Polymyxin B局所投与による術後尿路感染予防および治療効果の検討

Abstract

Effect of locally administered polymyxin B (PB) solution on postoperative urinary tract infection was studied. 1) Patients consisted of 24 males and 9 females, who received urological operations and indwelling catheters in the bladder or renal pelvis after the operation. 2) PB solution was locally administered every day after the operation in the following ways: Group l-(a) : bladder washing with 0.05% solution of PB in 6 cases. Group l-(b) : bladder washing with 0.1% solution of PB in 16 cases. Group 2 : intravesical instillation of 0.1 % solution of PB in 2 cases. Group 3 : continuous bladder irrigation through indwelling 3-way catheter with 0.0025% solution of PB in 9 cases. Group 4 : washing or irrigation through nephrostomy with 0.05 or 0.1 % solution of PB in 3 cases. 3) Species and colony counts of bacteria in urine were examined before and on the course of the treatment. The results of the treatment were evaluated successful when the bacteria disappeared or the colony counts diminished after the finish of PB administration. Successful results were obtained as follows: 5 cases of 6 in group l-(a), S cases of 16 in group l-(b), 1 case of 2 in group 2, 7 cases of 9 in group 3 and 0 case of 3 in group 4. In both group l-(a) and 3, the results were remarkable in comparison with the other 3 groups. Evaluation of the latter group, however, was thought to be difficult because of different causes of the diseaes, operative methods and other conditions of the patients. 4) Effective rate of polymyxin B was more than 51 % of counted strains in Proteus morganii, Pseudomonas aeruginosa, E. coli, Citrobactor, Streptococcus faecalis and Staphylococcus aureus. In contrast, it was less than 50% in Serratia, Klebsiella, Proteus vulgaris, Proteus rettgeri and glucose non-fermentable Gram negative rods (NFGNR). 5) Serratia and Proteus were detected most frequently, and NFGNR appeared continuously before and after the treatment. These findings showed the same tendency of superinfection as recent reports of urinary tract infection.