Enterobacter cloacaeが起炎菌と考えられた高齢者再発深頸部膿瘍の1例

Recurrent deep neck abscess caused by Enterobacter cloacae in the elderly

I．はじめに

　近年の抗菌薬の普及と発達により感染症が重症化する頻度は減少傾向にあるものの，逆に新しいタイプの難治性感染症の発生はあとをたたないのが現状である。感染症難治化の要因として，宿主側では易感染者の増加が挙げられ，細菌側としては，細菌の変異，菌交代現象などが挙げられる。なかでも加齢化に伴って発生する日和見感染症は，今後さらに増加の一途をたどることが予想されるため注意を要する。

　今回われわれは，日和見感染症の原因菌の一菌種であるEnterobacter cloacae（E. cloacae）が起炎菌と考えられた高齢者再発深頸部膿瘍を経験したので，本症例の病態について考察するとともに，若干の文献的考察を加え検討したので報告する。

A 78-year-old man presented with acute left cervical swelling and fever. He was diagnosed as a deep neck abscess from physical examination and CT scan,and he underwent surgical drainage and was give penicillins as an outpatient. Although his clinical symptoms temporarily ameliorated in 3 weeks,the abscess recurred 10 months later. CT scan showed a large abscess in his left upper neck,and he underwent surgical drainage again combined with thorough debridement and the placement of a drain. Intravenous panipenem and clindamycin were administered,and repeated irrigation of the wound was performed through the drain postoperatively. The abscess promptly disappeared,and he was discharged 2 weeks after surgery. On both occasions,Enterobacter cloacae,an attenuated and indigenous bacterium by nature,was isolated as a pathogen. Potential problems of the management of deep neck infections in the elderly were reviewed.