経直腸的前立腺生検後に敗血症を発症した2例

Abstract

症例1(63歳男).levofloxacin(LVFX)を予防投与し経直腸的生検を施行したが, 急性前立腺炎の診断で入院した.敗血症に伴う播種性血管内凝固症候群(DIC)と診断し膀胱瘻造設をし治療を開始した.敗血症性ショックと診断しdopamineを投与し, 徐々に安定4日目に中止したが全身の炎症所見に改善は見られず, 5日目に多剤耐性大腸菌が原因と判明した.抗生剤をmeropenem(MEPN), teicoplanin(TEIC)に変更したが7日目も改善は認められず, エンドトキシン検査結果の陽性からエンドトキシン吸着療法を施行後, 全身状態, 炎症所見は改善傾向となった.12日目に抗DIG療法を中止し, 14日目に抗生剤をcefdinir(CFDN)に変更し投与継続のまま27日目に退院となった.症例2(64歳男).cefazolin(CE2)の予防抗生剤を投与後, 経直腸的前立腺生検を実施した.翌日退院したが2日目に生検後前立腺炎の診断で入院となった.敗血症に伴うDICと判断し, 膀胱瘻造設し抗DIC療法を開始し, 5日目に全身状態改善で抗DIC療法を中止した.原因菌は多剤耐性大腸菌で6日目から抗生剤をLVFXに変更した.17日目にLVFXを中止したが19日目に再然した.MEPNの治療開始後, 主症状改善が見られ27日目にLVEXへ変更し投与継続で退院した

We report two cases of sepsis and disseminated intravascular coagulation (DIC), potentially fatal complications, following transrectal prostate biopsy. We also review similar cases reported in Japan. Case 1: A 63-year-old man received a cathartic and levofloxacin (LVFX) for prophylaxis. After transrectal prostate biopsy, he presented with fever and chills. Blood cultures grew Escherichia coli resistant to LVFX. Under a diagnosis of sepsis, he received intensive management that included endotoxin removal therapy. The patient was hospitalized for 27 days. Case 2: A 64-year-old man received a cathartic and cefazolin (CEZ) for prophylaxis. He presented with fever and chills after biopsy, and was admitted to hospital. Blood cultures grew E. coli resistant to CEZ. Under a diagnosis of sepsis, he received intravenous antibiotics, transfusion, and anti-DIC drugs. The patient was hospitalized for 11 days.