臨牀透析 Vol.22 No.2(7)


特集名 透析患者における難治性感染症 -- 最新の診断と治療
題名 感染性心内膜炎
発刊年月 2006年 02月
著者 佐藤 祐二 宮崎大学医学部内科学第一講座
著者 藤元 昭一 宮崎大学医学部内科学第一講座
【 要旨 】 感染性心内膜炎患者に占める透析患者の割合が増加し,同時に起炎菌も黄色ブドウ球菌の割合が増加している.透析患者はいずれかのバスキュラーアクセスをもっており,常に血液への感染の危険状態にあるといえる.自験および報告例をみても,透析患者の感染性心内膜炎の起炎菌は半数以上が黄色ブドウ球菌であり,感染弁は僧帽弁,次いで大動脈弁が多かった.死亡率も高く,予防が大切である.非透析患者の感染性心内膜炎の予防に関するガイドラインに準拠し,透析患者でも予防すべきである.しかし,透析患者においては心臓の弁自体に石灰化などの問題があり,予防すべき対象病態を拡げて考えるべきかもしれない.
Theme Intractable Infection in Hemodialysis Patients -- Current Diagnosis and Treatment
Title Infective endocarditis in patients undergoing hemodialysis
Author Yuji Sato First Department of Internal Medicine, Miyazaki Medical College
Author Shouichi Fujimoto First Department of Internal Medicine, Miyazaki Medical College
[ Summary ] Infective endocarditis (IE) is more frequently found in hemodialysis (HD) patients compared to the general population. More than half of the cases are caused by Staphylococcus aureus infection. Vascular access (internal AV fistula, AV vascular grafts or temporally catheters) infections are considered as sites of causative organism invasion. Patients' survival rates are quite poor, with approximately 30 to 65 % mortality. HD patients with prosthetic valves, congenital heart disease, a history of having IE, valvular heart disease, hypertrophic obstructive cardiomyopathy or pacemaker implantation should be prevented from contracting IE by using antibiotics when oral, dental, airway or genitourinary procedures are performed. In addition, HD patients have peculiar valvular lesions, such as mitral annular calcification (MAC) or aortic valve calcification (AVC). A connection between the presence of these lesions and the occurrence of IE has not been confirmed, however, we recommend the administration of antibiotics to prevent IE when performing various medical procedures.
戻る