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Neurological Surgery No Shinkei Geka Volume 28, Issue 5 （May 2000）

Neurological Surgery 脳神経外科 28巻5号（2000年5月発行）

Japanese English

症例

開頭術後MRSA敗血症の2例 Two Cases of Methicillin-resistant Staphylococcus aureus (MRSA) Sepsis Following Craniotomy 糟谷英俊 ¹ , 菊池賢 ² , 今村強 ¹ , 川島明次 ¹ , 藍原康雄 ¹ , 落合卓 ¹ , 山口浩司 ¹ , 深町きく代 ¹ , 堀智勝 ¹ , 志関雅幸 ² , 戸塚恭一 ² Hidetoshi KASUYA ¹ , Ken KIKUCHI ² , Tsuyoshi IMAMURA ¹ , Akitsugu KAWASHIMA ¹ , Yasuo AIHARA ¹ , Taku OCHIAI ¹ , Kouji YAMAGUCHI ¹ , Kikuyo FUKAMACHI ¹ , Tomokatsu HORI ¹ , Masayuki SHISEKI ² , Kyouichi TOZUKA ² ¹東京女子医科大学脳神経外科 ²東京女子医科大学感染対策科 ¹Departments of Neurosurgery, Tokyo Women's Medical University ²Departments of Infections Disease, Tokyo Women's Medical University キーワード： methicillin-resistant Staphylococcus aureus（MRSA）sepsis , spondylo-diskitis , venous thrombosis , antibioticus Keyword: methicillin-resistant Staphylococcus aureus（MRSA）sepsis , spondylo-diskitis , venous thrombosis , antibioticus pp.429-434

発行日 2000年5月10日 Published Date 2000/5/10

DOI https://doi.org/10.11477/mf.1436901888

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Abstract 文献概要
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I．はじめに

　Methicillin-resistant Staphylococcus aureas（MRSA）は現在，院内感染の起因菌として最も分離頻度の多い細菌の一つであり^{1,12,14,15）}，多くの抗菌剤に耐性を示すため，治療に難渋する，現在，脳神経外科手術後に予防的に使用する抗生物質はほとんどが単剤では効果のないβ-lactam系薬剤であるため^5,6），術後感染症の起炎菌としてMRSAを常に念頭におく必要がある．われわれは脳神経外科手術後に血液発症し，診断と治療に難渋したMRSA敗血症の2例を経験したので，診断及び治療方法，さらに手術後の抗生物質の使用方法について考察を加える．

We report here two cases of MRSA sepsis following craniotomy. In case 1, a petroclival meningioma was subtotally removed and lumbar drainage was inserted postoperatively to prevent cerebrospinal fluid leakage. Ventriculo-peritoneal shunt was performed after meningitis was treated with vancomycin and panipenem/betamipron. Two weeks after the procedure, the patient revealed continuous spiking fevers re-lated to MRSA sepsis, which did not improve with vancomycin and arbekacin administration. The focus of infection was found by scintigraphy and CT by ⁶⁷Ga to be spondylo-diskitis at the level of L₂-L₃. The le-sion was removed and bone from the iliac crest grafted. In case 2, seven days after surgery for multiple meningioma, the patient exhibited spiking fevers and swelling in the left leg. The central venous catheter was removed from the left femoral vein and MRSA was found from blood culture. The patient was tre-ated with arbekacin (200mg/day). Venous thrombosis diagnosed by CT was treated with heparin. Symp-toms related to the infection and laboratory data did not improve because the concentration of arbekacin in the blood did not reach an effective level. The symptoms markedly improved when the dose of arbekacin was doubled (400mg/day).