新しいcephamycin系抗生物質, T-1982の複雑性に対する有用性を客観的に評価する目的で, cefmetazole (CMZ) を対照薬として二重盲検法による比較を行なった.
T-1982は1回0.5g, CMZは1回1gをいずれも1日2回, 5日間静注により投与を行った後にUTI薬効評価基準により臨床効果の判定を行ったが, 両群の背景因子には全く差を認めなかった.
総合有効率はT-1982投与群の119例では73.9%, CMZ投与群の122例では57.4%と, T-1982投与群において有意に高かった. これはSerratia感染症例に対するT-1982の有効率が87.2%と, CMZ投与群の39.1%に比し有意に高いためであり, これを除く両群の有効率には差を認めなかった.
細菌学的効果は両群間に差を認めなかったが, Serratiaの消失率はやはりT-1982投与群において有意に高く, またP.aeruginosaの消失率は両群ともに低率であった. 副作用の発現率は両群間に差を認めなかった.
T-1982はCMZと同様に, P. aeruginosa以外の細菌による複雑性の治療に有用な薬剤と考えられ, とくにSerratia感染症に対してはCMZより有用性が高いと思われた.

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の原因菌の動向を調べる目的で単一菌と複数菌検出例に分け1980年から1982年までの3年間の統計的観察を行なった.
1) 入院由来の単一菌検出例ではE. coliが583例 (18.3%) と最も多く, ついでS. marcescens463例 (14.5%), P. aeruginosa 403例 (12.6%) であった. 外来由来では3年間ともE. coliが最も多く40%以上の高い検出率を示した.
2) 複数菌検出例ではEnterococcus groupが752例 (47.1%) と最も多く, ついでP. aeruginosa 458例 (28.7%), E. coli405例 (25.4%), P. mirabilis 291例 (18.2%) であった.3年間ともEnterococcusgroupが最も多く認められた.
3) 年齢別では単一菌検出例の20～40歳でE. coliが高い検出率を示し, P. aeruginosaは10歳以下と40歳以上で高い検出率を認めた.
4) 性別ではE. coliは女性が男性を, S. nzarcescensは男性が女性を上回わる検出率で有意差を認めた.
5) Enterococcus groupの検出率増加は当院における第二, 三世代セフェム系抗生剤使用量増加が一因と考えられた.

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はその感染部位によって腎盂腎炎と膀胱炎に分類されるが,とくに腎盂腎炎は診断と治療が適正を欠いた場合には再発をくりかえして,慢性の進行性腎疾患に進展することがある.そのために本症では正しい病態の把握と抗菌薬療法の評価ならびに適切な経過観察が要求される.

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In two cases with normal renal function, the blood levels reached the maximum (4.3μg/ml, 4.5μg/ml) at 1-2 hours after administration of Talampicillin 500 mg per os. In three cases with impaired renal function, the blood levels reached the maximum (7.6μg/ml-9.0μg/ml) at 2-4 hours after administration of Talampicillin 500 mg per os at fasting time.
The urinary recovery were 146.8 mg and 144.8 mg during 6 hours after administration of Talampicillin 500 mg per os in two cases with normal renal function.
Sixty-two cases with lower urinary tract infections were treated with Talampicillin 750 mg per day per os. Excellent or good results were obtained in 42 cases. Side effects were observed in 9 cases of this series 4 were gastro-intestinal symptoms and 5 were skin eruption. Talampicillin administration was discontinued in 2 cases of them.

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抗菌薬を投与した場合の経時的な尿中濃度をコンピューター制御により自動でシミュレートし得る腎-膀胱モデルを作成し, Onoxacinを用いてin vitroにおいて複雑性膀胱炎の問題点を検討し以下の結果を得た.
1) 尿路の病態の複雑性が高まるに従い除菌に要する時間が延長する事が判明した.
2) 尿流停滞の著しい高度複雑性膀胱モデルにおいては, OFLXの大量投与にもかかわらず異物表面のbiofilmの存在により再燃を認める事実をin vitroで証明した.
3) 除菌に要する時間は抗菌薬の投与量が増加するに従って短縮する傾向であった.
4) 細菌の再増殖開始までの時間は抗菌薬の投与量が増加するに従って延長する傾向であった.
5) 複雑性膀胱炎の治療に際しては, 尿流停滞をきたす基礎疾患の程度によって難治性が左右されることがin vitroの実験で明らかにすることができた.

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2009 年から2018 年までの10 年間に当院小児科において有熱性

の診断で入院した患者320 名・339 例の尿より分離された腸内細菌科細菌341 株を対象とし抗菌薬感受性を調査した．入院時の年齢は日齢11～14 歳9 カ月（中央値：日齢174），男児195 例，女児144 例であった．菌株はEscherichia coli が297 株（87.1%）で大半を占めた．extended-spectrum β-lactamase（ESBL）産生菌は16 株（4.7%）であり，すべてE. coli であった．CTX 耐性率は2014 年までは2～4% と低値で安定していたが，2015 年以降耐性株が増加し，直近2 年は10% 以上を占めた．LVFX 耐性率も近年上昇傾向をみとめ2018 年は13% を超えた．一方でCMZ は感性率90% 以上を保っていた．TAZ/PIPC の感性率は2010 年以降95% 以上，MEPM の感性率は全期間100% であった．
小児における腸内細菌科細菌の抗菌薬耐性化は現時点では成人と比較すると深刻ではないといえるが，ESBL 産生菌やAmpC 過剰産生菌など多剤耐性菌の増加傾向をみとめており，今後も継続して抗菌薬感受性の推移を監視することが必要と考えられた．

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老年者特に寝たきり老人のは無症候性のことが多く, 混合感染を伴つて難治性となる傾向があるとされている.著者は, 1974～1979年の6年間に脳血管障害後遺症で入院中にを合併した患者638例を対象に臨床細菌学的検討を行ない, 2～3の知見を得た.
1.のべ1267回の尿培養で, 1901株の細菌が分離され, 主要菌種はE. coli, Klebsiella, Proteus群で, グラム陰性桿菌が全体の90%を占めた.分離菌の年次推移をみると, Proteus群ことにイソドール陽性Proteusの増加が著しかつた. 又混合感染は約45%にみられた.
2.薬剤感受性試験の成績では年々耐性化傾向がみられ, 分離頻度の高いProteusで各種薬剤に多剤耐性を示した. 又化学療法剤投与による治療成績では, 一部の菌株に菌数および菌種の変化がみられた.
3.女性の難治性患者を対象に腔内細菌培養を試みた結果, 多菌種の細菌が分離され, 膣内のnormal floraに加えて, いわゆるopportunistic pathogenも少なからず認められた. これらの成績から脳血管障害後遺症例に合併したの治療に際しては, 耐性菌による菌交代を考慮し, 適切な化学療法剤を選択することが第一であるが, おむつによる汚染を避けるため, 局所の清潔を保つと同時に, 女性患者では膣内洗浄の実施も, 尿路感染防止の有効な手段と考えられた.

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We have formerly reported a method of classifying the type of infection in complicated urinary tract infections into six groups according to the efficacy of chemotheapeutics. This time, we investigated the characteristics of each group from a viewpoint of drug efficacy.
In UTI with indwelling catheter and afterprostatectomy, Proteus spp., Serratia and P. aeruginosa were isolated more frequently as infecting organisms than in the other groups, and MIC distribution of each drug in these two groups deviated significantly to resistant side, and also cross infection occurred frequently in cases with indwelling catheter. We believe that is the reason why drug efficacy was so low in these two groups.
Drug efficacy was also low in the cases with mixed infection compared to those of single infection, but the reason why drug efficacy was low in mixed infection was not clear. It was suggested, however, inactivation of drugs, especially penicillins, contributes to the lowering of the efficacy to some extent.

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S-6436, a new long-acting preparation of cephalexin (CEX), was studied both basically and clinically in the urological field and the results obtained were as follows:
1. In vitro antibacterial activity
MICs of CEX against clinically isolated 73 strains of E. coli were distriblited among ≤0.2≥100μg/ml with inoculum size of 10⁸ cells/ml but the majority of MICs was ≥100μg/ml. On the other hand, with inoculum size of 10⁶ cells/ml a peak of MIC distribution was 3.12μg/ml.
MICs of CEX against clinically isolated 15 strains of Klebsiella pneumoniae were distributed among 50-≥100μg/ml mostly ≥100μg/ml, with inoculum size of 10⁸ cells/ml but with 10⁶ cells/ml a peak was 3.12μg/ml.
MICs of CEX against clinically isolated 95 strains of Serratia marcescens and 18 strains of Pseudomonasaeruginosa were mostly ≥100μg/ml with both inoculum sizes of 108 and 106 cells/ml.
2. Serum level
Three healthy adult volunteers were orally administered S-6436 at a single dose of 500mg after usual meal. Mean peak serum concentration of S-6436 was appeared at five hours with 6.8μg/ml and effective serum levels continued for approximately five hours. Accordingly it is considered that therapeutic efficacy of S-6436 can be expected at a dose of 500mg b.i.d.
3. Urinary recovery
The urinary recovery of S-6436 for twelve hours was 83.1% on an average following an administration of a single dose of 500mg.
4. Clinical result
S-6436 was administered to the majority of 20 cases with urinary tract infections at a dose of 500mg b.i.d., and the clinical effects obtained were excellent in 15 cases, good in 3 cases and poor in 2 cases, effective ratio being 90%. In 13 cases with simple urinary tract infections, the effective ratio was 92% and in 7 cases with complicated urinary tract infections, the effective ratio was 86%.
5. Adverse reaction
In S-6436 administered 20 cases, no adverse reactions were complained. These results indicated that S-6436 was equal to CEX in the effectiveness and safety in the therapy of urinary tract infection. Accordingly it is considered that S-6436 500mg b.i.d. is more acceptable and more convenient for patients than CEX 250mg q.i.d.

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Correlation between the disc sensitivity and the clinical effect were investigated in 205 cases with acute simple cystitis and also in 283 cases with chronic complicated urinary tract infection (UTI).
The results were summarized as follows.
1. Significant correlation between the disc sensitivity and the bacteriological response were observed in cases with acute simple cystitis treated with 1g or 0.5g of ampicillin, but the correlation in cases treated with 2g of ampicillin was not significant.
2. Dose response in acute simple cystitis was significant only in cases with resistant strains, which were judged by the negativity of the disc sensitivity test.
3. Significant correlation between the disc sensitivity and the bacteriological response was also observed in cases with chronic complicated UTI treated with ampicillin or carindacillin, but correlation in cases treated with gentamicin was not significant.
4. In comparison with acute simple cystitis and chronic complicated UTI, both treated with 2g of ampicillin, bacteriological eradication rate was higher in acute cases than chronic cases both in the sensitive and resistant group. But the difference of eradication rate between acute and chronic cases was more obvious in the resistant group.
5. It was considered sufficient to divide the sensitivity of causative organisms into two groups, “sensitive” which was judged (+++)-(+), and “resistant” which was judged (-) by the disc sensitivity test.
6. From these results, the disc sensitivity test was considered useful in predicting the clinical efficacy of chemotherapy of UTI.

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1) PC-904 was administered into 20 cases with complicated urinary tract infection who were admitted into Department of Urology, Kyushu University Hospital and Department of Urology, National Beppu Hospital from October 1976 to March 1977.
2) Among 20 cases, 3 were administered 500 mg twice a day as one shot intravenously (iv), 2 as one shot iv 1, 000mg twice a day, 7 as iv drip infusion 1, 000mg twice a day, and 8 as iv drip infusion 2, 000 mg twice a day.
3) The effect of the drug was considered excellent in 5, good in 5, failure in 9 cases, and overall effectiveness amounted to 53%.
4) Bacteriological examinations revealed that 8 strains of disappearance, 7 of persistence and 5 of change to another organism, so effective rate was 40%.
5) Adverse reaction was observed in one case, which was parasthesia in lower extremities and forced to withdraw the drug on the first day of the therapy.
6) Abnormal elevations in GOT, GPT values were noted in one case who received the operation and blood transfusion 3 days before. But these abnormalities vanished within 1 week after completion of administration.

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新型コロナウイルス（以下 COVID-19）感染流行下におけるの発生状況を検討するために，2018 年 4 月から 2021 年 3 月の 3 年間にで当院入院治療を行った患者を後ろ向きに調査した。流行期（2020 年度）において，肺炎の入院患者数は減少したが，による入院患者数は不変であった。当 院救急外来受診者総数は，COVID-19流行期に減少していたが，救急外来からの入院となる割合は 2 割弱と変化なく，全入院患者数に占めるでの入院の割合も変化なかった。当院の医療圏での役割を考えると，の発症頻度は，COVID-19流行期において通年と変化なかったものと考えられる。

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T-1220 was tried on the 24 cases of urinary tract infection.
1) The drug was given intravenously in dose of 1 to 3 grams, 1 or 2 times a day.
2) Clinical results were evaluated as follows ; excellent in 8, good in 8, fair in 6 and overall efficacy was 73% of 24 cases.
3) 1 case was found to have nausea and vomiting and another had skin rush as the side effect.
In any case, no serious complication was observed.

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