| 特集名 | どうコントロールするか透析患者の感染症 | |
|---|---|---|
| 題名 | 腎代替療法関連 (1) 血液透析 -- バスキュラーアクセス感染 | |
| 発刊年月 | 2009年 01月 | |
| 著者 | 副島 一晃 | 済生会熊本病院腎泌尿器センター |
| 【 要旨 】 | バスキュラーアクセス (VA) 感染の多くはグラフト感染とカテーテル感染で，抗菌薬投与と外科的処置を必要することが多い．グラフト感染は穿刺，回収時の不潔操作による穿刺部感染が多く，抗菌薬投与と感染部抜去が不可欠である．カテーテル感染は出口部感染が多く，短期型カテーテルの場合はカテーテル抜去が確実な治療である．長期型カテーテルの場合は出口部の消毒処置と抗菌薬投与を行いカテーテル温存に努めるが，カテーテル内感染の場合は躊躇なく抜去すべきである．VA感染の起因菌の多くは表皮常在菌である．当院での経験から，敗血症化したVA感染の起因菌は90 %が黄色ブドウ球菌で，40 %がメチシリン耐性黄色ブドウ球菌 (MRSA) なので，バンコマイシンを中心とした抗菌薬を選択する必要がある． VA感染は患者にとって生命線であるVAの維持を困難にし，容易に敗血症化して患者の生命も脅かす重大な合併症である．透析室スタッフは患者のVA異常の早期発見に努め，生じたVA感染に対しては可及的速やかに適切な処置を行うべきである． |
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| Theme | Controlling Infections in Dialysis Patients | |
|---|---|---|
| Title | Vascular access infection | |
| Author | Kazuaki Soejima | Kidney and Urology Center, Saiseikai Kumamoto Hospital |
| [ Summary ] | Vascular access (VA) infection is a serious complication for hemodialysis patients. Primary arteriovenous fistula (AVF) infection presents the lowest infection risk. Most of VA infections are graft infections or catheter infections. Graft infections are caused by failures in canunlation or improper AV management. Antibiotic administration and the removal of infected grafts are indispensable in treating graft infections. Catheter infections usually occur in the exit region. Certain treatments for temporary catheter infections employ removal of catheters in the infected region. On the other hand, with permanent catheters, salvage treatments will be attempted, for instance antibiotic therapy, disinfection of the exit region and creation of a new tunnel. If infection extends inside the permanent catheter region, it is necessary to remove it immediately. VA pathogen infections are generally from the skin flora. In data from our institution, 90 % of pathogens associated with VA septicemia infection were Staphylococcus aureus while 40 % were associated with MRSA. For this reason, vancomycin should be selected for the treatment of VA infection with septicemia. VA infection is a serious complication that maintains VA that is life line for hemodialysis patient difficult, makes to septicemia easily, and threatens patient's life. Hemodialysis staff members should make every effort to detect eariy stage VA infection. If VA infection occurs, it is necessary to provide appropriate treatment as promptly as possible. |
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