Toshiaki Hirata

A study on postoperative enteritis caused by methicillin-resistant Staphylococcus aureus

We investigated the production of staphylococcal enterotoxin (SE) with respect to coagulase types by methicillin-resistant Staphylococcus aureus (MRSA). A total of 138 strains of MRSA, which were isolated from clinical materials in the surgical ward between 1983 and 1990, were studied. Coagulase type IV strains produced SE A only, whereas coagulase type II strains were classified into four groups by SE production: SE B producing strains (32.7%), SE C producing strains (29.8%), SE B and C coproducing strains (12.5%), and SE A and C coproducing strains (25.0%). Almost all of the organisms (nine of ten) which were isolated from the feces of patients with MRSA enteritis were SE A and C coproducing strains. The coincidence in time of the prevalence of MRSA enteritis and the isolation SE A and C coproducing strains also demonstrated that these strains caused MRSA enteritis. Although SE C producing strains and SE A and C coproducing strains were simultaneously prevalent in 1990, the former tended to be sensitive while the latter tended to be resistant to minocycline. Considering the variety of antibiotic sensitivity in coagulase type II strains, it is thus considered to be of critical importance for epidemiologic purposes to further characterize isolates by SE typing.

Studies of the Intraperitoneal Antibiotic Administration.

抗菌剤腹腔内1回投与が全身投与よりも術後感染予防に有用であるかを検討した. 消化器手術32例を対象にセフェム剤 (3剤) を1g点滴静注 (DI), 腹腔内投与 (IP) し体内動態を測定した. IP群での腹水中濃度は投与後30分, 1時間で1, 000,300μg/mlとDI群より有意に高い値が得られた. しかし, 投与後4, 6時間ではDI群と有意差のない値 (4-2μg/ml) となり, DI群に比べ有意の有効濃度の持続時間の廷長は得られなかった. 一方, flomoxef sodium (FMOX) は大腸菌に対し400, 40μg/mlでおのおの2, 4時間野接触時間で良好な殺菌効果を認めたが, 4μg/ml, 6時間接触では殺菌効果は得られなかった.緑膿菌, メチシリン耐性ブドウ球菌ではFMOX 400μg/ml, 6時間接触時間でも殺菌作用は得られなかった.高濃度の持続時間で期待できないので抗菌剤腹腔内1回投与では, 上記細菌.対象とした術後感染予防において全身投与以上の有用性は得られないと考えられた.