic urinary tract infection is a serious problem in patiel1ts with spinal cord injury. In recent years, due to development of antibiotics, fatal cases are decreasing. On contrary, incurable and antibiotics resistant urinary tract infections are increasing. Especially, infections with Pseudomonas aeruginosa have become increasingly common in patients with spinal cord injury. In order to combat incurable urinary tract infections with Pseudomonas aeruginosa, which are common in the special ward for patients with spinal cord injury, we carried out several clinical and bacteriological studies as follows. 1) Effect of 3'-4'-dideoxykanamycin B (DKB) administration to Pseudomonas infected patients. 2) Effect of daily bladder irrigation using Polymixin B sulfate solution (500 thousand units/100/ml) 3) Culture of falling bacteria in the ward. 4) Pseudomonas infections in bedsores. 5) Pseudomonas infection at the external urethral orifice. As a result of above mentioned studies, we concluded that urinary tract infections with Pseudomonas aeruginosa in this ward were a ward-acquired infection with Same strain and origins of infection were mainly contaminated urine and secretion from the external urethral orifice. And, as a route of infections, the contact infection was suspected. Then we carried out the following programs as the control and prevention of ward-acquired Pseudomonas infection. 1) Putting on gloves when man contacts with urine or penis 2) Daily bladder irrigation using Polymixin B solution to patients with indwelling catheter 3) Apply an ointment of gentamicin sulfate to the external urethral orifice twice a day for catheter indwelled patients 4) Use of amphoteric surface active agent (TEGO-51) as a disinfectant solution. After the practices of above mentioned programs, the rate of Pseudomonas infection decreased remarkably from 60% to 30%.