要約:ICU の感染症診断の要点は,抗菌療法に直接結びつく感染臓器や起炎病原微生物の同 定, 重症度の評価である。感染巣からの微生物の分離同定が診断のゴールドスタンダードだが, これは迅速性に欠け,制約から適切に検体が採取できない場合もある。感染に伴う炎症反応 のバイオマーカとしての procalcitonin (PCT) や soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) は補助的に用い得る指標である。PCT を臨床診断アルゴリズムに 取り入れることで,抗菌薬の使用日数を短縮できる可能性が示唆されている。新しいバイオ マーカの断続的な研究成果があるが,臨床的に有用な指標の確立は容易ではない。利用でき る微生物学的検査を正しく有効に利用すると共に,患者重症度を的確に把握し,既存の感染 症バイオマーカを適正に使用して,総合的な感染症診断を行う必要がある。 The rapid and accurate detection of causative pathogens, infective foci,

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... d the severity of illness are specifically important for diagnostic strategies for infection in critical care settings. Difficulties in obtaining appropriate samples and/ or the time required for traditional microbiological culture methods have been undesirable. Procalcitonin (PCT) or soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) have a relatively higher diagnostic ability compared with traditional biomarkers for infection, such as CRP or neutrophil counts. A meta-analysis, however, revealed that no single biomarker can be used for the definite diagnosis of infection. A PCT-guided treatment algorithm could become an option for curtailing excess antimicrobial use without affecting mortality. No other new biomarkers that have been developed experimentally or clinically have been established for clinical utilization. Intensivists should recognize that a comprehensive pathogen-directed diagnostic approach remains central but should be supplemented with currently available microbiological diagnosis in combination with an appropriate assessment of current biomarkers and the severity of each patient's illness.