臨牀透析 Vol.25 No.1(1-2)


特集名 どうコントロールするか透析患者の感染症
題名 病因微生物 : 感染症の動向 (2) 耐性菌
発刊年月 2009年 01月
著者 浜田 弘巳 日鋼記念病院外科
著者 伊丹 儀友 日鋼記念病院腎センター
著者 中島 泰志 日鋼記念病院腎センター
【 要旨 】 透析患者の感染対策,とくに耐性菌対策はきわめて重要である.とくにメチシリン耐性黄色ブドウ球菌 (MRSA),バンコマイシン耐性腸球菌 (VRE),多剤耐性緑膿菌 (MDRP) などは,治療に難渋するとともに感染対策上重要な細菌である.耐性菌由来の全身感染症の発生例の予後は不良である.よって,治療に際しては,適切な検体を培養に提出し原因菌を特定することと,可能な範囲での感染原因の除去を行うとともに感受性を有する抗菌薬を選択し,PK-PD (pharmacokinetics-pharmacodynamics) に考慮し投与を行うことが肝要である.また感染伝播の対策として,耐性菌保菌の情報の共有と接触予防策,飛沫感染予防策,接触感染予防策の徹底が必要である.
Theme Controlling Infections in Dialysis Patients
Title Drug resistant pathogenic bacteria -- Latest treatments
Author Hiromi Hamada Department of Surgery, Nikko Memorial Hospital
Author Noritomo Itami Kidney Center, Nikko Memorial Hospital
Author Taishi Nakashima Kidney Center, Nikko Memorial Hospital
[ Summary ] Infection control for end stage renal disease patients, especially measures for drug resistant bacteria, are extremely important. This is especially so for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin resistant Enterococcus (VRE), multi-drug resistant Pseudomonas aeruginosa (MDRP), and other infections. These conditions are difficult to treat in terms of being crucial bacilli for infection control. Because the prognosis is not favorable in cases where general infectious disease is due to resistant bacteria, the submission of an appropriate sample for culture and identification of the bacteria, elimination of as much of the cause of the infection as possible, the choice and administration of a receptive antimicrobial, considering PK-PD parameters, are all vital in it's treatment. To prevent the spread of infection, information on those patients with resistant bacteria needs to be shared, and contact precautions, droplet transmission precautions as well as contact transmission precautions must be implemented.
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