メタロβ-ラクタマーゼ産生緑膿菌感染による腎盂腎炎

Acute pyelonephritis caused by metallo-β-lactamase-producing pseudomonas aeruginosa

65歳，男性。左下腹部痛を主訴に当院救急外来を受診した。CT検査，血液検査，検尿にて左尿管結石およびこれに伴う左水腎症性腎盂腎炎と診断した。培養検査にて，中間尿，左腎盂内尿，および動脈血からメタロβ-ラクタマーゼ産生緑膿菌を検出した。左経皮的腎瘻造設術を契機に敗血症性ショック，急性呼吸促迫症候群をきたした。しかし，エンドトキシン吸着療法，人工呼吸器管理，体外衝撃波結石破砕術などの集学的治療により救命し，左尿管結石も治癒できた。

A 65-year-old male complaining left lower abdominal pain was admitted to our hospital with the diagnosis of left ureteral stone and left infected hydronephrosis. The bood and urine specimens were positive for metallo-β-lactamase-producing pseudomonas aeruginosa. After left percutaneous nephrostomy tube was inserted,the patient developed septic shock and acute respiratory distress syondrome（ARDS）. The patient,intubated and ventilated mechanically,was treated by extracorporeal elimination of endotoxin using polymxin B-immobilized fiber successfully. After the recovery from septic shock and ARDS,the patient received extra corpoleal shock wave lithotripsy for left ureteral stone and became free from the stone.