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Brain and Nerve No to Shinkei Volume 25, Issue 12 （December 1973）

Brain and Nerve 脳と神経 25巻12号（1973年12月発行）

Japanese English

特集脳神経外科論文集

脳動脈瘤術後に発症した緑膿菌性髄膜炎の治験例 A CASE REPORT:INTRACTABLE MENINGITES CAUSED BY Pseudomonas aeruginose AS AN UNUSUAL COMPLICATION AFTER CRANIOTOMY 尾藤昭二 ¹ , 榊三郎 ¹ Syoji Bito ¹ , Saburo Sakai ¹ ¹大阪厚生年金病院脳神経外科 ¹Dept. of Neurosurg., Osaka Koseinenkin Hospital pp.1887-1891

発行日 1973年12月1日 Published Date 1973/12/1

DOI https://doi.org/10.11477/mf.1406203466

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Abstract 文献概要
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緒言

　1966年R．L．　Wright^4）は2148例のclean int—racranial operationの術後感染頻度は5.7％と報告しているが，現今では開頭術後の感染はより低率である。われわれもmajor surgery 260例中術後髄膜炎は6例を経験したに過ぎず，かつ何れもが起炎菌，感受性抗生物質の検討結果を待つことなく短期間に治癒せしめ得たことから，ややもすれば髄膜炎に対して安易に惰し易い傾向にあることは否めない。この度脳動脈瘤術後に緑膿菌髄膜炎を経験したがその治療はまことに難渋し発症後3ヵ月経過して漸く治癒せしめることができた。近年術後感染として緑膿菌感染症が増加しつつあるが^{1,2,9,10,14,16）}，本菌に対する感受性抗生物質が少なく，かつそれらは副作用を有し，他方本感染症では特に生体側の因子すなわち防御機構，免疫機能の低下が発症に重要な関係にあることなどからその治療が困難なる場合が少なくない。殊に本菌髄膜炎では血液脳関門による抗生物質，抗体の移行し難い組織での感染症であり死亡率も高く治療上問題点も少なくない。ここに治験例を報告し大方の参考に資し度い。

A case of intractable meningitis is reported in this paper. Meningitis in this case was caused by Pseudomonas aeruginosa, and developed as an un-usual complication after craniotomy.

A 35-year-old man with an earlier aneurysm of the anterior communicating artery underwent sur-gical clipping of the aneurysm on October 4, 1971. The postoperative course was uneventful.

On the 8th postoperative day, he suddenly de-veloped signs of meningitis, and neutrophilic leukocytosis was found in the cerebrospinal fluid. No organisms, however, were detected in the fluid at this stage.

About 4 weeks after the onset of meningitis, the fluid contained Pseudomonas aeruginosa, which was found to be sensitive to 25 mcg/ml of car-benicillin and 3.12 mcg/ml of gentamicin but re-sistant to the antibiotics used thus far. Accordingly, these antibiotics were immediately withdrawn, and intrathecal treatment with daily doses of 300 mg of carbenicillin 12 mg of gentamicin was instituted. The patient remained afebrile for subsequent 12 days, when the meningitis recurred and caused a high temperature. The fluid on this occasion also contained Pseudomonas aeruginosa, which was found to be as susceptible to carbenicillin and gentamicin as that isolated before.

For the following and last 5 days, the does of carbenicllin was maintained but that of gentamicin was doubled to 24 mg a day, and two intrathecal doses of Gamma-Venin for intravenous use' (a brand of gammaglobulin) were additionally given on two separate days. As a result, the meningitis was completely cleared up after as long as 3 months of treatment for this disease.