腎癌手術後のメチシリン耐性黄色ブドウ球菌による腸炎

A CASE OF POSTOPERATIVE STAPHYLOCOCCAL ENTEROCOLITIS CAUSED BY METHICILLINRESISTANT STAPHYLOCOCCUS AUREUS

　左腎腫瘍核出術後に発症したメチシリン耐性黄色ブドウ球菌による細菌性腸炎について報告した．本症は菌交代現象として起こるものであるが，全例が術後に発症し，特に第3世代セフェム抗生剤の使用例に多いとされている．国内では25例の報告がこれまでになされているが，泌尿器科領域においては1例目と思われた．本症は重篤な疾患でありまた致命率も非常に高いことより，予防的化学療法において十分考慮しなければならないものと考えられた．

The patient was a 54-year-old male with right renal tumor. Since this patient underwent left nephrecto-my 3 years ago, an enucleation of tumor was performed on his right kidney. He developed severe diarrhea. vomitting and abdominal pain 5 days after operation. MRSA was detected from his feces. The patient was treated with oral vancomycin sensitive to this bacteria, which resulted successful improvement, including symptoms, leucocytosis and blood CRP level 7 days after administration of vancomycin. MRSA enterocoitis in this case seems to be due to superinfection within patient's bowel caused by postoperative cefzonam.