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P. aeruginosaによる複雑性尿路感染症に対するCPMの治療効果と副作用を評価する目的で, CPM 2g/日とCFS 2g/日の二重盲検法による比較試験をおこなった.総投与例数は274例で, うち効果を判定し得たのはCPM群136例, CFS群118例であった.1) P. aeruginosaを含む感染症では, CPMあるいはCFSを1日2g, 5日間投与時の効果では, 前者の有効率が有意に高かった.2) P. aeruginosaのみを対象にした場合も同様であった.3) P. aeruginosaを含む感染で細菌尿の陰性化率はCPM群はCFS群より有意に高かった.4)交代菌の出現は, CFS群でS. faecalisの出現率が有意に高く, 全体的にもCFS群の投与後の細菌出現率が有意に高かった, 5)薬剤投与開始前の分離菌のMICでは, CPM群の方がCFS群よりもMICの低いものが多かった.6)副作用発現率, 臨床検査値の異常化は両群間に差はなかった, The therapeutic efficacy and safety of Cefpiramide (CPM, SM-1652) at a 2 g/day dose were objectively compared with those of Cefsulodin (CFS) at a 2 g/day dose in patients with chronic complicated urinary tract infections (UTI) by P. aeruginosa in a double-blind study at 46 institutions in Japan. The results are as follows: The therapeutic efficacy was analyzed in 254 patients (136 cases administered CPM and 118 cases administered CFS) after excluding 20 cases as drop-out. Among 254 cases, the number of patients with infection of P. aeruginosa was 190 cases (100 cases administered CPM and 90 cases administered CFS), while that with infection of organisms other than P. aeruginosa was 64 cases (36 cases administered CPM and 28 cases administered CFS). By the administration of a 2 g/day dose for 5 days, the overall clinical effective rate of CPM was significantly higher than that of CFS in total patients. When the patients were classified into 2 groups with respect to causative organisms (P. aeruginosa and others), the clinical effective rate of CPM in patients with infections of P. aeruginosa was significantly higher than that of CFS, while the clinical effective rate of CPM in patients with infection of other organisms than P. aeruginosa was the same as that of CFS. As to the bacteriological effect on bacteriuria, the eradication rate of CPM was significantly higher than that of CFS not only against all causative organisms but also against P. aeruginosa. The rate of replacement by S. faecalis was significantly higher in the CFS-treated group than in the CPM-treated group. The same result was obtained on the rate of replacement by other organisms. The MIC values of CPM for isolated organisms before drug administration were lower than those of CFS. The incidence rates of side effects and the abnormal findings of clinical laboratory tests were the same for the CPM- and CFS-treated groups. From the results, it was concluded that CPM is a useful drug for the treatment of patients with chronic complicated urinary tract infections caused by P. aeruginosa.

1981年1月から1982年12月までの間に東海大学病院泌尿器科外来および入院患者尿中から105個/ml以上の細菌を検出したものについて検討した.外来患者からは2, 029株, 入院患者からは754株検出し, 外来ではE. coli 24.1%, Proteus spp. 9.4%, Enterococci 9.2%, S. epidermidis 8.8%, P. aeruginosa以外の非醗酵菌11.6%, K. pneumoniae 7.0%の順に多く, 入院のほうではEnterococci 11.6%, S. epidermidis 11.4%, P. aeruginosa 11.1%, P. aeruginosa以外の非醗酵菌10.7%, Proteus spp. 8.8%の順であった.9菌種について薬剤ディスク感受性をみたが, 全体的にTC, SBPCに対する感受性率の低下, Enterococcus, S. epidermidisに対すアミノ糖系薬剤の感受性率向上が認められた.入院患者由来菌種にグラム陽性球菌の増加が見られたことは, 第3世代セフェムの汎用に関係すると思われた, The following results were obtained from the statistical studies and drug sensitivity tests of bacterial florae isolated from the urinary tract in 1981 and 1982. Of the 2, 029 strains isolated from out-patients, 627 (30.9%) were gram positive cocci, 24.1% were E. coli, 9.4% were Proteus spp., 9.2% were Enterococci, 8.9% were S. epidermidis, 7.0 % were K. pneumoniae, 5.7% were P. aeruginosa and the rest were others. Of the 754 strains isolated from hospitalized patients, 276 (36.6%) were gram positive cocci, 16.8% were Enterococci, 11.4% were S. epidermidis, 11.1% were P. aeruginosa, 8.8% were Proteus spp, 7.2% were E.coli, 6.5% were K.pneumoniae and the rest were others. The number of Proteus spp., P. aeruginosa and Enterococci detected in the isolates from the out-patients and that of E.coli, K. pneumoniae and Proteus spp., detected in the isolates from the in-patients were smaller than in previous reports. More non-fermentative gram-negative bacilli and S. epidermidis were detected in the isolates from both patients were than in previous years. The major isolates i.e., 9 species, from out-patients were more susceptible to the antimicrobial agents tested. The susceptibility of TC and SBPC to major isolates was lower than in previous years. During the past two years, we have been routinely using on inpatients the so-called third generation cefem antibiotics to treat urinary tract infections. This might be why the number of isolates of gram positive cocci has increased especially isolates from inpatients.

膀胱内に注入したホルマリンについて, その血清への移行を検討した.ウサギ正常膀胱からはホルマリンは血清にほとんど移行しない.薬物により膀胱炎を起させたウサギの膀胱に, ホルマリンを注入すると血清中に移行するが, その移行のしかたは膀胱炎の起し方により異なる.移行するホルマリンの量は, 注入したホルマリンの量や濃度と平行しない, When some drug is injected into the bladder, it has been found to permeate through the bladder wall, and appear in the serum. Similarly, formaldehyde, which is in some clinical cases injected into the bladder on hemostatic purposes, could produce side effects if a large part of its injected dose is transferred into the serum. We, therefore measured the transfer of the agent into the serum in both experimental animals and human patients. Formaldehyde was found to be transferred into the serum through the bladder of rabbits with cystitis, but only a trace of it appeared in the serum through the normal bladder. The injection of 10 ml of a 10% solution of formaldehyde to rabbits with cystitis was followed by a peak level of 8 gamma/ml in the serum. Judging from this level, the same amount injected to humans would not be high enough to cause any particular problems. In the actual study, the formaldehyde level in the serum of human patients was not detectable by the assay method used.