多剤耐性緑膿菌による難治性眼窩感染症とofloxacin効果

Ofloxacin was effective in a case with refractile orbital infection due to multiply resistant pseudomonas aeruginosa

　81歳，女性，左眼窩腫瘍で眼窩内容除去術が施行された症例で，術後眼窩感染を発症した．眼窩内の膿性分泌物の培養でPseudomonas aer-uginosaが検出された．その薬剤感受性はcar-benicillin,sulbenicillin,piperacillin,cefsulodin，cefoperazone,cefpiramideのすべてに＞100μg／mlの高度耐性，ceftazidimeには12.5μg／mlgentamicin,amikacin,habekacinには25〜50μg／mlの最小発育阻止濃度で耐性を示した．ofloxacinには1.56μg／mlで高感受性であった．ofloxacinの局所，全身投与により，眼窩内の膿性分泌物の軽減，菌数の減少がみとめられて臨床症状の改善がみられた．多剤耐性のP aeruginosaによる難治症例の治療に，ofloxacinがきわめて有用な抗菌剤であると考えられた．

An 81-year-old female underwent orbital eviscera-tion due to malignant tumor of the orbit 4 years before. Suppurative orbital infection persisted ever since in spite of local or systemic treatments with GM, CFS and CL. Cultures from the orbital lesion showed pseudomonas aeruginosa which was serotype K, pyocyanin-productive and melanin non-productive. This strain was resistant to CBPC, SBPC, PIPC, CFS,CPZ, CPM, GM, AMK and HBK. ofloxacin was excep-tionally effective to this strain with MIC of 1.56μg/ml in both 10⁸ cfu/ml and 10⁶ cfu/ml.

We therefore initiated treatment with ofloxacin with instillation and irrigation. Also, it was given perorally at a daily dosis of 600 mg. The orbital lesion promptly responded to treatment and the state of clinical cure was attained 7 days after start of ofloxacin therapy. Ofloxacin may prove to be remarkably effective in infections due to multiply resistant pseudomonas as in our present case.

Rinsho Ganka (Jpn J Clin Ophthalmol) 40(10) : 1128-1131,1986