臨床整形外科57巻4号

2022年04月発行

特集 骨軟部組織感染症Update

壊死性軟部組織感染症の温故知新

著者： 安藤恒平¹

所属機関： ¹産業医科大学救急医学講座

ページ範囲：P.413 - P.418

2021年現在言われている壊死性軟部組織感染症(NSTI)は，古くから認知されており，ともすれば紀元前2,500年頃に作成されたヒエログリフの中に記述された48症例目なども含まれるかもしれない．20世紀初頭までは外傷性に由来することが多かったものの，昨今では疾患的に，または医療的に免疫抑制状態にある方々が多いこと，また，肝機能障害の方々を丁寧に治療・観察していく中で，本疾患を見出すようになってきている．本稿では，NSTIの歴史的な記述や，今に至るまでの先人の苦難と成功を紐解き，現在行われようとしているCLAP治療までの変遷を紹介する．

参考文献

1) Stevens DL, Bryant AE. Necrotizing soft-tissue infections. N Engl J Med 2017;377(23):2253-65.

2) Bonne SL, Kadri SS. Evaluation and management of necrotizing soft tissue infections. Infect Dis Clin North Am 2017;31(3):497-511.

3) Hedetoft M, Madsen MB, Madsen LB, Hyldegaard O. Incidence, comorbidity and mortality in patients with necrotising soft-tissue infections, 2005-2018:a Danish nationwide register-based cohort study. BMJ Open 2020;10(10):e041302.

4) Wong CH, Khin LW, Heng KS, et al. The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score:a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med 2004;32(7):1535-41.

5) Himeno D, Matsuura Y, Maruo A, et al. A novel treatment strategy using continuous local antibiotic perfusion:a case series study of a refractory infection caused by hypervirulent Klebsiella pneumoniae. J Orthop Sci 2022;27(1):272-80.

6) Breasted JH. The Edwin Smith Surgical Papyrus. Chicago:TheUniversity of Chicago Press;1930.

7) Hippocrates. Hippocrates. London:William Heinemann, New York:G.P. Putnam's sons;1923.

8) Lane N. The unseen world:reflections on Leeuwenhoek (1677) ‘Concerning little animals’. Phil Trans R Soc B Biol Sci 2015;370(1666):20140344. doi:10.1098/rstb.2014.0344

9) Brown JH. The biological approach to bacteriology. J Bacteriol 1932;23(1):1-10.

10) Chapnick EK, Abter EI. Necrotizing soft-tissue infections. Infect Dis Clin N Am 1996;10(4):835-55.

11) Hirsch EF. “The treatment of infected wounds,” Alexis Carrel's contribution to the care of wounded soldiers during World War I. J Trauma 2008;64(3 Suppl):S209-10.

12) Bentley R. Different roads to discovery;prontosil (hence sulfa drugs) and penicillin (hence beta-lactams). J Ind Microbiol Biotechnol 2009;36(6):775-86.

13) Schatz A, Bugie E, Waksman SA. Streptomycin, a substance exhibiting antibiotic activity against gram-positive and gram-negative bacteria. 1944. Clin Orthop Relat Res 2005;437:3-6.

14) Weinstein MJ, Luedemann GM, Oden EM, et al. Gentamicin, a new antibiotic complex from micromonospora. J Med Chem 1963;6:463-4.

15) Khamnuan P, Chongruksut W, Jearwattanakanok K, et al. Necrotizing fasciitis:epidemiology and clinical predictors for amputation. Int J Gen Med 2015;8:195-202.

16) Suzuki H, Muramatsu K, Kubo T, et al. Factors associated with mortality among patients with necrotizing soft tissue infections:an analysis of 4597 cases using the Diagnosis Procedure Combination Database. Int J Infect Dis 2021;102:73-8.

17) Fujinaga J, Kuriyama A, Ikegami T, et al. Laboratory risk indicator for necrotizing fasciitis score and patient outcomes. J Emerg Trauma Shock 2021;14(1):38-41.

18) Wu PH, Wu KH, Hsiao CT, et al. Utility of modified Laboratory Risk Indicator for Necrotizing Fasciitis (MLRINEC) score in distinguishing necrotizing from non-necrotizing soft tissue infections. World J Emerg Surg 2021;16(1):26.