9．重症熱傷に合併する感染症治療と感染予防—皮膚バリアの破綻を念頭に，受傷後日数をふまえて抗菌薬を選択する

Treatment and control of infection complicated by severe burn injuries

重症熱傷患者において感染に起因する病態は，急性期以降の死因の1位であり，感染症の予防および診断・治療は重要である。感染の診断・治療においては，創部感染およびburn wound sepsis（創部からの微生物侵入）を常に念頭におき，早期の経験的抗菌薬投与とともに，焼痂組織（熱傷創部）切除と植皮術が欠かせない。受傷からの時期や経過により創部から検出される微生物が異なるので，それもふまえて経験的治療の抗菌薬を選択する。血行・代謝動態は通常と大きく異なり，抗菌薬投与量の調整や血中濃度測定を要し，薬剤師との協働が必要である。一律の予防的抗菌薬投与は推奨されておらず，患者の感染リスクに応じて投与する。環境整備および標準予防策による感染制御も重要である。

Infection is the leading cause of death after the acute phase of injury in severely burned patients. Thus, the prevention, diagnosis, and treatment of infections are critical. Burn wound infection and burn wound sepsis （caused by microorganism invasion from the wound） must be considered when patients are suspected to have infections. Early administration of empiric antibiotics, as well as burn wound incision and skin grafting, are essential. Knowing what pathogenic microorganisms are cultured in different time intervals and treatment courses is necessary. Empiric antibiotics should be selected based on that information. Adjustment of antibiotic doses and measurement of serum concentration should be made with the aid of a skilled pharmacologist because of abnormal hemodynamics and hypermetabolism in severely burned patients. While routine prophylactic use of antibiotics is not recommended, prophylactic treatment may be needed based on a patient's infection risk. Management of central catheter and assiduous wound washing lower the infection risk. Infection control by environmental cleaning and the use of standard precautions is also needed.