トブラマイシン吸入療法で人工呼吸器離脱が可能となった難治性緑膿菌気道感染の1例
緑膿菌による人工呼吸器関連肺炎（ventilator-associated pneumonia, VAP）は再発率が高い。VAPを繰り返す難治性の緑膿菌気道感染に対し，トブラマイシンの吸入療法にて改善した症例を経験したので報告する。症例は66歳，男性。作業中に右前腕を受傷し緊急手術を施行された。術後，VAPを発症して呼吸不全の状態が続き，当院集中治療部に転院となった。ICU入室57日目に気管支液から緑膿菌が検出され，以後，緑膿菌による肺炎を繰り返して人工呼吸器からの離脱が困難となった。入室192日目から難治性の慢性緑膿菌気道感染に対する維持療法としてトブラマイシンの吸入療法を開始した。その後，...
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| Published in | 日本集中治療医学会雑誌 Vol. 22; no. 2; pp. 122 - 126 |
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| Main Authors | , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本集中治療医学会
2015
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| Online Access | Get full text |
| ISSN | 1340-7988 1882-966X |
| DOI | 10.3918/jsicm.22.122 |
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| Abstract | 緑膿菌による人工呼吸器関連肺炎（ventilator-associated pneumonia, VAP）は再発率が高い。VAPを繰り返す難治性の緑膿菌気道感染に対し，トブラマイシンの吸入療法にて改善した症例を経験したので報告する。症例は66歳，男性。作業中に右前腕を受傷し緊急手術を施行された。術後，VAPを発症して呼吸不全の状態が続き，当院集中治療部に転院となった。ICU入室57日目に気管支液から緑膿菌が検出され，以後，緑膿菌による肺炎を繰り返して人工呼吸器からの離脱が困難となった。入室192日目から難治性の慢性緑膿菌気道感染に対する維持療法としてトブラマイシンの吸入療法を開始した。その後，気管支液中の緑膿菌数および気道感染増悪の頻度は減少し，入室260日目に人工呼吸器を離脱できた。トブラマイシン吸入療法は安全性が高く，緑膿菌によるVAP再発の制御に有効である可能性が示唆された。 |
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| AbstractList | 緑膿菌による人工呼吸器関連肺炎（ventilator-associated pneumonia, VAP）は再発率が高い。VAPを繰り返す難治性の緑膿菌気道感染に対し，トブラマイシンの吸入療法にて改善した症例を経験したので報告する。症例は66歳，男性。作業中に右前腕を受傷し緊急手術を施行された。術後，VAPを発症して呼吸不全の状態が続き，当院集中治療部に転院となった。ICU入室57日目に気管支液から緑膿菌が検出され，以後，緑膿菌による肺炎を繰り返して人工呼吸器からの離脱が困難となった。入室192日目から難治性の慢性緑膿菌気道感染に対する維持療法としてトブラマイシンの吸入療法を開始した。その後，気管支液中の緑膿菌数および気道感染増悪の頻度は減少し，入室260日目に人工呼吸器を離脱できた。トブラマイシン吸入療法は安全性が高く，緑膿菌によるVAP再発の制御に有効である可能性が示唆された。 |
| Author | 鷺島, 克之 山口, 絵美 興梠, 博次 廣佐古, 進 右山, 洋平 蒲原, 英伸 木下, 順弘 田代, 貴大 |
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| References | 7) Silver DR, Cohen IL, Weinberg PF. Recurrent Pseudomonas aeruginosa pneumonia in an intensive care unit. Chest 1992;101:194-8. 16) Gil-Perotin S, Ramirez P, Marti V, et al. Implications of endotracheal tube biofilm in ventilator-associated pneumonia response: a state of concept. Crit Care 2012;16:R93. 10) Moss RB. Long-term benefits of inhaled tobramycin in adolescent patients with cystic fibrosis. Chest 2002;121:55-63. 4) Planquette B, Timsit JF, Misset BY, et al; OUTCOMEREA Study Group. Pseudomonas aeruginosa ventilator-associated pneumonia. predictive factors of treatment failure. Am J Respir Crit Care Med 2013;188:69-76. 3) Clinical and Laboratory Standards Institue (CLSI). Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Second Informational Supplement. M100-S22. PA: CLSI; 2012. p. 62-3. 9) Ramsey BW, Pepe MS, Quan JM, et al. Intermittent administration of inhaled tobramycin in patients with cystic fibrosis. Cystic Fibrosis Inhaled Tobramycin Study Group. N Engl J Med 1999;340:23-30. 13) Drobnic ME, Suñé P, Montoro JB, et al. Inhaled tobramycin in non-cystic fibrosis patients with bronchiectasis and chronic bronchial infection with Pseudomonas aeruginosa. Ann Pharmacother 2005;39:39-44. 5) Rello J, Mariscal D, March F, et al. Recurrent Pseudomonas aeruginosa pneumonia in ventilated patients: relapse or reinfection? Am J Respir Crit Care Med 1998;157(3 Pt 1):912-6. 15) Arnold HM, Sawyer AM, Kollef MH. Use of adjunctive aerosolized antimicrobial therapy in the treatment of Pseudomonas aeruginosa and Acinetobacter baumannii ventilator-associated pneumonia. Respir Care 2012;57:1226-33. 1) Combes A, Luyt CE, Fagon JY, et al. Early predictors for infection recurrence and death in patients with ventilator-associated pneumonia. Crit Care Med 2007;35:146-54. 6) Chastre J, Wolff M, Fagon JY, et al; PneumA Trial Group. Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial. JAMA 2003;290:2588-98. 8) Rello J, Lorente C, Diaz E, et al. Incidence, etiology, and outcome of nosocomial pneumonia in ICU patients requiring percutaneous tracheotomy for mechanical ventilation. Chest 2003;124:2239-43. 2) Siempos II, Athanassa Z, Falagas ME. Frequency and predictors of ventilator-associated pneumonia recurrence: a meta-analysis. Shock 2008;30:487-95. 11) Sawicki GS, Signorovitch JE, Zhang J, et al. Reduced mortality in cystic fibrosis patients treated with tobramycin inhalation solution. Pediatr Pulmonol 2012;47:44-52. 17) Kallet RH. Adjunct therapies during mechanical ventilation: airway clearance techniques, therapeutic aerosols, and gases. Respir Care 2013;58:1053-73. 12) Quittner AL, Buu A. Effects of tobramycin solution for inhalation on global ratings of quality of life in patients with cystic fibrosis and Pseudomonas aeruginosa infection. Pediatr Pulmonol 2002;33:269-76. 14) Palmer LB, Smaldone GC, Chen JJ, et al. Aerosolized antibiotics and ventilator-associated tracheobronchitis in the intensive care unit. Crit Care Med 2008;36:2008-13. |
| References_xml | – reference: 2) Siempos II, Athanassa Z, Falagas ME. Frequency and predictors of ventilator-associated pneumonia recurrence: a meta-analysis. Shock 2008;30:487-95. – reference: 13) Drobnic ME, Suñé P, Montoro JB, et al. Inhaled tobramycin in non-cystic fibrosis patients with bronchiectasis and chronic bronchial infection with Pseudomonas aeruginosa. Ann Pharmacother 2005;39:39-44. – reference: 12) Quittner AL, Buu A. Effects of tobramycin solution for inhalation on global ratings of quality of life in patients with cystic fibrosis and Pseudomonas aeruginosa infection. Pediatr Pulmonol 2002;33:269-76. – reference: 4) Planquette B, Timsit JF, Misset BY, et al; OUTCOMEREA Study Group. Pseudomonas aeruginosa ventilator-associated pneumonia. predictive factors of treatment failure. Am J Respir Crit Care Med 2013;188:69-76. – reference: 7) Silver DR, Cohen IL, Weinberg PF. Recurrent Pseudomonas aeruginosa pneumonia in an intensive care unit. Chest 1992;101:194-8. – reference: 10) Moss RB. Long-term benefits of inhaled tobramycin in adolescent patients with cystic fibrosis. Chest 2002;121:55-63. – reference: 14) Palmer LB, Smaldone GC, Chen JJ, et al. Aerosolized antibiotics and ventilator-associated tracheobronchitis in the intensive care unit. Crit Care Med 2008;36:2008-13. – reference: 3) Clinical and Laboratory Standards Institue (CLSI). Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Second Informational Supplement. M100-S22. PA: CLSI; 2012. p. 62-3. – reference: 11) Sawicki GS, Signorovitch JE, Zhang J, et al. Reduced mortality in cystic fibrosis patients treated with tobramycin inhalation solution. Pediatr Pulmonol 2012;47:44-52. – reference: 6) Chastre J, Wolff M, Fagon JY, et al; PneumA Trial Group. Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial. JAMA 2003;290:2588-98. – reference: 9) Ramsey BW, Pepe MS, Quan JM, et al. Intermittent administration of inhaled tobramycin in patients with cystic fibrosis. Cystic Fibrosis Inhaled Tobramycin Study Group. N Engl J Med 1999;340:23-30. – reference: 1) Combes A, Luyt CE, Fagon JY, et al. Early predictors for infection recurrence and death in patients with ventilator-associated pneumonia. Crit Care Med 2007;35:146-54. – reference: 5) Rello J, Mariscal D, March F, et al. Recurrent Pseudomonas aeruginosa pneumonia in ventilated patients: relapse or reinfection? Am J Respir Crit Care Med 1998;157(3 Pt 1):912-6. – reference: 17) Kallet RH. Adjunct therapies during mechanical ventilation: airway clearance techniques, therapeutic aerosols, and gases. Respir Care 2013;58:1053-73. – reference: 15) Arnold HM, Sawyer AM, Kollef MH. Use of adjunctive aerosolized antimicrobial therapy in the treatment of Pseudomonas aeruginosa and Acinetobacter baumannii ventilator-associated pneumonia. Respir Care 2012;57:1226-33. – reference: 16) Gil-Perotin S, Ramirez P, Marti V, et al. Implications of endotracheal tube biofilm in ventilator-associated pneumonia response: a state of concept. Crit Care 2012;16:R93. – reference: 8) Rello J, Lorente C, Diaz E, et al. Incidence, etiology, and outcome of nosocomial pneumonia in ICU patients requiring percutaneous tracheotomy for mechanical ventilation. Chest 2003;124:2239-43. |
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| Title | トブラマイシン吸入療法で人工呼吸器離脱が可能となった難治性緑膿菌気道感染の1例 |
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