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英文誌(2004-)

Journal of Medical Ultrasonics

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1995 - Vol.22

Vol.22 No.12

Case Report(症例報告)

(0873 - 0876)

パニペネム/べタミプロン投与後二弁置換術を施行したペニシリン耐性 streptococcus sanguis 心内膜炎の1例

A Case of Infective Endocarditis Caused by Penicillin-Tolerant Streptococcus Sanguis That Was Successfully Treated With Panipenem/Betamipron and Double Valve Replacement

渡辺 賢一1, 大滝 英二2, 草野 頼子1, 宮島 静一1

Kenichi WATANABE1, Eiji OHTAKI2, Yoriko KUSANO1, Seiichi MIYAJIMA1

1燕労災病院循環器内科, 2榊原記念病院循環器内科

1Division of Cardiology Tsubame Rosai Hospital, 2Division of Cardiology Sakakibara Heart Institute

キーワード : Color Doppler echocardiography, Infective endocarditis, Minimum bactericidal concentration, Panipenem/betamipron, Streptococcus sanguis

A 55-year-old man was hospitalized because of breathlessness and a continuous fever that had appeared about 4 weeks earlier. His condition was NYHA classification III; and he had a white blood cell count of 9700/mm3, elevated CRP, red blood cell sedimentation rate of 110 mm/hr, and positive Streptococcus sanguis in blood culture. Echocardiography showed the presence of regurgitant flows and ruptured aortic and mitral valves. Minimum bactericidal/minimum inhibitory concentrations (MBC/MIC) of benzyl penicillin and panipenem/betamipron (Carbenin®, PAPM/BP) were 12.5/0.05 μg/ml and 0.025/0.025 μg/ml, respectively. The diagnosis was active infective endocarditis caused by penicillin-tolerant S. sanguis. The infection was treated with daily intravenous administration of 10 million units penicillin G and of 2 g of PAPM/BP for about 1 month. Double valve replacement for the aortic and mitral valves was performed 46 days after admission, when signs and symptoms of infection had improved. The operation was successful, and cardiac function was improved. Transesophageal and transthoracic echocardiography proved useful for clinical diagnosis and follow-up of endocarditis, as well as for clinical selection of surgical procedures. It is important to determine penicillin tolerance with MBC/MIC, especially when Streptococcus organisms are present.