基礎疾患別にみた敗血症の臨床的解析 Clinical Analysis of Patients with Sepsis Comparison between Underlying Diseases

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当科入院患者でBoneらの敗血症診断基準を満たして血液培養が陽性であった症例83例 (男性57例・女性26例, 平均年齢52.0±19.0歳)・117エピソードを患者の基礎疾患別に血液悪性腫瘍群・固形悪性腫瘍群・非悪性腫瘍群の3群に分け, その臨床像を比較検討した.各群の症例内訳は血液悪性腫瘍群46例・72エピソード, 固形悪性腫瘍群23例・25エピソード, 非悪性腫瘍群14例, 20エピソードであった.血液培養分離菌はグラム陽1生菌が多く, 特に血液悪性腫瘍群でcoagulase negative staphyloccocci (CNS) の頻度が高かった.発症誘因または感染病巣は血液悪性腫瘍群では痔疾・口内炎・血管内留置カテーテル, 固形悪性腫瘍群では肺炎, 非悪性腫瘍群では尿路感染症が多かった.死亡率は固形悪性腫瘍群が最も高かった.ショックまたは播種性血管内凝固症候群 (DIC) 合併症例は各群とも予後不良で, 死亡症例は生存症例に比べ血清アルブミン値が有意に低値であった.したがって血液培養陽性症例の臨床病態は基礎疾患により異なることを明らかにした.

We evaluated the clinical data in 83 patients with sepsis, which was diagnosed by both Bone's difinition of sepsis and positive isolates from blood culture, according to their underlying diseases. This study enrolled a total of 117 septic episodes in 83 patients (57 males and 26 females, mean age: 52.0 years). We classified 3 groups, including hematological malignancies (46 patients, 72 episodes), solid malignant tumors (23 patients, 25 episodes) and non-malignancies (14 patients, 20 episodes), by the underlying diseases.<BR>Of the total number of isolates from blood culture, 53.0% were single gram-positive bacteria, 33.3% were single gram-negative bacteria, 7.7% were single fungus and 6.0% were polymicrobial organisms. In addition, coagulase negative staphylococci was isolated most often in patients with hematological malignancies. Sepsis was often caused by infectious focuses of hemorrhoid, stomatitis or intravenous catheter in patients with hematological malignancies, by pneumonia in patients with solid malignant tumors and by urinary tract infection in patients with non-malignancies. Mortality of sepsis in patients with solid malignant tumors (48%) was highest in 3 groups. Septic patients, who were complicated with shock and/or DIC, has poor prognosis in all groups. Serum albumin level was significantly lower in dead patients than patients who survived.<BR>These results suggest that clinical features may be different according to the underlying diseases of patients wih sepsis.

収録刊行物

  • 感染症学雑誌 : 日本伝染病学会機関誌 : the journal of the Japanese Association for Infectious Diseases

    感染症学雑誌 : 日本伝染病学会機関誌 : the journal of the Japanese Association for Infectious Diseases 72(7), 681-687, 1998-07-20

    The Japanese Association for Infectious Diseases

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各種コード

  • NII論文ID(NAID)
    10008718360
  • NII書誌ID(NCID)
    AN00047715
  • 本文言語コード
    JPN
  • 資料種別
    ART
  • ISSN
    03875911
  • NDL 記事登録ID
    4536818
  • NDL 雑誌分類
    ZS9(科学技術--医学--病理学・微生物学・寄生虫学・感染・免疫学・血清学・アレルギー)
  • NDL 請求記号
    Z19-193
  • データ提供元
    CJP書誌  CJP引用  NDL  J-STAGE 
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