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本稿のテーマは「急性膵炎」「脾摘後」「誤嚥後」における感染症予防である。急性膵炎に対しては,感染性膵壊死の予防を目的とした抗菌薬投与は一般的に推奨されない。その根拠となる臨床研究では循環不全や多臓器不全合併例が除外されており,これらの重症例に対する予防的抗菌薬の是非はいまだ不明である。脾摘後では,予防的抗菌薬とワクチンが重要となる。予防的抗菌薬の適応および期間はガイドラインによって異なり,ワクチンの接種スケジュールも,年齢,過去のワクチン接種歴,手術様式(緊急手術か待機手術か)によって異なる。誤嚥性肺臓炎(胃内容物の誤嚥による化学性の肺臓炎)では一般的に抗菌薬は不要とされるが,実臨床においては誤嚥性肺炎との区別は難しいことが多い。現在までに誤嚥後の予防的抗菌薬の有効性に関する質の高い研究は存在せず,特に重症例に関しては臨床医の判断に依拠する場合が多い。
The purpose of this review is to evaluate the prevention of infection, particularly in patients with “acute pancreatitis,” “status-post splenectomy,” and “post-aspiration”. Antimicrobial therapy for patients with acute pancreatitis to prevent infectious pancreatic necrosis is generally not recommended. Clinical studies that support this view exclude patients with circulatory failure or multiple organ failure, and the pros and cons of prophylactic antimicrobial therapy in these patients are still unclear. Prophylactic antimicrobial agents and vaccines are important in patients status-post splenectomy. Indications for and duration of administering prophylactic antimicrobial agents vary according to guidelines. The vaccination schedule varies according to age, previous vaccination history, and surgical procedure (emergency or elective surgery). Aspiration pneumonitis (chemical pneumonia caused by aspiration of gastric contents) generally does not require administration of antimicrobial agents, but in practice it is often difficult to distinguish it from aspiration pneumonia. To date, there are no high-quality studies on the efficacy of prophylactic antimicrobial agents after aspiration, especially in patients after severe aspiration, which often depends on the judgment of the treating clinician.
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