著者

宮尾 泰慶 芝野 克彦 嶋田 延光 加藤 智絵里 吉峰 俊樹

出版者

日本脊髄外科学会

雑誌

脊髄外科

巻号頁・発行日

vol.22, no.1, 2008

著者

佐々木 学 梅垣 昌士 鶴薗 浩一郎 松本 勝美 芝野 克彦 呉村 有紀 米延 策雄

出版者

日本脊髄外科学会

雑誌

脊髄外科 (ISSN:09146024)

巻号頁・発行日

vol.30, no.2, pp.170-175, 2016 (Released:2016-09-03)

参考文献数

14

被引用文献数

2

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Objective : Surgical site infection (SSI) caused by methicillin-resistant Staphylococcus aureus (MRSA) after spinal instrumentation surgery is often intractable, and removal of the implants is frequently necessary for infection control. Although vancomycin (VCM) has been most frequently used against SSI caused by MRSA, recent literatures questioned its efficacy because of its low tissue penetration. Some experts recommend combination therapy with anti-MRSA agents possessing higher tissue penetration or an anti-biofilm effect. The present report shows outcomes of antibiotic therapy for SSI caused by MRSA after spinal instrumentation surgery.  Materials and methods : From January 2011 to December 2013, four patients developed SSI caused by MRSA after spinal instrumentation surgery. Posterior lumbar interbody fusion was used in all patients. As initial therapy, VCM was given to one patient, and combined teicoplanin (TEIC) and rifampicin (RFP) were administered to the other three. These patients subsequently received therapy with TEIC, linezolid, or daptomycin combined with RFP, sulfamethoxazole-trimethoprim, or clindamycin. These agents were stopped sequentially if C-reactive protein remained negative for more than a week.  Results : Infection was uncontrolled in one patient initially treated with VCM, and removal of the posterior instrumentation and interbody cages was required for infection control. Combined therapy was given postoperatively, with complete cure by 13 weeks after removal of the implants. Infection was controlled and the implants could be retained in the other three patients who were initially treated with TEIC and RFP ; cure was achieved with subsequent combined therapy for 3-15 weeks.  Conclusion : The present study suggests that SSI caused by MRSA is treatable with retention of the implant by using combined therapy with anti-MRSA agents possessing higher tissue penetration than VCM or those with an anti-biofilm effect.

著者

黒田 淳子 藤中 俊之 中村 元 西田 武生 梶川 隆一郎 芝野 克彦 吉峰 俊樹

出版者

特定非営利活動法人 日本脳神経血管内治療学会

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

vol.5, no.2, pp.106-111, 2011 (Released:2012-01-05)

参考文献数

16

被引用文献数

1

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【目的】bare platinum coilを用いた脳動脈瘤塞栓術(BC群)とbioacitive coilを用いた脳動脈瘤塞栓術(BAC群)の治療成績を比較し,bioactive coilの安全性および再開通予防効果について検討した.【方法】当院にて2007年1月~2009年12月までに動脈瘤瘤内塞栓術を行い,術後1年以内にfollow upの血管造影検査を行った破裂/未破裂脳動脈瘤を対象とし,治療直後およびfollow upでの塞栓状況,動脈瘤頚部での内皮新生を示唆するwhite collar signの有無,術後MRI DWIでの微小脳梗塞の有無について比較検討を行った.【結果】follow upの血管造影検査施行時に,治療直後と比べ塞栓状況が改善されたものはBC群で9.38%,BAC群で15.8%であり,有意差は認められないものの(p=0.58),BAC群で多い傾向にあった.また,動脈瘤ネック部分の内膜新生を示唆すると考えられているwhite collar signの有無に関しては,BC群の6.3%,BAC群の26.3%にみられ,有意差は認められないもののBAC群で多い傾向にあった(p=0.13).しかし,術後の微小梗塞はBA群よりも多い傾向にあり,血栓性合併症に対しては十分な注意が必要である.〈第26回日本脳神経血管内治療学会学術総会優秀演題推薦論文〉