重症尿路感染症におけるDIC に対する遺伝子組み換えトロンボモジュリンの使用経験

Abstract

Severe urinary tract infection occasionally causes urosepsis and disseminated intravascular coagulation (DIC). We experienced six cases of DIC with severe urinary tract infection from July 2009 to January 2011. Patientscompris ed two men and four women, ranging in age from 67-84 years old. In all cases, urinary tract infection was caused by pyelonephritis. The results of analysis of bacterial culture from blood and urine revealed E. faecalis in 2 cases, E. coli in 1 case, P. mirabilis in 1 case and Candida tripicalis in 1 case. Percutaneous nephrostomy in 1 case and ureteral stent indwelling in 3 cases and ureteral stent exchange in 2 cases were used for the drainage of the origin of infection. Under the diagnosis of DIC, the administration of antibioticsand anti-DIC treatment with recombinant thrombomodulin (rTM) were performed. rTM isa new drug for the treatment of DIC. rTM bindsto thrombin to inactivate coagulation, and the thrombinrTM complex activatesprotein C to form activated protein C. Therefore, rTM actsasa negative feedback regulator of blood coagulation. Treatment with rTM improved in 5 of the 6 patients.