両室ペーシング機能付き植込み型除細動器リード感染を抗菌化学療法のみで治療可能であった1症例

• 中蔵 伊知郎

  国立循環器病研究センター薬剤部 国立循環器病研究センター感染対策室

• 関本 裕美

  国立循環器病研究センター薬剤部

• 山下 大輔

  国立循環器病研究センター薬剤部 国立循環器病研究センター感染対策室

• 堀部 明美

  国立循環器病研究センター薬剤部 国立循環器病研究センター感染対策室

• 中村 慶

  国立循環器病研究センター薬剤部

• 岡田 博

  国立循環器病研究センター薬剤部

• 小原 延章

  国立循環器病研究センター薬剤部

• 佐田 誠

  国立循環器病研究センター感染対策室

• 鎌倉 史郎

  国立循環器病研究センター心臓血管内科

書誌事項

タイトル別名

• Defibrillator Lead Infection Occurring in Cardiac Resynchronization Therapy Successfully Treated with Antimicrobial Chemotherapy

抄録

In pacemaker-related infections,as for all foreign body related infections,it is usually desirable to remove the infected device.However,we report the case of a patient undergoing treatment with a Cardiac Resynchronization TherapyDefibrillator (CRT-D) for severe arrhythmia in whom removal of the defibrillator was difficult and infection control was achieved only with antimicrobial chemotherapy.<br>The patient,in whom a CRT-D had been implanted for ventricular tachycardia,was hospitalized for catheter infection disease.She was diagnosed with infective endocarditis as methicillin-resistant Staphylococcus aureus (MRSA) was detected in a blood culture,and vegetation on the CRT-D lead by TTE.Owing to her severe arrhythmia,the lead was not removed,and a doctor requested a pharmacist’s advice on drug selection for antimicrobial chemotherapy and planning its administration.<br>We conducted administration planning for vancomycin,gentamycin,linezolid and arbekacin,achieved success in controlling vancomycin-intermediate resistant Staphylococcus aureus,and the vegetation disappeared.However,we encountered drug interactions and the adverse effects of hematologic abnormalities and renal dysfunction.<br>It has been suggested that treatment of infections associated with cardiac devices is possible using only antimicrobial chemotherapy if appropriate,effective antimicrobials are selected.However,it is generally necessary to continue such therapy for a long period of time in a patient like this and it is therefore important to be aware of the incidence of antimicrobial resistance,the adverse effects of antimicrobial agents,and drug interactions when selecting antimicrobials for treatment.

収録刊行物

• 医療薬学

  医療薬学 36 (7), 502-508, 2010

  一般社団法人日本医療薬学会

キーワード

• infection control
• infective endocarditis
• VISA
• antimicrobial chemotherapy
• pharmaceutical care
• adverse effect

詳細情報

• CRID: 1390001204776001664
• NII論文ID: 130004502623
• DOI: 10.5649/jjphcs.36.502
• ISSN: 18821499
• ISSN: 1346342X
• Web Site: https://search.jamas.or.jp/link/ui/2010331556
• 本文言語コード: ja
• データソース種別:
  • JaLC
  • Crossref
  • CiNii Articles
• 抄録ライセンスフラグ: 使用不可