日本泌尿器科学会-the japanese urological association (jua)...表1 eau guidelines for the...

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Page 1: 日本泌尿器科学会-The Japanese Urological Association (JUA)...表1 EAU guidelines for the management of uri-nary and male genital tract infections ・原則として単回投与

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Page 2: 日本泌尿器科学会-The Japanese Urological Association (JUA)...表1 EAU guidelines for the management of uri-nary and male genital tract infections ・原則として単回投与

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Page 3: 日本泌尿器科学会-The Japanese Urological Association (JUA)...表1 EAU guidelines for the management of uri-nary and male genital tract infections ・原則として単回投与

表1 手術創の分類

特徴創分類

Uninfected operative wound in which no inflammation is encountered and the respiratory, alimen-tary, genital, or uninfected urinary tract is not entered.

清潔手術(Clean)

Operative wound in which the respiratory alimentary, genital, or urinary tracts are entered under controlled condition and without unusual contamination.

準清潔手術(Clean-contaminated)

Open, fresh or accidental wounds.汚染手術(Contaminated)

Old tranmatic wounds with retained devitalized tissue and those that involve existing clinical infec-tion or perforated viscera.

不潔または感染手術(Dirty and infected)

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�������� ����������������� !"#����$%�� &�'()�*����+,����-./0�12�34"567����$89 ���:��� ���;<()=��*� !"#���>����/??@AB CDEFG�H�6 IJKLJF/H�4$M���/ %N�� O�PQ����R�� IJKLJF�ST�UV�4�$WXYZ��[F\]^CDC_Centers for dis-ease control and prevention �� a()�*����IJKLJFbcde fg���4Ah"4�1`$e?e��A ���R�54"� ijk���l6 mn���54"/ onp�bq4 �r)/st���4uv�����l49! %N��wx��yz�IJKLJF�7�w{@h�$Mt� |��}~���b�� �]�F���]�b��e IJKLJF���b��9$1$&�'()=���w����o 1���i���e9���;<()

=b&�'()=w�V�4�$t���� ��a�������()=^��a()�Surgi-cal site infection`w��aw�������4()= ����()=_Remote infection w����h�$t��<�&�'()=� �������� 89  ¡r)�¢£¤�¥4���"&�'() O���a()�¦§�¥4����� ��b ¡r)�¢£¤�¥4�����e"4�$%N���R�� ¨©��^Clean ª¨©

^Clean-contaminated r) Contaminated 5�«¬©^Dirty and infected`����h"4�^­ 1 $ ©��� ¡r)�¢£¤�H�6 �®� PQ� �¯�()=b�e"4�4°±���$ª¨©����®� PQ� �¯�����²��³´�4? ³V�/µF¶·]��h"4�°±���$r)����®� PQ� �¯���²��³«  ¡r)�¢£¤���°±���$89 ¬©��� ¡()=bste"4�������¸4�¹����¯ º§�r)�st�"4���������$t��<�������R����� t

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1

Page 4: 日本泌尿器科学会-The Japanese Urological Association (JUA)...表1 EAU guidelines for the management of uri-nary and male genital tract infections ・原則として単回投与

表2 泌尿器科領域における手術の分類

手術の種類創分類

根治的腎摘除術,副腎開放手術ほか清潔手術

根治的前立腺摘除術,膀胱部分切除術,TUR-p,TUR-Bt,PNL,TULほか

準清潔手術

腸管利用尿路変向術,感染結石に対する手術ほか汚染手術

尿路の開放性外傷,感染腎への手術ほか不潔または感染手術

��� CDC�������� ����Superficial incisional SSI������Deep inci-sional SSI�������������Organ/Space SSI�������� �!�"�#$�����%!&'��$�(�!��� )��������*+,*�-��.��/0�.�1�//���)����2� 2 CDC�)�345647CDC189����)�:$;2�34

5647��<=�!�"�#$>?@A/�1�BC���1.�D���E��� FG$HI$2JBK1L�����M���N �1.� 1�O�P��QRSTUSVWO�P�$�(�QRSTUSVW�XBN

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o!�����pq����r�������s�t��������uvPwC+1.� gh��i�������xy����z�������{w�|}��~����Pw���d�����������xy� }���!��"�5�W7�~�����������S��SC+���1.� 2�z�����^_�������$z����$�

Z(��NJB�.� CDC������z�� ����$2JB�.b��B��(��C��1#������ ��������� ��C*����kz�SQW� "����$�����$��)��$�1 N���*¡�����{w1¢(£¤¢�¥+�%1 NC

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Page 5: 日本泌尿器科学会-The Japanese Urological Association (JUA)...表1 EAU guidelines for the management of uri-nary and male genital tract infections ・原則として単回投与

表3 論文のランク付け

内容レベル

最低一つのRCTやMeta-anslysisによる実証IRCTではない比較試験,コホート研究による実証I I症例集積研究や専門家の意見I I I

表4

内容推奨度

強く推奨するA一般的に推奨するB任意でよいC

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1JMangram AJ, Horan TC, Pearson ML, Silver LC,Jarvis WR : Guideline for prevention of surgicalsite infection, 1999. Infect. Cont. Hosp. Epidemiol.,20, 247Ã278, 1999.

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Page 6: 日本泌尿器科学会-The Japanese Urological Association (JUA)...表1 EAU guidelines for the management of uri-nary and male genital tract infections ・原則として単回投与

表 1 EAU guidelines for the management of uri-

nary and male genital tract infections

・原則として単回投与

・尿路+消化管:第2世代セファロスポリン+metronidazole

βLI配合ペニシリン+metronidazole

・尿路のみ:Fluoroquinolone

第2世代セファロスポリン

βLI配合ペニシリン

(感染リスクの高い患者のみ)

・尿路外(清潔):第1,2世代セファロスポリン

(感染リスクの高い患者のみ)

BLI:β ラクタマーゼ阻害剤

��������������� ������������������������������ !�"��2�Centers for Disease Control and Prevention

#CDC$�%& European Association of Urology#EAU$'()*(+, ��- SSI�.�/"�0123�4��

�5 CDC� 1999�� SSI�/"�'()*(+�6�781$�CDC'()*(+�����9-:;<�=>��#class I$�?=>��#classII$�:;��#class III$�%&@;�����#class IV$� �ABC�����D�"���E8�FG-���?=>��#class II$�7C �ABCH��7I7��JK�LM�-��D�"����%&��������N�O7CN-%��PQ���R���I��NST�UV��ABCH�H�W��EAU� 2001���XJ@;Y'()

*(+-W�7C���@;Z.�/"� rec-ommendation�6�7CH�2$#� 1$�[-\��]�^H-��PQ��@;Z.-�_�7C`aW�b�c-�������de������f���g��hi7CH�g�����jklm��n�Hop��qr�7C=>����D�������PQ����H�7C���s�ope�t�uop�N@;vwx�yHop�-zPQ�-{��|}CH����������~ PQ�{���������XQ�!!7C� 2������w�v+�

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"�%¥�¦�a�&'()*(+§2� £78¨©��HCª«78¬���­"#� 2$�®¯°±�JK������²³<�:;<

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Page 7: 日本泌尿器科学会-The Japanese Urological Association (JUA)...表1 EAU guidelines for the management of uri-nary and male genital tract infections ・原則として単回投与

表2 周術期感染阻止薬の使用状況と感染発症率 ※文献2)を基に作製

投与期間(日)使用抗菌薬SSI症例数手術分類

京都大学※(2001~2002年)

術当日ペニシリン 4(1.8%) 224清潔小手術

第1,2世代セフェム内視鏡手術

3日間ペニシリン 8(7.6%) 105清潔大手術

第1,2世代セフェム準清潔手術

4日間第2,3世代セフェム 3(30.0%) 10腸管利用手術

岡山大学(1998~2002年)

1.10±0.26ペニシリン+BLI 0 41清潔小手術

第1世代セフェム

2.77±1.15ペニシリン+BLI 1(1.6%) 64清潔大手術

第1,2世代セフェム

3.06±0.25ペニシリン+BLI 0 16準清潔(軽度)手術

第3世代セフェム

3.11±0.47ペニシリン+BLI10(14.3%) 70準清潔(高度)手術

第3世代セフェム

4.05±1.18ペニシリン+BLI 6(60.0%) 10腸管利用手術

第1,2世代セフェム

BLI:β ラクタマーゼ阻害剤

��2�������� 2�3���� ��������������������� !"#$%&%�'(����)*�%+ SSI���,-.�/01�234�%+methicillinresistant Staphylococcus aureus5MRSA678�9:;4,-����<"+=>?@�ABCDE#$0� F�Matsukawa!56� ���GH��%+I 3JKLMNOP��Q�RSH%�TUVWXP��I 1�2JKLMNOP��YRQ�%0Z[\�SSI�4�=]#MRSA�^��_!` 93.3aRbc0�d%+e#$f�!�ghijklm66�=e+\�SSI&!kn<"0234�g.,opO�;4�MRSA�����qr� 58.8aRbc0�d<"+e#$s��tuv��%+nw%+e#MRSA�xy#xz�� ���GH���{|]�}~%7e��e DE>�������7s���xz� ���xz,��E#$4$ ��=]#(�5� 36 ����������4�������

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¿��±² 30���y#5AI6$�À�, 4À�RÁ #Z[�ÂÃ��R¨¤5AI6$/0��4�ÄRÅÆ%�HÇ�ÈÉ�ÊË��ÌÍ�ÎÏ�Ð_�Ñc#$ÒÓ¬XRQ�y#Z[���ÔÕÒÓ¬XRÖ×y#5BII6$@�(��%+�ÊØ��Ù%ev�,7e

Z[�@ 48�72À��ÒÓ¸VXoÚ�+�¤5BII6$ Ûª«¬«­�ÒÓ¬X�Ü�ÝÞ�Ñ

5

Page 8: 日本泌尿器科学会-The Japanese Urological Association (JUA)...表1 EAU guidelines for the management of uri-nary and male genital tract infections ・原則として単回投与

表3 泌尿器科手術における周術期管理

・手術までの入院期間の短縮(可及的に外来で術前検査)

・検尿 ⇒尿路の開放を伴う手術症例に実施

⇒UTI認める症例では術前に抗菌薬投与を行う

・治療可能症例:原則として治癒を確認して手術を行う

・治療困難な症例(カテーテル留置症例など):手術前日より抗菌薬投与を行う

・剃毛は行わない

必要なら術当日にクリッパーにて,術野の手術に支障のある範囲のみ除毛を行う

術中

・周術期抗菌薬投与方法

初回投与は手術開始30分前とする

手術時間が4時間を越える場合は追加投与を行う

・無菌手技の遵守

・手術手技

止血の徹底,術野の洗浄

死腔の軽減 ⇒ 皮下縫合

・術創の洗浄

・閉鎖式ドレーンの使用

術後

・創部は,著しい汚染がない場合48~72時間はドレッシング材にて覆う

・尿道カテーテル,ドレーンの早期抜去

・カーゼ交換時の滅菌手技の徹底

⇒手袋の着用,滅菌機材の使用

・病棟回診時の手指消毒の徹底

・耐性菌感染患者の回診は最後にする

⇒包交カートを患者のベッドサイドまで持ち込まず,必要な物品のみをベッドサイドまで持参し,その場で使い切ることが望ましい

表4 泌尿器科開腹手術における周術期感染阻止薬投与方法

投与期間投与薬剤手術名手術分類

単回又は24時間以内第1世代セファロスポリン系薬外陰部手術清潔手術

ペニシリン系薬腎摘除術

後腹膜腫瘍摘除術,など

48~72時間以内第1,2世代セファロスポリン系薬腎尿管摘除術準清潔手術

βLI配合ペニシリン系薬根治的前立腺摘除術

膀胱摘除術(尿管皮膚瘻),など

72~96時間以内第2世代セファロスポリン系薬膀胱摘除術,など汚染手術(腸管利用手術)膀胱拡大術

第2世代セファマイシン系薬

βLI配合ペニシリン系薬

BLI:β ラクタマーゼ阻害剤

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1�Mangram, A.J., Horan, T.C., Pearson, M.L., Silver,L.C., Jarvis, W.R. : Guideline for prevention of sur-gical site infection. Infect . Control Hosp . Epide-miol, 20, 250�78, 1999.

2�Naber, K.G., Bergman, B., Bishop, M.C., Bjerklund-Johansen, T.E., Botto, H., Lobel, B., Jinenez Cruz,F., Selvaggi, F.P., Urinary Tract Infection�UTI�Working Group of the Health Care Office�HCO�

of the European Association of Urology�EAU�:EAU guidelines for the management of urinaryand male genital tract infections. Urinary TractInfection�UTI�Working Group of the HealthCare Office�HCO�of the European Associationof Urology�EAU�, Eur. Urol., 40, 576�588, 2001.

3�Kanamaru, S., Ogawa, O., Terai, A., Ishitoya, S.,Kunishima, H., Nishiyama, H., Segawa, T., Naka-mura, E., Kinoshita, H., Moroi, S., Ito, N., Kamoto,T., Okuno, H., Habuchi, T., Senda, K., Ichiyama, S.,Yamamoto, S. : Assessment of a protocol for pro-phylactic antibiotics to prevent perioperative in-fection in urological surgery : a preliminarystudy. Int. J. Urol., 11, 355�363, 2004.

4�LM�������+R�ST�DV(N�?� ���Urology View, 3, 58�61, 2005.

5�Matsukawa, M. , Kunishima , Y. , Takahashi , S . ,Takahashi , S . , Takeyama, K. , Tsukamoto , T . :Staphylococcus aureus bacteriuria and surgicalsite infections by methicillin-resistant Staphylo-coccus aureus. Int . J . Antimicrob . Agents . , 17,327�329, 2001.

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1 Mangram, A.J., Horan, T.C., Pearson, M.L., Silver,L.C., Jarvis, W.R. : Guideline for prevention of sur-gical site infection. Infect . Control Hosp . Epide-miol, 20, 250©78, 1999%�II A

2 Naber, K.G., Bergman, B., Bishop, M.C., Bjerklund-Johansen, T.E., Botto, H., Lobel, B., Jinenez Cruz,F., Selvaggi, F.P., Urinary Tract Infection�UTI Working Group of the Health Care Office�HCO of the European Association of Urology�EAU :EAU guidelines for the management of urinaryand male genital tract infections. Urinary TractInfection�UTI Working Group of the HealthCare Office�HCO of the European Associationof Urology�EAU , Eur. Urol., 40, 576©588, 2001%�II A

3 Richards, C., Edwards, J., Culver, D., Emori, T.G.,Tolson, J., Gaynes, R. : National Nosocomial Infec-tions Surveillance�NNIS System, Centers forDisease Control and Prevention. : Does using a la-paroscopic approach to cholecystectomy decrea-se the risk of surgical site infection? Ann. Surg.,237, 358©362, 2003%�II A

4 McCall, J.L., Sharples, K., Jadallah, F. : Systematicreview of randomized controlled trials comparinglaparoscopic with open appendicectomy . Br . J .Surg., 84, 1045©1050, 1997%�II B

5 Meltomaa, S.S., Makinen, J.I., Taalikka, M.O., He-lenius, H.Y. : Incidence, risk factors and outcomeof infection in a 1-year hysterectomy cohort : aprospective follow-up study. J. Hosp. Infect., 45,211©217, 2000%�II B

6 Yamamoto, S., Kunishima, Y., Kanamaru, S., Ito,N., Kinoshita, H., Kamoto, T., Ogawa, O., Arai, Y.,Okumura, K., Terachi, T., Moroi, S., Okada, Y. ,Nishio, Y., Kanamaru, H., Inui, M., Asazuma, A.,Kanatani, I. , Sasaki, M., Nishikawa, N., Hida, S.,Nonomura, M., Terai, A., Ogura, K., Mitsumori, K.,Nishimura, K., Onishi, H., Horii, Y., Yamasaki, T. :A multi-center prospective study for antibioticprophylaxis to prevent perioperative infections inurologic surgery. Hinyokika Kiyo, 50, 673©683,2004%�II A

7 Takeyama, K., Shimizu, T., Mutoh, M., Nishiyama,N., Kunishima, Y., Matsukawa, M., Takahashi, S.,Hotta, H., Itoh, N., Tsukamoto, T. : Prophylacticantimicrobial agents in urologic laparoscopic sur-gery : 1-day versus 3-day treatments . J . Infect .

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Chemother., 10, 168�171, 2004��II A�8�Fahlenkamp, D., Rassweiler, J., Fornara, P., Frede,T., Loening, S.A. : Complications of laparoscopicprocedures in urology : experience with 2, 407procedures at 4 German centers . J . Urol . , 162,765�770 ; discussion 770�771, 1999.�II A�

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3�da Silva , F . C . : Prophylactic antibiotherapy in

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15�Ersev, D. , Dillioglugil , O. , Ilker, Y. , Simsek, F. ,Akdas, A. : Efficacy of Prophylactic GentamicinUse in Postoperative Urinary Tract Infections af-ter Endoscopic Procedures of the Urinary Tract.Urol. Int., 48, 401�403, 1992.

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21�Delahaye, F., Hoen, B., McFadden, E., Roth, O., deGevigney, G. : Treatment and prevention of infec-tive endocarditis. Expert Opin. Pharmacother., 3,131�145, 2002.

22�American Urological Association ; American Aca-demy of Orthopaedic Surgeons . Antibiotic pro-phylaxis for urological patients with total joint re-placements. J. Urol., 169, 1796�1797, 2003.

23�Schneede P , Hofstetter AG , Naber KG ,Vahlensieck W, Ludwig M, Bach D, Bauer HW,Beyaert G, Blenk H, Bootz T, Friesen A, Geiges G,Himstedt HW, Hochreiter W, Keller HJ, Knopf HJ,Lenk S , Liedl B , Michaelis R , Neubauer L ,Piechota H, Rassler J, Riedasch G, RothenbergerKH, Rudiger K, Schmitz HJ, Stadie G, Thiel U,Truss MC , Wagenlehner FM , Weidner W ,Westenfelder M, Gockel-Beining B, HeidenreichA, Rubben H, Schalkhauser K, Thon W, ThuroffJW, Weidner W ; Arbeitskreis Infektologie, Deut-schen Gesellschaft fur Urologie : European Asso-ciation of Urology guidelines on urinary and malegenital tract infection Urologe A, 42, 104�112,2003.

24�Wagenlehner, F., Stower, H.J., Schneider, B.W.,Naber, K.G., Lehn, N. : Influence of a prophylacticsingle dose of ciprofloxacin on the level of resis-tance of Escherichia coli to fluoroquinolones inurology. Int. J. Antimicrob. Agents., 15, 207�211,2000.

12

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1�Grabe, M. : Perioperative antibiotic prophylaxis inurology. Curr. Opin. Urol., 11, 81�85, 2001.

2�Puppo, P., Ricciotti, G., Bozzo, W., Introini, C. : Pri-mary endoscopic treatment of ureteric calculi. Areview of 378 cases. Eur. Urol., 36, 48�52, 1999.

3�Larsen, E.H., Gasser, T.C., Madsen, P.O. : Antimi-crobial Prophylaxis in Urologic Surgery . Urol .Clin. North. Am., 13, 591�604, 1986.

4�Rao , P . N . , Dube , D . A . , Weightman , N . C . ,Oppenheim, B.A., Morris, J. : Prediction of septice-mia following endourological manipulation forstones in the upper urinary tract . J . Urol . , 146,955�960, 1991.

5�Higgins, P.M. : Value of prophylactic antibacterialtherapy in instrumentation of urinary tract. Brit.Med. J., 1, 26�29, 1966.

6�Chodak, G.W., Plaut, M.E. : Systemic antibioticsfor prophylaxis in urologic surgery : a critical re-view. J. Urol., 121, 695�699, 1979.

7�Westenfelder, M., Rosset, K., Pelz, K. : Develop-ment of nosocomial and iatrogenic urinary tractinfections�uti�following urological interventions.A prospective clinical study. Scand. J. Urol. Neph-rol., 104, 59�63, 1987.

8�Taylor, A.L., Oakley, N., Das, S., Parys, B.T. : Day-case ureteroscopy : an observational study. BJUinternational, 89, 181�185, 2002.

9�Amin, M. : Antibacterial prophylaxis in urology :a review. Am. J. Med., 92, S114�117, 1992.

10�Trinchieri, A., Mangiarotti, B., Lizzano, R. : Use oflevofloxacin in the antibiotic prophylaxis for diag-nostic procedure in urology. Arch. Ital. Urol. An-drol., 74, 33�39, 2002.

11�Knopf, H.J., Graff, H.J., Schulze, H. : Perioperative

antibiotic prophylaxis in ureteroscopic stone re-moval. Eur. Urol., 44, 115�118, 2003.

12�Christiano, A.P., Hollowell, C.M., Kim, H., Kim, J.,Patel, R., Bales, G.T., Gerber, G.S. : Double-blindrandomized comparison of single-dose ciproflox-acin versus intravenous cefazolin in patients un-dergoing outpatient endourologic surgery. Urol-ogy, 55, 182�185, 2000.

13�Klimberg, I.W. : A multicenter comparison of orallomefloxacin versus parenteral cefotaxime as pro-phylactic agents in transurethral surgery. Am. J.Med., 92, 121S�125S, 1992.

14�Swedish Norwegian Consensus Group : Antibioticprophylaxis in surgery : Summary of a Swedish-Norwegian Consensus Conference. Scand. J. In-fect. Dis., 30, 547�557, 1998.

15�Delahaye, F., Hoen, B., McFadden, E., Roth, O., deGevigney, G. : Treatment and prevention of infec-tive endocarditis. Expert Opin. Pharmacother., 3,131�145, 2002.

16�Schneede P , Hofstetter AG , Naber KG ,Vahlensieck W, Ludwig M, Bach D, Bauer HW,Beyaert G, Blenk H, Bootz T, Friesen A, Geiges G,Himstedt HW, Hochreiter W, Keller HJ, Knopf HJ,Lenk S , Liedl B , Michaelis R , Neubauer L ,Piechota H, Rassler J, Riedasch G, RothenbergerKH, Rudiger K, Schmitz HJ, Stadie G, Thiel U,Truss MC , Wagenlehner FM , Weidner W ,Westenfelder M, Gockel-Beining B, HeidenreichA, Rubben H, Schalkhauser K, Thon W, ThuroffJW, Weidner W ; Arbeitskreis Infektologie, Deut-schen Gesellschaft fur Urologie : European Asso-ciation of Urology guidelines on urinary and malegenital tract infection Urologe A, 42, 104�112,2003.

17�Wagenlehner, F., Stower, H.J., Schneider, B.W.,Naber, K.G., Lehn, N. : Influence of a prophylacticsingle dose of ciprofloxacin on the level of resis-tance of Escherichia coli to fluoroquinolones inurology. Int. J. Antimicrob. Agents, 15, 207�211,2000.

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1bChilds, S.J. : Appropriate surgical prophylaxis intransurethral genitourinary surgery and poten-tial reduction in nosocomial infections . Urology ,27, 415Þ420, 1986.

2bMcEntee, G.P., McPhail, S., Mulvin, D., Thomson,R.W. : Single dose antibiotic prophylaxis in highrisk patients undergoing transurethral prostatec-tomy. Br. J. Surg., 74, 192Þ194, 1987.

3bMebust, W.K. : Prophylactic antibiotics in tran-surethral surgery. J. Urol., 150, 1734Þ1735, 1993.

4bChodak, G. and Plaut, M. : Systemic antibiotics forprophylaxis in urologic surgery : a critical review.J. Urol., 121, 695Þ699, 1979.

5bGrabe, M. : Antimicrobial agents in transurethralprostatic resection. J. Urol., 138, 245Þ252, 1987.

6bHargreave, T., Hindmarsh, J., Elton, R., Chisholm,G.D., Gould, J. C : Short-term prophylaxis with ce-fotaxime for prostatic surgery. Br. Med. J., 284,1008Þ1010, 1982.

7bRamsey, E. and Sheth, N. : Antibiotic prophylaxisin patients undergoing prostatectomy. Urology ,21, 376Þ378, 1983.

8bHellsten, S., Forsgren, A., Bjork, T., Grabe, M. :Use of ciprofloxacin in patients undergoing tran-surethral prostatic surgery. Scand. J. Infect. Dis.,suppl., 60, S104Þ107, 1989.

9bMillar, M., Inglis, T., Ewing, R., Clark, P., Williams,R.E., Lacey, R.W. : Double-blind study comparingazetronam with placebo for prophylaxis of infec-

16

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tion following prostatic surgery. Br. J. Urol., 60,345�348, 1987.

10�Morris, M.J., Golovsky, D., Guinness, M.D., Maher,P .O . : The value of prophylactic antibiotics intransurethral prostatic resection : a controlledtrial, with observations on the origin of postopera-tive infection. Br. J. Urol., 48, 479�484, 1976.

11�Gibbons , R .P . , Stark , R .A . , Correa , R . J . Jr . ,Cummings, K.B., Mason, J.T. : The prophylacticuse-or misuse-of antibiotics in transurethral pros-tatectomy. J. Urol., 119, 381�383, 1978.

12�Williams, M., Hole, D.J., Murdoch, R.W., Ogden,A.C., Hargreave, T.B. : 48-Hour cephradine andpost-prostatectomy bacteriuria . Br. J . Urol . , 52,311�315, 1980.

13�Shah, P.J., Williams, G. and Chaudary, M. : Short-term antibiotic prophylaxis and prostatectomy .Br. J. Urol., 53, 339�343, 1981.

14�Nielsen, O.S. , Maigaard, S. , Frimodt-Moller, N. ,Madsen , P .O. : Prophylactic antibiotics in tran-surethral prostatectomy. J . Urol . , 126, 60�62,1981.

15�Holl, W.H. and Rous, S.N. : Is antibiotic prophy-laxis worthwhile in patients with transurethralresection of prostate? Urology, 14, 43�46, 1982.

16�Falkiner, F.R., Ma, P.T., Murphy, D.M., Cafferkey,M.T. , Gillespie, W.A. : Antimicrobial agents forthe prevention of urinary tract infection in tran-surethral surgery. J. Urol., 129, 766�768, 1983.

17�Childs, S.J., Wells, W.G., Mirelman, S. : Antibioticprophylaxis for genitourinary surgery in commu-nity hospitals. J. Urol., 130, 305�308, 1983.

18�Grabe, M., Forsgren, A., Hellsten, S. : The effect ofa short antibiotic course in transurethral prosta-tic resection. Scand. J. Urol. Nephrol., 18, 37�42,1984.

19�Qvist, N., Christiansen, H.M., Ehlers, D. : Prophy-lactic antibiotics in transurethral prostatectomy.Urol. Res., 12, 275�277, 1984.

20�Botto, H., Richard, F., Mathieu, F., Perreau, A.M.,Camey , M . : Short-term prophylaxis with cefo-taxime in prostatic surgery . J . Antimicr . Che-mother. suppl., 14, S231�235, 1984.

21�Ferrie, B.G. and Scott, R. : Prophylactic cefurox-ime in transurethral resection . Urol . Res . , 12,279�281, 1984.

22�Finkelstein, L.H., Arsht, D.B., Manfrey, S.J., Childs,S. : Ceftriaxone in the prevention of postoperativeinfection in patients undergoing transurethral re-section of the prostate. Am. J. Surg., 148, 19�21,1984.

23�Dorflinger, T. and Madsen, P.O. : Antibiotic pro-phylaxis in transurethral surgery . Urology , 24,

643�646, 1984.24�Prokocimer, P., Quazza, M., Gibert, C., Lemoine, J.

E., Joly, M.L., Dureuil, B., Moulonguet, A., Manual,C., Desmonts, J.M. : Short-term prophylactic anti-biotics in patients undergoing prostatectomy : re-port of a double-blind randomized trial with 2 in-travenous doses of cefotaxime. J. Urol., 135, 60�64, 1986.

25�Fair , W . : Perioperative use of carbenicillin intransurethral resection of prostate . Urology ,suppl., 27, S15�18, 1986.

26�Murdoch, D.A., Badenoch, D.F. and Gatchalian,E. R . : Oral ciproflocacin as prophylaxis intransurethral resection of the prostate . Br . J .Urol., 60, 153�156, 1987.

27�Charton, M., Vallancien, G. , Veillon, B. , Brisset ,J.M. : Antibiotic prophylaxis of urinary tract in-fection after transurethral resection of the pros-tate : a randomized study. J. Urol . , 138, 87�89,1987.

28�Shearman, C.P. , Silverman, S .H . , Johnson , M. ,Young, C.H., Farrar, D.J., Keighley, M.R., Burdon,D.W. : Single dose, oral antibiotic cover for tran-surethral prostatectomy. Br. J. Urol., 62, 434�438,1988.

29�Conn, I.G. and Moffat, L.E. : Short-term cephra-dine prophylaxis in elective transurethral pros-tatectomy. J. Hosp. Infect., 11, 373�375, 1988.

30�Taylor, E.W. and Lindsay, G. : Antibiotic prophy-laxis in transurethral resection of the prostatewith reference to the influence of preoperativecatheterization. J. Hosp. Infect., 12, 75�83, 1988.

31�Stricker, P.D. and Grant, A.B. : Relative value ofantibiotics and catheter care in the prevention ofurinary tract infection after transurethralprostatic resection. Br. J. Urol., 61, 494�497, 1988.

32�Desai, K.M., Abrams, P.H. and White, L.O. : Adouble-blind comparative trial of short-termorally administered enoxacin in the prevention ofurinary infection after elective transurethralprostatectomy : a clinical and pharmacokineticstudy. J. Urol., 139, 1232�1234, 1988.

33�Kjaergaard , B . , Petersen , E . , Lauridsen , K .G . ,Petersen, A.S. : Prophylactic one-dose treatmentwith clindamycin and gentamicin in transurethralprostatic resection. A double-blind placebo con-trolled study. Scand. J. Urol. Nephrol., 23, 109�113, 1989.

34�Houle, A.M., Mokhless, I., Sarto, N., Elhiali, M.M. :Perioperative antibiotic prophylaxis for transure-thral resection of the prostate : is it justifiable? J.Urol., 142, 317�319, 1989.

35�Slavis, S.A., Miller, J.B., Golji, H., Dunshee, C.J. :

17

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Comparison of single-dose antibiotic prophylaxisin uncomplicated transurethral resection of theprostate. J. Urol., 147, 1303�1306, 1992.

36�Viitanen, J., Talja, M., Jussila, E., Nurmi, M., Permi,J., Puolakka, V.M., Rintala, E., Salmela, H., Tiitinen,J., Tuhkanen, K. : Randomized controlled study ofchemoprophylaxis in transurethral prostatec-tomy. J. Urol., 150, 1715�1717, 1993.

37�Hargreave , T . B . , Botto , H . , Rikken , G . H . ,Hindmarsh, J.R. , McDermott , T .E . , Mjolnerod ,O.K. , Petays, P. , Schalkhauser, K . , Stellos , A . :European collaborative study of antibiotic pro-phylaxis for transurethral resection of the pros-tate. Eur. Urol., 23, 437�443, 1993.

38�Raz, R., Almog, D., Elhanan, G., Shental, J. : Theuse of ceftriaxone in the prevention of urinarytract infection in patients undergoing transure-thral resection of the prostate�TUR-P�. Infection,22, 347�349, 1994.

39�Gasser, T.C., Wisard, M. and Frei, R. : Oral flerox-acin prophylaxis in transurethral surgery. J. Urol.,156, 146�148, 1996.

40�Scholz, M., Luftenegger, W., Harmuth, H., Wolf, D.,Holtl , W . : Single-dose antibiotic prophylaxis intransurethral resection of the prostate : a pro-spective randomized trial. Br. J. Urol., 81, 827�829, 1998.

41�Wilson, N.I. and Lewi, H.J. : Survey of antibioticprophylaxis in British urological practice. Br. J .Urol., 57, 478�482, 1985.

42�Mebust, W.K. , Holtgrewe, H.L. , Cockett , A.T. ,Peters, P.C. : Transurethral prostatectomy, imme-diate and postoperative complications. A coopera-tive study of 13 participating institutions evaluat-ing 3,885 patients. J. Urol., 141, 243�247, 1989.

43�Platt, R., Polk, B., Murdock, B., Rosner, B. : Mortal-ity associated with nosocomial urinary-tract infec-tion. N. Engl. J. Med., 307, 637�642, 1982.

44�Bryan, C . and Reynolds , K . : Hospital-acquiredbacteremic urinary tract infections : epidemiol-ogy and outcome. J. Urol., 132, 494�498, 1984.

45�Berry, A., Barratt, A. : Prophylatic antibiotic usein transurethral prostatic resection : a meta-ana-lysis. J. Urol., 167, 571�577, 2002.

46�Naber, K.G., Bergman, B., Bishop, M.C., Bjerklund-Johansen, T.E., Botto, H., Lobel, B., Jinenez, Cruz.F., Selvaggi, F.P. : Urinary Tract Infection�UTI�Working Group of the Health Care Office�HCO�of the European Association of Urology�EAU�.EAU guidelines for the management of urinaryand male genital tract infections. Urinary TractInfection�UTI�Working Group of the HealthCare Office�HCO�of the European Association

of Urology�EAU�. Eur. Urol., 40, 576�88, 2001.47�Qiang, W., Jianchen, W., MacDonald, R., Monga,

M., Wilt, T.J. : Antibiotic Prophylaxis for Transu-rethral Prostatic Resection in Men with Preop-erative Urine Containing less than 100,000 Bacte-ria per ml : A Systemic Review . J . Urol . , 173,1175�1181, 2005.

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� �

1�Lindert KA, Kabalin JN, Terris MK : Bacteremiaand bacteriuria after transrectal ultrasound gui-ded prostate biopsy. J Urol 164, 76Þ80, 2000.

2�Carey JM, Korman HJ. : Transrectal ultrasoundguided biopsy of the prostate . Do enemas de-crease clinically significant complications? J Urol,166, 82Þ85, 2001.

3�Griffith BC, Morey AF , Ali-Khan MM, Canby-Hagino E, Foley JP, Rozanski TA. : Single doselevofloxacin prophylaxis for prostate biopsy in pa-tients at low risk. J Urol, 168, 1021Þ1023, 2002.

4�Cormio L , Berardi A , Callea N , Fiorentino D ,Sblendorio V, Zizzi V and Traficante A. : Antimi-

19

Page 22: 日本泌尿器科学会-The Japanese Urological Association (JUA)...表1 EAU guidelines for the management of uri-nary and male genital tract infections ・原則として単回投与

crobial prophylaxis for transrectal prostatic bi-opsy : a prospective study of ciprofloxacin vspiperacillin/tazobactum. BJU Int, 90, 700�702,2002.

5�Aron M, Rajeev TP, Gupta NP. : Antibiotic pro-phylaxis for transrectal needle biopsy of the pros-tate : a randomized controlled study. BJU Int, 85,682�685, 2000.

6�Shigemura K, Tanaka K, Yasuda M, Ishihara S,Muratani T, Deguchi T, Matsumoto T, KamidonoS, Nakano Y, Arakawa S, Fujisawa M. : Efficacyof 1-day prophylaxis medication with fluoroqui-nolone for prostate biopsy . World J Urol , 23,356�360, 2005.

7������������� ������������������������ ������������� !"#$%&�'()*+,-�./012345 16 �789/:;<�76, 893�897, 2002.

8�Packer MG, Russo P and Fair WR : Prophylacticantibiotics and foley catheter use in transperinealneedle biopsy of the prostate. J Urol, 131, 687�689, 1984.

9�Thompson PM, Pryor JP, Williams JP, Eyers DE,Dulake C, Scully MF, Kakkar VV. : The problemof infection after prostatic biopsy : the case forthe transperineal approach. Br J Urol, 54, 736�40, 1982.

10�Madsen PO, Larsen EH, Dorflinger T. : Infectioncomplications after instrumentation of urinarytract. Urology, 26, 15�17, 1985.

11�Tal R, Livne PM, Lask DM, Baniel J. : Empiricalmanagement of urinary tract infections compli-cating transrectal ultrasound guided prostate bi-opsy. J Urol, 169, 1762�1765, 2003.

VII��������

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20

Page 23: 日本泌尿器科学会-The Japanese Urological Association (JUA)...表1 EAU guidelines for the management of uri-nary and male genital tract infections ・原則として単回投与

表1 尿道膀胱鏡検査時の予防的抗菌薬投与方法

投与期間投与開始時期投与薬剤危険因子尿路感染症

施行前に抗菌薬投与で細菌尿陰性化した上で予防投与を行う.あり

単回投与を原則とし,高リスクでも検査後72時間を超えないこと.

検査開始前投与を原則とする.

ニューキノロン系薬

あり

なし

アミノグリコシド系薬

広域ペニシリン系薬

第一世代セファロスポリン系薬

単回投与.必須ではない.投与する場合は,上記の通り行う.

なし

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B��������III�B���� !"#$%�&'()*+,3�-./�012�345�678�9:9;

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� �

1�Rehm, R.A. : Urinary infections following cysto-scopy. J. Urol., 88, 301[302, 1962.

2�Seneca, H., Lattimer, J .K. , Reilly, M. , Peer, P. :Cephalothin in cystoscopy and retrograde pyelo-graphy. J. Urol., 94, 489[491, 1965.

3�Higgins, P.M. : Value of porphylactic antibacterialtherapy in instrumentation of urinary tract . Br.Med. J., 5478, 26[29, 1966.

4�Last, P.M., Harbison, P.A., Marsh, J.A. : Bacterae-mia after urological instrumentation . Lancet , 1,74[76, 1966.

5�Mendoza, G.B., Gerwig, W.H., Stackhouse, K.L.,Easley , G .W. : Prophylactic use of antibacterialdrugs following cystoscopy : a double-blind con-trolled study of demeclocycline hydrochlorideand sulfamethoxypyridazine. J. Urol., 106, 682[684, 1971.

6�Blackard , C . E . , Nicolaidis , A .N . : Use of azo-sulfonamide for the prevention of urinary tractsymptoms and bacteriuria following cystoure-throscopic examination. J . Urol . , 107, 650[651,1972.

7�Sullivan , N .M . , Sutter , V . L . , Carter , W . T . ,Attebery, H.R., Finegold, S.M. : Bacteremia aftergenitourinary tract manipulation : bacteriological

aspects and evaluation of various blood culturesystems. Appl. Microbiol., 23, 1101[1106, 1972.

8�Sullivan, N.M., Sutter, V.L., Mims, M.M., Marsh,V.H., Finegold, S.M. : Clinical aspects of bactere-mia after manipulation of the genitourinary tract.J. Infect. Dis., 127, 49[55, 1973.

9�Marier , R . , Valenti , A . J . , Mardi , J .A . : Gram-negative endocarditis following cystoscopy . J .Urol, 119, 134[137, 1978.

10�Richards, B., Bastable, J.R. : Bacteriuria after out-patient cystoscopy. Br. J. Urol., 49, 561[564, 1977.

11�Quintiliani, R., Klimek, J., Cunha, B.A., Maderazo,E.G. : Bacteraemia after manipulation of the uri-nary tract . The importance of pre-existing uri-nary tract disease and compromised host de-fences. Postgrad. Med. J., 54, 668[671, 1978.

12�Hares, M.M. : A double-blind trial of half-strengthPolybactrin Soluble GU bladder irrigation incystoscopy. Br. J. Urol., 53, 62[67, 1981.

13�Reilly, C.S., Hart, A.J., McAllister, T.A. : Compari-son of cephazolin and gentamicin in the prophy-lactic treatment of infection in out-patient urinarytract endoscopy. Br. J. Urol., 53, 138[140, 1981.

14�Chisholm , G . D . : Antimicrobial prophylaxis inurology and transplantation. World. J . Surg . , 6,281[292, 1982.

15�Madsen, P.O., Larsen, E.H., D�rflinger, T. : Infec-tious complications after instrumentation of uri-nary tract. Urology, 26�Suppl�, S15[17, 1985.

16�Arpi, M., Werner, C., Timmermann, B. : Bactere-mia following transurethral instrumentation. Thepredictive value of a serum bactericidal activitytest. Scand. J. Urol. Nephrol., 20, 169[176, 1986.

17�MacDermott, J.P., Ewing, R.E., Somerville, J.F.,Gray, B.K. : Cephradine prophylaxis in transure-thral procedures for carcinoma of the bladder. Br.J. Urol., 62, 136[139, 1988.

18�Manson, A.L . : Is antibiotic administration indi-cated after outpatient cystoscopy. J. Urol . , 140,

21

Page 24: 日本泌尿器科学会-The Japanese Urological Association (JUA)...表1 EAU guidelines for the management of uri-nary and male genital tract infections ・原則として単回投与

316�317, 1988.19���������� ��������� ���������������� !"�#�$%&'()*+,-./0+123�45�34, 1601�1605, 1988.

20�Bavetta S, Olsha O, Fenely J. : Spreading sepsisby cystoscopy. Postgrad. Med. J. , 66, 734�735,1990.

21�Van Poppel , H . , Willemen , P . , Wegge , M . ,Kraseman, P., Chysky, V. , Baert , L. : Antibioticcover of transurethral maneuvers with ciproflox-acin and susceptibility behavior of pathogens inpatients with neurogenic bladder. Urol. Int . , 45,342�345, 1990.

22�Clark, K.R., Higgs, M.J. : Urinary infection follow-ing out-patient flexible cystoscopy. Br. J. Urol., 66,503�505, 1990.

23�Ersev, D., Dillioglugil , O. , Ilker, Y. , Simsek, F. ,Akdas, A. : Efficacy of prophylactic gentamicinuse in postoperative urinary tract infections afterendoscopic procedures of the urinary tract. Urol.Int., 48, 401�403, 1992.

24��67�89 :�;<=��>?=@�ABCD�E��FGH�#�$'()0IJK 3LMN#./OP2L3�QR�85, 802�805,1994.

25�Tsugawa, M., Monden, K., Nasu, Y., Kumon H.,Ohmori . H . : Prospective randomized compara-tive study of antibiotic prophylaxis in urethrocysto-scopy and urethrocystography. Int . J . Urol . , 5,441�443, 1998.

26�Thompson, A., Pearce, I., Robinson, E., Ladds, T.J.,Payne , S . R . : Bacteriological safety and cost-effectiveness of a nonrefluxing valve in the irriga-tion system during outpatient flexible cystoscopy.BJU Int., 85, 1019�1022, 2000.

27�Almallah, Y.Z., Rennie, C.D., Stone, J., Lancashire,M.J. : Urinary tract infection and patient satisfac-tion after flexible cystoscopy and urodynamicevaluation. Urology, 56, 37�39, 2000.

28�Ran�, A., Cahill, D., Saleemi, A., Montgomery, B.,Palfrey, E. : The issue of prophylactic antibioticsprior to flexible cystoscopy. Eur. Urol., 39, 212�214, 2001.

29�Burke, D.M., Shackley, D.C., OSReilly, P.H. : Thecommunity-based morbidity of flexible cystosco-py. BJU Int., 89, 347�349, 2002.

30�Chodak, G.W., Plaut, M.E. : Systemic antibioticsfor prophylaxis in urologic surgery : a critical re-view. J. Urol., 121, 695�699, 1979.

31�Naber, K.G., Bergman, B., Bishop, M.C., Bjerklund-Johansen, T.E., Botto, H., Lobel, B., Jinenez, Cruz.

F., Selvaggi, F.P. : Urinary Tract InfectionTUTI�Working Group of the Health Care OfficeTHCO�of the European Association of UrologyTEAU�.EAU guidelines for the management of urinaryand male genital tract infections. Urinary TractInfectionTUTI�Working Group of the HealthCare OfficeTHCO�of the European Associationof UrologyTEAU�. Eur. Urol., 40, 576�88, 2001.

32�Schneede , P . , Hofstetter , A .G . , Naber , K . G . ,Vahlensieck, W., Ludwig, M., Bach, D., Bauer, H.W., Beyaert, G., Blenk, H., Bootz, T., Friesen, A.,Geiges, G., Himstedt, H.W., Hochreiter, W., Keller,H.J., Knopf, H.J., Lenk, S., Liedl, B., Michaelis, R.,Neubauer, L., Piechota, H., Rassler, J., Riedasch, G.,Rothenberger, K.H., Rudiger, K. , Schmitz, H.J. ,Stadie, G., Thiel, U., Truss, M.C., Wagenlehner, F.M . , Weidner , W . , Westenfelder , M . , Gockel-Beining , B . , Heidenreich , A . , Rubben , H . ,Schalkhauser , K . , Thon , W . , Thuroff , J .W . ,Weidner , W . ; Arbeitskreis Infektologie , Deut-schen Gesellschaft fur Urologie ; Leitinienkom-mission, Deutschen Urologie. American Urologi-cal Association ; American Academy of Ortho-paedic Surgeons Antibiotic prophylaxis for uro-logical patients with total joint replacements. J .Urol., 169, 1796�1797, 2003.

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Page 25: 日本泌尿器科学会-The Japanese Urological Association (JUA)...表1 EAU guidelines for the management of uri-nary and male genital tract infections ・原則として単回投与

表1 小児泌尿器科手術における周術期感染防止薬投与方法

投与薬剤手術名手術分類

第1,2世代セファロスポリン系薬停留精巣,精索軸捻転尿路を開放しない手術

精索静脈瘤,陰嚢水腫

経口セフェム系薬包茎などの根治術

第1,2世代セファロスポリン系薬後部尿道弁切開術内視鏡手術

第1,2世代セファロスポリン系薬,ペニシリン系薬膀胱尿道鏡検査内視鏡検査

アミノグリコシド系薬

第1,2世代セファロスポリン系薬,ペニシリン系薬腎盂形成術尿路を開放する手術

尿道下裂,巨大尿管

膀胱尿管逆流などの根治術

第1,2世代セファロスポリン系薬腎摘除術体腔鏡手術

第1,2世代セファロスポリン系薬,ペニシリン系薬腎盂形成術

*:72hr以後の経口セフェム系薬の7日間追加投与が推奨される

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Page 26: 日本泌尿器科学会-The Japanese Urological Association (JUA)...表1 EAU guidelines for the management of uri-nary and male genital tract infections ・原則として単回投与

表2 小児用量の設定がある注射用抗菌薬

投与方法小児用量mg/kg/day

主な製品抗菌薬名略記号

静・点50―125/2―4 ペントシリンピペラシリンPIPCペニシリン

静・点40―80/2―4 ドイルアスポキシシリンASPC

筋50―100/3―4 ビクシリンSアンピシリン /ABPC/MCIPC

クロキサシリンMCIPC

筋・静・点20―50/2―3 セファメジンαセファゾリンCEZセフェム

静・点40―80/3―4 パンスポリンセフォチアムCTM

静・点25―100/2―4 セフメタゾンセフメタゾールCMZ

静・点40―60/2―3 ヤマテタンセフォテタンCTT

静・点60―80/3―4 メイセリンセフミノクスCMNX

静・点40―80/2―4 トミポランセフブペラゾンCBPZ

静・点60―100/3―4 タケスリンセフスロジンCFS

静・点50―100/3―4 クラフォランセフォタキシムCTX

静・点25―100/2―4 セフォペラジンセフォペラゾンCPZ

静・点40―80/3―4 ベストコールセフメノキシムCMX

静・点40―80/2―4 エポセリンセフチゾキシムCZX

静・点20―60/2 ロセフィンセフトリアキソンCTRX

静・点40―100/2―4 モダシンセフタジジムCAZ

静・点60―80/3―4 ケニセフセフォジジムCDZM

静・点60―80/3―4 ケイテンセフピロムCPR

静・点40―80/3―4 ファーストシンセフォゾプランCZOP

静・点40―80/2―4 シオマリンラタモキセフLMOXオキサセフェム

静・点60―80/3―4 フルマリンフロモキセフFMOX

静・点40―80/2―4 アザクタムアズトレオナムAZTモノバクタム

静・点40―80/2―4 チエナムイミペネムIPMカルバペネム

静・点30―60/3 カルベニンパニペネムPAPM

静・点40―80/2―4 スルペラゾンスルバクタム /SBT/CPZβLI-配合剤セフォペラゾン

静・点60―150/3―4 ユナシンSスルバクタム /SBT/ABPCアンピシリン

筋30―50/1―2 カナマイシンカナマイシンKMアミノグリコシド

筋0.8―2.4/2―3 ゲンタシンゲンタマイシンGM

筋・点3/2~3トブラシントブラマイシンTOB

筋1― 2/1―2 パニマイシンジベカシンDKB

筋・点4―8/1―2 アミカシンアミカシンAMK

筋10―20/2 カネンドマイシンベカナマイシンAKM

筋20―40/1―2 ビスタマイシンリボスタマイシンRSM

静2004/6/2 ハベカシンアルベカシンABK

筋20―45/2―3 リンコシンリンコマイシンLCMリンコマイシン

点15―25/3―4 ダラシンSクリンダマイシンCLDM

静・点100―200/2―4 ホスミシンホスホマイシンFOMその他

点40/2~4バンコマイシンバンコマイシンVCM

点6~10/2 タゴシッドテイコプラニンTEIC

BLI:β ラクタマーゼ阻害剤

���� �� 30������72�� ������� 12���������

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1��234567��89:;�� <=�

>�?@ABCDECF�G�H������ IIJ1�+K4-./0 1LM��NOP�QR��7S��JA-I��!TU�V(A23�G�WUX������

Y(Z [\8]�� <=�>�

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)�.?@>��A� 25����B:619��q��CAD;@78��HIDES� 6�¡E>F¢£¤�XY!ZY �G¥:>4;t6��¦0�=>§S)��¨©43���.ªH12345S.«¬'�5@­;6�G�a��C5E��IJ®¯,¯°S±K>R.���'�²³´>e3g�6E�.Lµ�¶;5�a'(XY!ZY �%(·M0�m�25@¸S>¹'�6L³Sº»¹� � ¼.D�2;�a�E�(6v*��N>R��C5 ½�DE6��J�OPE6O¾�PI¿Q6¿ÀRS6b�ÁÂ6¿À��T��C5OPE'�e;@h2�SDE'(6%&SXY!ZY �[Ã6��������.��1234;@78DE(U�����Aªi0�m�2.ÄÅ.6��S� �,�VÆS�Ç'(6)��9��S� (���S±K6����0�%&S¸20�È(>¹e;@�W6��SL%.ÉX0>5K�L%E�M��N6�NQ���C5OPE'(��IJ®¯,¯°SY�ZÊ.ËÌÍ�2345�SS6EvS¯ �.IJ12345��(Î[S)*��wx����AÏ\��C5��.]Ðuf�Ñ�2;@Ev�p�C50L%E0:3(^%Ò�Ó¶5h0.L4S(Ô«'�5.6���S��.p�_A`J1Õ50SÖ×Ø �>4;t C-II#6�vSÙa.b;250h�'�5@

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1#Uc��§�*deA�p��ÚÛÜÝf�A�p��ÚXY!ZY 6� 2g62003.

2#Margram, A.J., Horan, T.C., Pearson, M.L., Silver,L.C., Jarvis, W.R. : Guideline for prevention of sur-gical site infection. Infect. Control . Hosp. Epide-miol., 20, 250Þ278, 1999.

3#Naber, K.G., Bergman, B., Bishop, M.C., Bjerklund-Johansen, T.E., Botto, H., Lobel, B., Jinenez Cruz,F., Selvaggi, F.P., Urinary Tract Infection^UTI#Working Group of the Health Care Office^HCO#of the European Association of Urology^EAU#:EAU guidelines for the management of urinaryand male genital tract infections. Urinary TractInfection^UTI#Working Group of the HealthCare Office^HCO#of the European Associationof Urology^EAU#, Eur. Urol., 40, 576Þ588, 2001.

25

Page 28: 日本泌尿器科学会-The Japanese Urological Association (JUA)...表1 EAU guidelines for the management of uri-nary and male genital tract infections ・原則として単回投与

4�Swedish-Norwegian Consensus Group : Antibioticprophylaxis in surgery : summary of a Swedish-Norwegian consensus conference. Scand. J. Infect.Dis., 30, 547�557, 1998.

5���������������� ����� ������������ ����������� !"#��$�% �&�'(�49, 551�556, 2001.

6���� ����) ��������������������� ���������������������� !"#��$�%�&�'(�49, 601�605, 2001.

7�Routledge, P.A. : Pharmacokinetics in children. J.Antimicrob. Chemother., 34*Suppl. A�, S19�24,1994.

8�+,-�./0��1�23���%40���5�9, 43�48, 1997.

9�+,-�678�9:�;<=23����>?�40@���>?*./0ABC��%&D����E�19, 571�582, 2003.

10�F�GH�����1D' ��&D��D'��I23�I��J� 4%�KLM�N�1@� O�40P./0@� O�23�I��QRS�!T"�23�24�U#V?�$W�2001.

11�F�GH�40��1�23���%2/%X���&YZ�=C�[\]^\��*_`a'(b����Zc(�94*)*��178�189, 1985.

12�F�GH�+,-�./0P+d0@�23&D����I<�%e��82*Suppl.��558�562,2002.

13�`, -�f��e�� 2004�.g/�$W�2004.14�Antimicrobial prophylaxis in surgery . MedicalLetter on Drugs and Therapeutics , 41, 75�79,1999.

15������h01��i�jT�2�3k�456(�l7-8�m�9:����������� �;<n������:o<p���� !=q%Jpn. J. Antibiol., 55, 500�513,2002.

16���.r�st>u�4� ��v�_w�x�_���?)y�+z7�@{|(�m�}���� ~�2�3k�_A ��4B��T��� ��CA�T�l7-8�gDE��F���AGT|�i�jT�h01���A H�vJ 9��� ���AIk�?�9(�m�9:�;<n����:���23��I���:o<p���� !=q%;<�J.�50,779�786, 2004.

17�Thomas, L., O�Connor, Jr. and Marc, Goldstein :Topical perioperative antibiotic prophylaxis forminor clean inguinal surgery. J. Am. Coll. Surg.,194, 407�410, 2002.

18�mJe����K��L�(�40;<n��E:������Q��M��%&;�50, 839�842, 1996.

19�Stickland, M.D., Kirkpartrick, C.M., Begg, E.J. ,Duffull, S.B., Oddie, S.J . , Darlow, B.A. : An ex-tended interval dosing method for gentamicin inneonates. J . Antimicrob. Chemother. , 48, 887�893, 2001.

20���NT(���O��PQRO�$� ��40� VUR�e����S� T�¡¢���£O�¤U�%�4�'(.�39, 204�209, 2003.

21��,# �+B�¥�¦V<£:W§�e��¨¢Q��%&;�48*X��168�176, 1994.

IX����������ExtracorporealShock Wave Lithotripsy ; ESWL

1%YZESWL��1©� UTI*M[��\c�ª]ª

«�¬�<­3®1A�§�¯¢AYZ¢§�%°�� 2o�±²�:������³´µ¶·�%1��¸:¹3<³º<{N2��¸:¹3<³¬�{N^»¢¼:<£9½�!A_`¾º< in situ

ESWL¢<£9½�!A_`§�{N³¬�%2%evidence�¿À�[\]^\�AÁ"§�:¬=��2004a 6

Â��Sà PubMedĶ ESWL�UTI�prophy-laxis� 3o� key wordAÅÆ!¾pb¶·=64c7�ÇÈ�ÉÊËÌ�ÍÎ��Ìc7°��¼�AÏ�¾=%d<p�study design³�[\]^\�Á"�д:º¶º<¼��eµÑ�¹3<�fÒ³ghìÓ=��ESWLÔ¥¸:¹3<³I�ìÓ=¼�ABÕäU¾p<�¼�ºÖAÏ�¾=%¯�Á×:Í�ØÓ=¼�­O�¢ÙºÚ�ESWL�����AYZ¢¾=23����:Û§� prospective study³ 5��ESWL����1i�jk³¤UÜ·p<�study³ 8��Ý�l�3®1:W§�23����A¤U¾= study 1�AÞ�¾��[\]^\�Á"�=C� evidence¢¾=%

26

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表 1 ESWLの感染予防投与に関する比較試験

判定ESWL後の発現率(%)

n対象薬文献報告年報告者菌血症症候性

UTI細菌尿

N.S.012 632azocillin

11987Herringer A, et al.0 61932control

N.S.

0 1.8 3.557ST or DMPPC

21989Pettersson B, et al. 0 8.51347methenamine

0 2.2 4.445control

N.S.0 1.57.4―1166OFLX

31995森本ら0 013―2467control

N.S.0 0 1.217OFLX

41995Ilker Y, et al.0 0 0.732control

N.S.

08.4―1224―2577CXM-AX

51997Birkens AF, et al. 05.4―1014―2270CPFX

01017―1930control

N.S. : not significant

表2 術前に細菌尿がない症例におけるESWL後の感染率

ESWL後の発現率(%)n文献報告年報告者

菌血症症候性UTI細菌尿

00.4 1.5278 61990Charton M, et al.7.7*0 0 26 71993Kattan S, et al.4.3ndnd 23 81993Gasser TC, et al.01.4 4.8145 91994Raz R, et al.0.61.2 8500101995Simon D00.8 2250111997Deliveliotis CH, et al.02.6 5.1117121998Dincel C, et al.5.3nd13 75132003Yilmaz E, et al.

nd : not described* : contamination

3�ESWL�������ESWL�� ������� ESWL�

�������������� 1��� 2����� 1��� �!"#$%&'()*+�,-./'�0��1.� control23�� 4#$25������67&'��89�:;�<'=0ESWL���� ����� 0>24?=@A��BC�/'�0DEB 10?�./'�F�0�GH UTI����� 0>10?=0�8I@A��BC�/'�0JK� 3?LM=

N��O90�P����QR� 0>7.7?=�S@A./'�0�89�JK� contamination./TS=�SUV��O8B�'�LW�DX&'=0�� �/'YR�QR.

��&'�0Z[W\]=�'�GH UTI/'���P����QR�^_N��`a0ESWLL�� �/'���b'

ESWL��������0�� � 16>21?0�GH UTI� 7.9>11?0�P�� 0?=�S@A./��3� 35�����B0ESWLcd�

27

Page 30: 日本泌尿器科学会-The Japanese Urological Association (JUA)...表1 EAU guidelines for the management of uri-nary and male genital tract infections ・原則として単回投与

表4 推奨される感染予防法

1)術前に細菌尿がない場合・抗菌薬の予防投与は不要である.A-I2)術前に細菌尿がある場合・術前の尿の定量培養と薬剤感受性試験により分離された細菌に抗菌力を有する腎排泄型の抗菌薬を術前から投与する.B-III

3)尿管ステントを留置している症例・細菌尿がなければ抗菌薬の予防投与は不要であるが,細菌尿があれば2)に準ずる.B-III

4)High risk群術前後に抗菌薬を予防投与することが望ましい.B-III

①感染結石(MAP,カーボネイト・アパタイト)②過去のESWL術後の有熱性腎盂腎炎あるいは菌血症

表5 術後の有熱性腎盂腎炎あるいは菌血症が疑われたときの観察項目

1)Vital sign・体温,血圧,心拍数などの観察2)尿の定量培養,血液培養,(血中エンドトキシン定量)・前2者の結果を得るまでには4~5日かかる.・早急な結果を得たいときには血中エンドトキシン定量3)血液・生化学検査・末梢血白血球数,CRP定量による炎症の程度の把握・多臓器不全の有無の把握4)KUB,腹部超音波検査・結石破砕片の位置,大きさの把握・水腎症の有無の把握

表6 術後の有熱性腎盂腎炎あるいは菌血症に対する対処法

1)抗菌化学療法・静注用の抗菌薬投与を原則とする.・尿の定量培養,血液培養の結果が得られるまでの間のempiric therapy①first line:第二世代セフェム系薬,静注用キノロン系薬であるPZFX

②second line:カルバペネム系薬・尿の定量培養,血液培養の結果が得られたときには分離菌に抗菌力を有する抗菌薬へ変更する.

2)尿流停滞の解除・結石破砕片による尿流停滞(水腎症)があり,かつ抗菌化学療法のresponseがない場合に考慮する.

経皮的腎瘻造設術,尿管ステントの留置があり前者が一般的である.

表3 術前に細菌尿がある症例におけるESWL後の感染率

ESWL後の発現率(%)n文献報告年報告者

菌血症症候性UTI細菌尿

07.91689 61990Charton M, et al.0112190111997Deliveliotis CH, et al.

�������� ESWL������ ��� UTI������� ESWL��������� ������� ������ �!������"�� #$%&'�(4(ESWL�)*�+��,-./�012

34 15567 18�9:; 5<�=>���(=>�?@12A;/�0�BC 12D 12EF GHIEJ��� K'�=>L/�0�,-12�?M�)*NOPQ�R:�# STUV&'�W&K ESWL��������� ���/�0�,-12XY���#TZ[\� �(ESWL��!�O,-��;]�/�0�

12O^_A;=>148� /�0O12A�L`�/�0�/�a�� ���?��!��b]&' ,-12Qc�� # STU�V&'� �(5(ESWL�deE)*,-fg� evidenceOh�ijk'�lmO7 4

�9:;(e������� in situ ESWL�e�Pn�opoq�� �!�#��rs�t ;] /�0�,-12XY���(

AuA e��������vw �xyz{|O}~� ESWLOW��Svw ���)*T�����#�G�A� �vw `A����ESWL�Pn�opoq�� �!�#�M;�����vw�/�0�,-12��Y���#$%&'�(ESWL�Pn�opoq�� �!�O

�E���A����;]�7 5�9:;m�O����A�W��#��Y��@ �'&�

28

Page 31: 日本泌尿器科学会-The Japanese Urological Association (JUA)...表1 EAU guidelines for the management of uri-nary and male genital tract infections ・原則として単回投与

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1�Herringer, H., Bornhof, C., Kuehn, R. : Antibioticprophylaxis before extracorporeal shock wavelithotripsy by single-shot application of azocillin.Chemioterapia, 6�2 suppl�, S607�609, 1987.�I�

2�Pettersson, B. , Tiselius, H.G. : Are prophylacticantibiotics necessary during extracorporealshockwave lithotripsy? Br. J. Urol., 63, 449�452,1989.�I�

3���� !"#$%!&'()!*+ ,!-.$/!0#12!3456789:;<=>?@ABCD�EF�GH�IJ�KALM!41,245�251, 1995.N�I�

4�Ilker, Y., Turkeri, L.N., Korten, V., Tarcan, T. ,Akdas, A. : Antimicrobial prophylaxis in manage-ment of urinary tract stones by extracorporealshock-wave lithotripsy : Is it necessary? Urol., 46,165�167, 1995.�I�

5�Birkens, A.F., Hendrikx, A.J., Ezz el Din, K.E., dela Rosette, J . J . , Horrevorts , A . , Doesburg , W. ,Debruyne, F.M. : The value of antibiotic prophy-laxis during extracorporeal shock wave lithot-ripsy in the prevention of urinary tract infectionsin patients with urine proven sterile prior totreatment. Eur. Urol., 31, 30�35, 1997.�I�

6�Carton, M., Vallancien, G., Veillon, B., Prapotnich,D., Mombet, A., Brisset, J.M. : Use of antibiotics inthe conjunction with extracorporeal lithotripsy .Eur. Urol., 17, 134�138, 1990.�III�

7�Kattan, S., Husain, I., el-Faqih, S.R., Atassi, R. : In-cidence of bacteremia and bacteriuria in patientswith non-infection-related urinary stones under-going extracorporeal shock wave lithotripsy . J .Endourol., 7, 449�451, 1993.�III�

8�Gasser, T.C., Frei, R. : Risk of bacteremia duringextracorporeal shock wave lithotripsy . Br . J .Urol., 71, 17�20, 1993.�III�

9�Raz, Z., Zoabi, A., Sudarsky, M., Shental, J. : Theincidence of urinary tract infection in patientswithout bacteriuria who underwent extracorpo-real shock wave lithotripsy. J. Urol . , 151, 329�330, 1994.�III�

10�Simon, D. : Experience with 500 extracorporealshockwave lithotripsy patients using a low-costunit : TheOEconolithP. J. Endourol., 9, 215�218,1995.�III�

11�Deliveliotis, C.H., Giftopoulos, A., Koutsokalis, G.,Rapitidis, G., Kostakopoulos, A. : The necessity ofprophylactic antibiotics during extracorporeal

shock wave lithotripsy. Internat Urol . Nephrol . ,29, 517�521, 1997.�III�

12�Dincel, C., Ozdiler, E., Ozenci, H., Tazici, N., Kozar,A . : Incidence of urinary tract infection in pa-tients without bacteriuria undergoing SWL :Comparison of stone types. J. Endourol., 12, 1�3,1998.�III�

13�Yilmaz, E., Batislam, E., Tuglu, D., Kilic, D., Basar,M. , Ozluk, O. , Basar , H . : C-reactive protein inearly detection of bacteremia and bacteriuria af-ter extracorporeal shock wave lithotripsy . Eur .Urol., 43, 270�274, 2003.�III�

14�Westh , H . , Knudsen , F . , Hedengran , A .M . ,Weischer, M., Mogensen, P., Andersen, J.T. : Ex-tracorporeal shock wave lithotripsy of kidneystones does not induce transient bacteremia . Aprospective study. J. Urol., 144, 15�16, 1990.�I�

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表1 FN(好中球減少時の発熱)における危険因子

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10Viscoli , C. , Bruzzi , P. , Castagnola, E. , Boni , L . ,Calandra, T., Gaya, H., Meunier, F., Feld, R., Zin-ner, S., Klastersky, J., et al . : Factors associatedwith bacteraemia in febrile , granulocytopeniccancer patients. The International AntimicrobialTherapy Cooperative Group� IATCG0 of theEuropean Organization for Research and Treat-ment of Cancer�EORTC0. Eur. J . Cancer, 30,430Å437, 1994.

20ÆÇ È�ÉÊËÉ0¤Ì�ÍÎÏ@§6ÐÑÒÓ@ÔÕ6Ö"R�@×C6^ع�&@ÙÚÛÜÝ�Int. J. Hematol., 68, S1ÅS40, 1998.

30De Pauw, B.E., Deresinski, S.C., Feld, R., Lane-Allman, E.F. , Donnelly, J .P . : Ceftazidime com-pared with piperacillin and tobramycin for the

empiric treatment of fever in neutropenic pa-tients with cancer . A multicenter randomizedtrial . The Intercontinental Antimicrobial StudyGroup. Ann. Intern. Med., 120, 834Å844, 1994.

40Ramphal, R., Gucalp, R., Rotstein, C., Cimino, M.,Oblon, D. : Clinical experience with single agentand combination regimens in the management ofinfection in the febrile neutropenic patient. Am. J.Med., 100, 83SÅ89S, 1996.

50Cometta, A., Calandra, T., Gaya, H., Zinner, S.H.,de Bock , R . , Del Favero , A . , Bucaneve , G . ,Crokaert , F . , Kern , W . V . , Klastersky , J . ,Langenaeken , I . , Micozzi , A . , Padmos , A . ,Paesmans, M., Viscoli, C., Glauser, M.P. : Mono-therapy with meropenem versus combinationtherapy with ceftazidime plus amikacin as em-piric therapy for fever in granulocytopenic pa-tients with cancer. The International Antimicro-bial Therapy Cooperative Group of the EuropeanOrganization for Research and Treatment of Can-cer and the Gruppo Italiano Malattie Ema-tologiche Maligne dellÞAdulto Infection Program.Antimicrob. Agents. Chemother., 40, 1108Å1115,1996.

60Bodey, G.P., Jadeja, L., Elting, L. : Pseudomonasbacteremia . Retrospective analysis of 410 epi-sodes. Arch. Intern. Med., 145, 1621Å1629, 1985.

70Hughes, W.T., Armstrong, D., Bodey, G.P., Feld,R . , Mandell , G .L . , Meyers , J .D . , Pizzo , P .A . ,Schimpff, S.C., Shenep, J.L. , Wade, J .C. , et al . :From the Infectious Diseases Society of America.Guidelines for the use of antimicrobial agents inneutropenic patients with unexplained fever . J .Infect. Dis., 161, 381Å396, 1990.

80Hughes, W.T., Armstrong, D., Bodey, G.P., Brown,A.E., Edwards, J.E., Feld, R., Pizzo, P., Rolston, K.V., Shenep, J.L., Young, L.S. : 1997 guidelines forthe use of antimicrobial agents in neutropenic pa-tients with unexplained fever. Infectious DiseasesSociety of America. Clin. Infect. Dis., 25, 551Å573,1997.

90Hughes, W.T., Armstrong, D., Bodey, G.P., Bow,E.J., Brown, A.E., Calandra, T., Feld, R., Pizzo, P.A., Rolston, K.V., Shenep, J.L., Young, L.S. : 2002guidelines for the use of antimicrobial agents inneutropenic patients with cancer . Clin . Infect .Dis., 34, 730Å751, 2002.

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12�Rotstein, C., Bow, E.J., Laverdiere, M., Ioannou, S.,Carr, D., Moghaddam, N. : Randomized placebo-controlled trial of fluconazole prophylaxis for neu-tropenic cancer patients : benefit based on pur-pose and intensity of cytotoxic therapy. The Ca-nadian Fluconazole Prophylaxis Study Group .Clin. Infect. Dis., 28, 331�340, 1999.

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