ｂａｃｔｅｒｉａｌ　ｔｒａｎｓｌｏｃａｔｉｏｎの診断と治療　　ＭＲＳＡ腸炎とｂａｃｔｅｒｉａｌ　ｔｒａｎｓｌｏｃａｔｉｏｎ

• Published in: Nihon Fukubu Kyukyu Igakkai Zasshi (Journal of Abdominal Emergency Medicine) Vol. 23; no. 3; pp. 477 - 483
• Main Authors: Tanaka Hidenori, Sumiyama Yoshinobu, Kusachi Shinya, Arima Yoichi, Yoshida Yuichi, Nakamura Yoichi, Nagao Jiro, Kajiwara Hirohisa, Saida Yoshihisa, Usui Sadahito
• Format: Journal Article
• Language: Japanese
• Published: 日本腹部救急医学会 2003; Japanese Society for Abdominal Emergency Medicine
• Subjects: bacterial translocation; RSA腸炎; 肝脾マクロファージ; 腸内細菌叢
• ISSN: 1340-2242; 1882-4781
• DOI: 10.11231/jaem1993.23.477

Methicilline resistant staphylococcus aureus (MRSA) can be grown alone in a neutral culture medium but not when other kinds of bacteria are present. Under conditions where the growth of Escherichia coli (E. coli) and Bacteroides fragilis (B. fragilis) or E. coli and Escherichia faecalis (E. faecalis) are prohibited, however, the growth of MRSA increases significantly. In a rat model fed by total parenteral nutrition (TPN), MRSA was able to translocate to the small intestine when gastric acidity was suppressed. However, MRSA enteritis and diarrhea did not occur because MRSA enteritis requires a series of treatments, including the administration of antibiotics prior to and after MRSA inoculation. Bacterial translocation was confirmed using a postoperative MRSA enteritis mouse model; hepato-splenic macrophages were thought to be the front line of host protection during the initial stage of infection. Careless antibiotic administration may cause MRSA enteritis. MRSA enteritis could be a serious complication in postoperative patients with a low hepato-splenic macrophage count. SAは単独培養では培地が中性化すると発育できるが, 複数の菌株が同時に発育する環境では, 細菌間のinteractionにより異常増殖が起きなかった. しかし, E. coliとB. fragilisないしE. coliとE. faecalisの発育を抑制するとMRSAは有意に増加した. 完全静脈栄養 (TPN) ラットを用いた実験では, 胃内が減酸状態となればMRSAは小腸以下へ侵入できるが, 腸炎を発症することはなく, 抗菌薬による腸管前処置後MRSAを接種し, その後抗菌薬を投与すると下痢を生じMRSA腸炎を認めた. マウス術後MRSA腸炎モデルではbacterial translocationが確認され, 肝脾マクロファージが感染初期における宿主防御の最前線であると考えられた. 臨床の場において, 不用意な抗菌薬による腸管前処置はMRSA腸炎を惹起すると考えられる. また, 肝脾マクロファージが減少する術後の患者では, MRSA腸炎を併発した際, 重篤化する可能性が高いと考えられる.