臨床泌尿器科70巻8号

2016年07月発行

特集 もう慌てない!　重症尿路性器感染症のマネジメント

ウロセプシス（敗血症）の治療法

著者： 桧山佳樹¹ 高橋聡² 舛森直哉¹

所属機関： ¹札幌医科大学医学部泌尿器科学講座 ²札幌医科大学医学部感染制御・臨床検査医学講座

ページ範囲：P.574 - P.581

文献概要

▶ポイント

・ウロセプシスは重症化する可能性のある疾患のため，適切な診断と対応が求められる．

・重症敗血症に対しては「初期蘇生」を意識して対応する．

・判断および対応に難渋する場合は上級医や集中治療専門医に適時コンサルトする．

参考文献

1）Hamasuna R, Takahashi S, Nagae H, et al : Obstructive pyelonephritis as a result of urolithiasis in Japan : diagnosis, treatment and prognosis. Int J Urol 22 : 294─300, 2015

2）Dellinger RP, Levy MM, Rhodes A, et al : Surviving Sepsis Campaign : international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 39 : 165─228, 2013

3）日本集中治療医学会Sepsis Registry委員会 : 日本版敗血症診療ガイドラインThe Japanese Guidelines for the Management of Sepsis. 日集中医誌20 : 124─173, 2013

4）Singer M, Deutschman CS, Seymour CW, et al : The Third International Consensus Definitions for Sepsis and Septic Shock （Sepsis-3）．JAMA 315 : 801─810, 2016

5）Rivers E, Nguyen B, Havstad S, et al : Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345 : 1368─1377, 2001

6）De Backer D, Aldecoa C, Njimi H, et al : Dopamine versus norepinephrine in the treatment of septic shock : a meta-analysis. Crit Care Med 40 : 725─730, 2012

7）Ferrer R, Artigas A, Suarez D, et al : Effectiveness of treatments for severe sepsis : a prospective, multicenter, observational study. Am J Respir Crit Care Med 180 : 861─866, 2009

8）Gaieski DF, Mikkelsen ME, Band RA, et al : Impact of time to antibiotics on survival in patients with severe sepsis or septic shock in whom early goal-directed therapy was initiated in the emergency department. Crit Care Med 38 : 1045─1153, 2010

9）JAID/JSC感染症治療ガイド・ガイドライン作成委員会 （編） : JAIDS/JSC感染症治療ガイド2014. p212, ライフ・サイエンス出版, 東京, 2014

10）Takahashi S, Kurimura Y, Takeyama K, et al : Efficacy of treatment with carbapenems and third-generation cephalosporins for patients with febrile complicated pyelonephritis. J Infect Chemother 15 : 390─395, 2009

11）Ishikawa K, Hamasuna R, Uehara S, et al : Japanese nationwide surveillance in 2011 of antibacterial susceptibility patterns of clinical isolates from complicated urinarytract infection cases. J Infect Chemother 21 : 623─633, 2015

12）Bagshaw SM, Uchino S, Bellomo R, et al : Timing of renal replacement therapy and clinical outcomes in critically ill patients with severe acute kidney injury. J Crit Care 24 : 129─140, 2009

13）Karvellas CJ, Farhat MR, Sajjad I, et al : A comparison of early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury : a systematic review and meta-analysis. Crit Care 15 : R72, 2011

14）Tian H, Sun T, Hao D, et al : The optimal timing of continuous renal replacement therapy for patients with sepsis-induced acute kidney injury. Int Urol Nephrol 46 : 2009─2014, 2014

15）Cruz DN, Perazella MA, Bellomo R, et al : Effectiveness of polymyxin B-immobilized fiber column in sepsis : a systematic review. Crit Care 11 : R47, 2007

16）Sherwin RL, Garcia AJ and Bilkovski R : Do low-dose corticosteroids improve mortality or shock reversal in patients with septic shock? A systematic review and position statement prepared for the American Academy of Emergency Medicine. J Emerg Med 43 : 7─12, 2012

17）Alejandria MM, Lansang MA, Dans LF, et al : Intravenous immunoglobulin for treating sepsis, severe sepsis and septic shock. Cochrane Database Syst Rev 16 : 9, 2013