臨牀透析 Vol.32 No.2(1-1)


特集名 高齢・超高齢透析患者の致死的感染症
題名 肺炎 (1) 誤嚥性肺炎
発刊年月 2016年 02月
著者 塚本 美鈴 長崎大学病院感染制御教育センター
著者 泉川 公一 長崎大学病院感染制御教育センター
【 要旨 】 肺炎は2011年以降,脳血管障害を抜いて全死亡原因の第3位となり,入院肺炎の多くは70歳以上の高齢者が占め,そのほとんどが誤嚥性肺炎である.口腔・咽頭や胃内容物を喉頭や気道内に誤嚥し,その結果生じた肺炎を誤嚥性肺炎という.高齢者では咳,痰,発熱などの肺炎に典型的な症状に乏しいこともあるため,早期発見・治療のためには,いつもと違う患者の様子に注意が必要である.治療には口腔内常在菌や嫌気性菌の関与が強くなるため,それらに活性を有するβラクタマーゼ阻害薬配合のペニシリン系薬(SBT-ABPCなど)を使用する.誤嚥性肺炎は繰り返すことが多く,さまざまな予防策を講じることが再発予防に重要である.
Theme Fatal infections of elderly and super-elderly dialysis patients
Title Aspiration pneumonia
Author Misuzu Tsukamoto Nagasaki University Hospital, Infection Control and Education Center
Author Koichi Izumikawa Nagasaki University Hospital, Infection Control and Education Center
[ Summary ] Pneumonia has been the third leading cause of death in Japan since 2011. Most hospitalized patients with pneumonia are elderly (over 70 years of age), typically presenting with aspiration pneumonia. In most cases, pneumonia arises from aspiration of microorganisms from the oral cavity or nasopharynx. Since elderly patients may not present with typical symptoms of pneumonia, such as cough, sputum, and fever, it is necessary to pay attention to any unusual appearance in elderly patients, in order to detect and treat pneumonia early. For treatment, oral indigenous microorganisms and anaerobic bacteria should be considered as causative agents. Therefore, penicillin drugs combined with a β-lactamase inhibitor, such as ampicillin-sulbactam, are often effective. Because aspiration pneumonia often recurs, it is important to take various precautions to prevent recurrence of this serious illness.
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