敗血症16年間147例の検討-1-臨床的解析
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概要
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In order to reveal some important factors that deteriorated the outcome of septicemia including infective endocarditis during the past 16 years at the department of internal medicine of Yamaguchi Prefectural Central Hospital was done.<BR>Among 153 strains isolated from these patients, sixty seven percent were Gram negative rods (39%, fermentatives, 28%, non-fermentatives), and 22%, Gram positive cocci, 11%, anaerobes, respectively. <I>E. coli</I> was the most frequent etiologic agent followed in frequency by <I>P. aerginosa</I>, a-hemolytic streptococci, <I>S. aureus, K. pneumoniae</I> and <I>B. fragilis</I>. These six organisms holded the seventy percent of all isolates.<BR><I>E. coli</I> was frequently isolated from the out- and inpatients with mild underlying diseases resulting good prognosis. On the other hand, <I>P. aerginosa</I> was mainly isolated, as hospital acquired infection, from the patients with severe underlying diseases, especially with hematological diseases having miserable outcome. <I>S. aureus</I> was usually isolated from outpatients with cutaneoarthral infections. <I>K. pneumoniae</I>was often isolated from the patients with ultimately-fatal and non-fatal diseases. <I>B. fragilis</I> was mainly isolated from the inpatients with gastrointestinal malignancies. The prognosis of septicemia due to <I>P. aerginosa</I> or <I>K. pneumoniae</I> was poor and of that due to <I>B. fragilis</I> was the worst.<BR>Among these organisms, <I>K. pneumoniae</I> and <I>B. fragilis</I> were apt to complicate with shock with or without DIC. Three quarters of the patients with septicemia complicated with shockdied.<BR>The propriety of antibiotic therapy influenced directly upon the prognosis of patients with septicemia. Namely, such patients received inappropriate antibiotic therapy, as having hematological diseases, as complicating with shock, as with septicemia due to <I>B. fragilis</I>, were alldied of septicemia.<BR>In conclusion, main factors which deteriorated the prognosis of septicemia were as follows; 1) severity of underlying diseases, 2) inappropriate antibiotic therapy, 3) complication with shock, 4) <I>B. fragilis</I> as causative organism.
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