Acinetobacterによる菌血症例の臨床病理学的検討  [in Japanese] Bacteremia with Acinetobacter species : Clinicopathological Characteristics of 27 Cases  [in Japanese]

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平成元年1月から平成5年12月までの5年間に血液培養で<I>Acinetobacter</I> spp.が陽性となった37例のうち27例について, その薬剤感受性, 年齢, 基礎疾患, 臨床症状, 炎症マーカー, 中心静脈カテーテル挿入の有無, および使用薬剤について調査した.<BR>27症例のうち<I>Acinetobacter anitratus</I>が23例, <I>A. lwoffii</I>が4例を占めた. 患者の年齢は新生児が5例, 60歳以上の高齢者が11例であり, 基礎疾患は血液疾患や悪性腫瘍例, 未熟児, 先天異常児などであった. 発熱を23例, 血圧低下を6例, 頻脈を17例, 多呼吸を12例で認め臨床的にsepsis syndromeの状態にあった症例が多かった. 炎症マーカーも多くの例で上昇していた. 中心静脈カテーテルは22例に挿入されており, 培養陽性後すみやかにカテーテルを抜去した13例中9例は解熱し, うち4例はカテーテル先端から同菌が分離された. 7例にヘパリンが投与されていた.<BR><I>Acinetobacter</I> spp. による菌血症はcatheter-related infection, およびヘパリンとの関係が報告されているが, 今回の調査もそれを支持するものであった. 臨床的にsepsisの症状を示した症例ではカテーテルの抜去により解熱を認めた治療成功例があり, 留置カテーテルのある症例ではカテーテル敗血症の可能性を考えた早期診断, 治療が重要であると思われた.

<I>Acinetobacter</I> spp. are non-fermented gram-negative rods that are widespread in the environment and colonize in the human skin. They are known to be a nosocomial pathogen causing, pneumonia, menigitis and bacteremia. Recently, they have been found increasingly in catheterrelated infections (CRI). Thirty-seven cases of bateremia were developed in our hospital during the past five years. Of these 27 cases were chosen out of the medical records for discussion in this paper.<BR>Twenty-three cases are blood positive for <I>Acinetobacter anitratus</I> and 4 cases for <I>A. lwoffii</I>. Most cases have an underlying disease like hematological malignancy, solid tumor and infantile congenital abnormality. There were also some clinical signs ; high fever, hypotention, tachycardia, tachypnea, peripheral cyanosis. A central venus catheter was inserted in 22 cases, and in 13 of these, the catheter was removed after the bacteremic episode. Nine cases became afebrile after the removal of the catheter and <I>A. anitratus</I> was isolated from the catheter tip in four cases. Heparin was administered through the catheter in 7 cases.<BR>Formerly <I>Acinetobacter</I> spp. were not recognized as a major pathogen, but recently found increasingly in CRI. We also found 9 cases which were definitely diagnosed or suspected as CRI, and were successfully treated by removal of the central venus catheter. Association between administration of heparin and bacteremia of <I>Acinetobacter</I> spp. was reported, we actually detected such association in 7 cases, but the potential role of heparin has not been clarified yet.<BR>Compared with <I>A. lwoffii, A. anitratus</I> were resistant to many drugs, but had good susceptibility to imipenem, minocycline, aminoglycoside, and fluoroquinolone.<BR>We have to pay attention to clinical signs of sepsis in patients with indwelling catheter, and appropriate treatment is required when CRI is suspected. <I>Acinetobacter</I> spp. have been identified as one of the important pathogens of CRI.


  • Kansenshogaku Zasshi

    Kansenshogaku Zasshi 69(8), 895-902, 1995-08-20

    The Japanese Association for Infectious Diseases

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