ジェネラリストのための臨床感染症入門

出版社： 文光堂
著者：
発行日： 2022-02-17
分野： 臨床医学：内科  >  内科学一般
ISBN： 9784830610318
電子書籍版： 2022-02-17 （第1版第1刷）
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院内に細菌検査室がない！助言を求める専門医がいない！焦りと不安が募るこのような場面でも，落ち着いて基本の5原則（POMA-R）に忠実に進めよう――．2人の若手医師と指導医との対話によって，これまで「もやもや」していたことも，どのように考えればよいかが明確になり，実臨床の現場で生きる考え方が身につきます．ありそうでなかった，どのような状況でも通用する感染症診療の基本の考え方が身につく一冊です．感染症診療を学ぼうと思ったらまずはこの一冊から．

目次

  • 1章　感染症診療の基本を身につけよう
    　A　感染症診療には原則がある
    　　1　発熱患者を診たら何があってもまず感染症から考える
    　　2　「感染症診療のロジック」に学ぶ基本的な考え方
    　　〔COLUMN〕略語で覚える感染症診療，POMA-R ！
    　B　STEP1　患者背景Patient's backgroundを考える
    　　1　患者背景って……？
    　　2　“渡航歴”という背景
    　　3　“免疫不全”という背景
    　　4　市中感染か医療関連感染かという背景
    　　5　患者背景は雄弁である
    　　〔もっと知りたい！〕いつ海外渡航歴を聴取すべきか
    　　〔もっと知りたい！〕患者背景
    　C　STEP2　問題の臓器Organを考える
    　　1　問診と身体診察で臓器特異的な症状を探す
    　　2　問診と身体診察ではわからないこともある
    　　〔COLUMN〕筆者の失敗談～臓器編～
    　　〔もっと知りたい！〕敗血症≠菌血症
    　　〔もっと知りたい！〕それぞれのカテーテル関連血流感染症とその発生頻度
    　D　STEP3　原因微生物Micro-organismを考える
    　　1　傾向その1：ウイルス感染症は多臓器，細菌感染症は
    　　　　　　　　　単一臓器の症状をきたすことが多い
    　　2　傾向その2：横隔膜より上の細菌感染症はグラム陽性球菌，横隔膜より下は
    　　　　　　　　　グラム陰性桿菌，皮膚科と整形外科領域はブドウ球菌と連鎖球菌
    　　3　傾向その3：医療関連感染では耐性菌の頻度が上がる
    　　〔もっと知りたい！〕腸内細菌目細菌とSPACEの関係
    　　〔MEMO〕患者背景に免疫不全がある場合の原因微生物
    　　4　傾向その4：1回良くなった後にまた悪くなった，という二峰性の経過は
    　　　　　　　　　細菌性を示唆する
    　E　STEP4　適切に治療Antimicrobial agents（Antibiotics）する
    　　1　感染症ごとの第一選択薬を選ぶ
    　　2　適切な量・投与回数で投与する
    　　3　感受性試験結果は第一選択薬が感受性かどうかを確認し，なるべく狭域のものを選ぶ
    　　〔もっと知りたい！〕カルバペネム耐性菌とは？
    　　4　ざっくりわかる抗菌薬
    　　〔MEMO〕トラフ値 vs. AUC/MIC
    　　〔MEMO〕腎機能障害時のリネゾリドの投与量
    　　〔もっと知りたい！〕セフトリアキソンの投与方法は？
    　F　STEP5　適切に経過観察Reassessmentする
    　　1　5つのSTEPの1～4をみてみよう　
    　　2　良くなっているのか，いないのか――assessmentする
    　　3　評価に困ったら診断に立ち返る
    　　4　“Re”assessment――繰り返してこその経過観察
    　　5　全身と局所――2つの観点
    　　6　客観的な評価，定量的な評価
    　　7　グラム染色は最強の評価ツールにもなる
    　　8　経過観察の2つのコツ
    　　〔COLUMN〕「解釈ではなく事実を述べるべき」なのはどのようなときか
    　　9　抗菌薬を投与した後に考えること
    　　〔COLUMN〕プレゼンテーションのトレーニング
    　　〔COLUMN〕初学者と熟練者の違い
    　G　5つのSTEPの流れとは逆向きの裏技
    　　1　微生物から臓器がわかることもある
    　　2　治療経過から微生物がわかることもある
    　　〔もっと知りたい！〕静注抗菌薬を経口抗菌薬に変更するタイミングは？
    　　〔COLUMN〕地域住民のリアルな受療行動とは？

    2章　感染症検査各論
    　A　グラム染色
    　　1　そもそもグラム染色はどんなときに役立つのか
    　　2　グラム染色の大まかな流れ
    　　3　痰のグラム染色の手順と観察の基本
    　　4　喀痰グラム染色で鑑別できる菌種
    　　5　喀痰グラム染色は“使える”か？
    　　6　尿のグラム染色の手順
    　　7　尿グラム染色で鑑別できる菌種
    　　8　治療効果判定のためのグラム染色
    　　9　検体の採取保存方法について
    　B　血液培養検査
    　　1　血液培養検査の意義
    　　2　血液培養検査の手順
    　　3　血液培養を採取すべきタイミング
    　　4　血培を採取すべきか――症例から考える
    　　〔COLUMN〕どうしても不要な血液培養検査を省略したいあなたへ
    　　　　　　　～感染症診療のChoosing Wisely～

    3章　感染症診療における細菌検査室の役割
    　A　細菌検査室がある場合とない場合で何が変わる？
    　B　細菌検査室がある場合
    　　1　培養検査はどのように行われる？
    　　2　有益な情報をタイムリーに得られる
    　　3　とは言え，“基本”の大切さは揺るがない
    　C　細菌検査室がない場合
    　　1　培養検査，何日くらいかかる？
    　　2　つきまとう検体不良
    　　3　得られる情報には限界がある
    　　4　かなり不利な環境ではあるけれど
    　　〔COLUMN〕感染症診療における検査について

    4章　ケーススタディ―せっかくだから，POMA-Rに沿って考えてみよう
    　case 1
    　case 2
    　case 3
    　case 4
    　case 5
    　case 6

    巻末付録
    　本書に出てくる抗菌薬名称および略称
    　本書で使われる感染症関連略称
    　本書で使われる臨床検査名および略称

この書籍の参考文献

参考文献のリンクは、リンク先の都合等により正しく表示されない場合がありますので、あらかじめご了承下さい。

本参考文献は電子書籍掲載内容を元にしております。

1章 感染症診療の基本を身につけよう

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2章 感染症検査各論

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14) 林俊誠ほか : 腸球菌のペニシリン感受性をグラム染色所見の「落花生サイン」で推定. 感染症誌 93 : 306-311, 2019
 
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3章 感染症診療における細菌検査室の役割

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4章 ケーススタディ - せっかくだから, POMA - R に沿って考えてみよう

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