藤島 清太郎 (フジシマ セイタロウ)

Fujishima, Seitaro

写真a

所属(所属キャンパス)

医学部 総合診療教育センター (信濃町)

職名

准教授

外部リンク

経歴 【 表示 / 非表示

  • 1982年04月
    -
    1984年04月

    大学病院研修医(内科)

  • 1984年05月
    -
    1986年04月

    大学伊勢慶應病院内科

  • 1986年05月
    -
    1991年06月

    大学医学部助手(専修医)(内科学、呼吸・循環器内科)

  • 1991年07月
    -
    1997年09月

    大学医学部助手(救急部)

  • 1993年05月
    -
    2003年03月

    看護短期大学講師

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学歴 【 表示 / 非表示

  • 1982年03月

    慶應義塾, 医学部

    大学, 卒業

学位 【 表示 / 非表示

  • びまん性肺疾患におけるN-isopropyl-I-123-p-iodoamphetamine (IMP)の肺内動態の解析とその評価, 慶應義塾, 論文, 1992年03月

 

研究分野 【 表示 / 非表示

  • 内科学一般(含心身医学)

  • 呼吸器内科学

  • 感染症内科学

研究キーワード 【 表示 / 非表示

  • 急性呼吸促迫症候群

  • 敗血症

  • 炎症性肺疾患

  • 高濃度酸素性肺傷害

 

著書 【 表示 / 非表示

  • 気管支肺胞洗浄(BAL)法の手引き.

    藤島 清太郎, 克誠堂出版, 2017年10月

    担当範囲: 170-172

  • 救急集中治療アドバンス:重症患者における炎症と凝固・線溶系反応.

    藤島 清太郎, 中山書店, 2017年03月

    担当範囲: 16-21

  • 呼吸器疾患最新の治療2016-2018.

    豊崎光信,藤島 清太郎, 南江堂, 2016年03月

    担当範囲: 114-116

  • 新呼吸器専門医テキスト.

    多村知剛,藤島 清太郎, 南江堂, 2015年04月

    担当範囲: 205-207

  • 呼吸器疾患診療最新ガイドライン.

    藤島 清太郎, 最新医学社, 2014年09月

    担当範囲: 158-164

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論文 【 表示 / 非表示

  • Implementation of earlier antibiotic administration in patients with severe sepsis and septic shock in Japan: A descriptive analysis of a prospective observational study

    Abe T., Kushimoto S., Tokuda Y., Phillips G., Rhodes A., Sugiyama T., Komori A., Iriyama H., Ogura H., Fujishima S., Shiraishi A., Saitoh D., Mayumi T., Naito T., Takuma K., Nakada T., Shiino Y., Tarui T., Hifumi T., Otomo Y., Okamoto K., Umemura Y., Kotani J., Sakamoto Y., Sasaki J., Shiraishi S., Tsuruta R., Hagiwara A., Yamakawa K., Masuno T., Takeyama N., Yamashita N., Ikeda H., Ueyama M., Gando S.

    Critical Care (Critical Care)  23 ( 1 )  2019年11月

    ISSN  13648535

     概要を見る

    © 2019 The Author(s). Background: Time to antibiotic administration is a key element in sepsis care; however, it is difficult to implement sepsis care bundles. Additionally, sepsis is different from other emergent conditions including acute coronary syndrome, stroke, or trauma. We aimed to describe the association between time to antibiotic administration and outcomes in patients with severe sepsis and septic shock in Japan. Methods: This prospective observational study enrolled 1184 adult patients diagnosed with severe sepsis based on the Sepsis-2 criteria and admitted to 59 intensive care units (ICUs) in Japan between January 1, 2016, and March 31, 2017, as the sepsis cohort of the Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis and Trauma (FORECAST) study. We compared the characteristics and in-hospital mortality of patients administered with antibiotics at varying durations after sepsis recognition, i.e., 0-60, 61-120, 121-180, 181-240, 241-360, and 361-1440 min, and estimated the impact of antibiotic timing on risk-Adjusted in-hospital mortality using the generalized estimating equation model (GEE) with an exchangeable, within-group correlation matrix, with "hospital" as the grouping variable. Results: Data from 1124 patients in 54 hospitals were used for analyses. Of these, 30.5% and 73.9% received antibiotics within 1 h and 3 h, respectively. Overall, the median time to antibiotic administration was 102 min [interquartile range (IQR), 55-189]. Compared with patients diagnosed in the emergency department [90 min (IQR, 48-164 min)], time to antibiotic administration was shortest in patients diagnosed in ICUs [60 min (39-180 min)] and longest in patients transferred from wards [120 min (62-226)]. Overall crude mortality was 23.4%, where patients in the 0-60 min group had the highest mortality (28.0%) and a risk-Adjusted mortality rate [28.7% (95% CI 23.3-34.1%)], whereas those in the 61-120 min group had the lowest mortality (20.2%) and risk-Adjusted mortality rates [21.6% (95% CI 16.5-26.6%)]. Differences in mortality were noted only between the 0-60 min and 61-120 min groups. Conclusions: We could not find any association between earlier antibiotic administration and reduction in in-hospital mortality in patients with severe sepsis.

  • Nighttime and non-business days are not associated with increased risk of in-hospital mortality in patients with severe sepsis in intensive care units in Japan: The JAAM FORECAST study

    Matsumura Y., Nakada T., Abe T., Ogura H., Shiraishi A., Kushimoto S., Saitoh D., Fujishima S., Mayumi T., Shiino Y., Tarui T., Hifumi T., Otomo Y., Okamoto K., Umemura Y., Kotani J., Sakamoto Y., Sasaki J., Shiraishi S., Takuma K., Tsuruta R., Hagiwara A., Yamakawa K., Masuno T., Takeyama N., Yamashita N., Ikeda H., Ueyama M., Fujimi S., Gando S.

    Journal of Critical Care (Journal of Critical Care)  52   97 - 102 2019年08月

    ISSN  08839441

     概要を見る

    © 2019 Elsevier Inc. Purpose: Hospital services are reduced during off-hour such as nighttime or weekend. Investigations of the off-hour effect on initial management and outcomes in sepsis are very limited. Thus, we tested the hypothesis that patients who were diagnosed with severe sepsis during the nighttime or on non-business days had altered initial management and clinical outcomes. Materials and methods: Patients with severe sepsis from 59 ICUs between 2016 and 2017 were enrolled. The patients were categorized according to the diagnosis time or day and were then compared. The primary outcome was in-hospital mortality. Results: One thousand one hundred and forty-eight patients were analyzed; 769 daytime patients, vs. 379 nighttime patients, and 791 business day patients vs. 357 non-business day patients. There were no significant differences in in-hospital mortality between either daytime and nighttime (24.4% vs. 21.4%, P =.27; nighttime, adjusted odds ratio [OR]1.17, 95% confidence interval [CI], 0.87–1.59, P =.30)or between business and non-business days (22.9% vs. 24.6%, P =.55; non-business day, adjusted OR 0.85, 95% CI 0.60–1.22, P =.85). Time to antibiotics was significantly shorter in the nighttime (114 vs. 89 min, P =.0055). Conclusions: Nighttime and weekends were not associated with increased in-hospital mortality of severe sepsis.

  • In-hospital mortality associated with the misdiagnosis or unidentified site of infection at admission

    Abe T., Tokuda Y., Shiraishi A., Fujishima S., Mayumi T., Sugiyama T., Deshpande G., Shiino Y., Hifumi T., Otomo Y., Okamoto K., Kotani J., Sakamoto Y., Sasaki J., Shiraishi S., Takuma K., Hagiwara A., Yamakawa K., Takeyama N., Gando S., Muroya T., Koike K., Anan H., Sugita M., Miki Y., Yamashita H., Kittaka H., Maehara J., Nachi S., Morino K., Hoshino A., Yamaguchi H., Harada M., Ishikura H., Kawakami M., Deguchi Y., Yoshihara H., Hanaki Y., Okada K., Kaneko T., Kiyota K., Shimizu Y.

    Critical Care (Critical Care)  23 ( 1 )  2019年06月

    ISSN  13648535

     概要を見る

    © 2019 The Author(s). Background: Rapid detection, early resuscitation, and appropriate antibiotic use are crucial for sepsis care. Accurate identification of the site of infection may facilitate a timely provision of appropriate care. We aimed to investigate the relationship between misdiagnosis of the site of infection at initial examination and in-hospital mortality. Methods: This was a secondary-multicenter prospective cohort study involving 37 emergency departments. Consecutive adult patients with infection from December 2017 to February 2018 were included. Misdiagnosis of the site of infection was defined as a discrepancy between the suspected site of infection at initial examination and that at final diagnosis, including those infections remaining unidentified during hospital admission, whereas correct diagnosis was defined as site concordance. In-hospital mortality was compared between those misdiagnosed and those correctly diagnosed. Results: Of 974 patients included in the analysis, 11.6% were misdiagnosed. Patients diagnosed with lung, intra-abdominal, urinary, soft tissue, and CNS infection at the initial examination, 4.2%, 3.8%, 13.6%, 10.9%, and 58.3% respectively, turned out to have an infection at a different site. In-hospital mortality occurred in 15%. In both generalized estimating equation (GEE) and propensity score-matched models, misdiagnosed patients exhibited higher mortality despite adjustment for patient background, site infection, and severity. The adjusted odds ratios (misdiagnosis vs. correct diagnosis) for in-hospital mortality were 2.66 (95% CI, 1.45-4.89) in the GEE model and 3.03 (95% CI, 1.24-7.38) in the propensity score-matched model. The difference in the absolute risk in the GEE model was 0.11 (0.04-0.18). Conclusions: Among patients with infection, misdiagnosed site of infection is associated with a > 10% increase in in-hospital mortality.

  • Role of disseminated intravascular coagulation in severe sepsis

    Gando S., Shiraishi A., Yamakawa K., Ogura H., Saitoh D., Fujishima S., Mayumi T., Kushimoto S., Abe T., Shiino Y., Nakada T., Tarui T., Hifumi T., Otomo Y., Okamoto K., Umemura Y., Kotani J., Sakamoto Y., Sasaki J., Shiraishi S., Takuma K., Tsuruta R., Hagiwara A., Masuno T., Takeyama N., Yamashita N., Ikeda H., Ueyama M., Fujimi S., Tasaki O., Mizobata Y., Funakoshi H., Okuyama T., Yamashita I., Kanai T., Yamada Y., Aibiki M., Sato K., Yamashita S., Yoshida K., Kasaoka S., Kon A., Rinka H., Kato H., Okudera H., Narimatsu E., Fujiwara T., Sugita M., Shichinohe Y., Nakae H., Iiduka R., Murata Y., Nakamura M., Sato Y., Ishikura H., Myojo Y., Tsujita Y., Kinoshita K., Yamaguchi H., Sakurai T., Miyatake S., Saotome T., Yasuda S., Mizushima Y.

    Thrombosis Research (Thrombosis Research)  178   182 - 188 2019年06月

    ISSN  00493848

     概要を見る

    © 2019 Elsevier Ltd Background: Disseminated intravascular coagulation (DIC) associated with multiple organ dysfunction syndrome (MODS) plays pivotal roles in severe sepsis. Objectives: We performed a multicenter, prospective data collection study and retrospectively analyzed the data to confirm the role of DIC in severe sepsis. Methods: Eligible patients were ICU patients who met the definitions of severe sepsis, and 1013 patients were included. DIC scores as well as disease severity and the development of MODS on the day of the diagnosis of severe sepsis (day 0) and at day 3 were evaluated. The primary outcome was hospital mortality, and MODS on days 0 and 3 was the secondary outcomes. Results: The overall mortality rate of severe sepsis was 21.5%, and the prevalence of DIC was 50.9% (516/1013). DIC patients were more seriously ill and exhibited a higher prevalence of MODS (32.0% vs. 13.1%) on day 0 and worse mortality rate (24,8% vs. 17.5%) than non-DIC patients. DIC patients also showed a lower survival probability than non-DIC patients (Log rank p = 0.028). Logistic regression analyses after propensity score adjustment for potential confounders confirmed a significant association between DIC and MODS and hospital death in the patients with severe sepsis. The new development of DIC and persistent DIC from days 0 to 3 were associated with a high incidence of MODS and low survival probability. Conclusions: The mortality rate of severe sepsis has been improved; however, DIC is still associated with the poor prognosis of these patients. Evaluating the dynamic changes in the DIC status may improve the prediction capability.

  • Variations in infection sites and mortality rates among patients in intensive care units with severe sepsis and septic shock in Japan

    Abe T., Ogura H., Kushimoto S., Shiraishi A., Sugiyama T., Deshpande G., Uchida M., Nagata I., Saitoh D., Fujishima S., Mayumi T., Hifumi T., Shiino Y., Nakada T., Tarui T., Otomo Y., Okamoto K., Umemura Y., Kotani J., Sakamoto Y., Sasaki J., Shiraishi S., Takuma K., Tsuruta R., Hagiwara A., Yamakawa K., Masuno T., Takeyama N., Yamashita N., Ikeda H., Ueyama M., Fujimi S., Gando S.

    Journal of Intensive Care (Journal of Intensive Care)  7 ( 1 )  2019年05月

     概要を見る

    © 2019 The Author(s). Background: Accurate and early identification of infection sites might help to drive crucial decisions regarding the treatment of sepsis. We aimed to determine the clinical and etiological features of infection according to sites among patients with severe sepsis in Japan. Methods: This secondary analysis of a multicenter, prospective cohort study included 59 intensive care units (ICU) and proceeded between January 2016 and March 2017. The study cohort comprised 1184 adults (≥ 16 years) who were admitted to an ICU with severe sepsis and septic shock diagnosed according to the sepsis-2 criteria. Sites of infection diagnosed by physicians in charge at the time of arrival comprised the lung, abdomen, urinary tract, soft tissue, bloodstream, central nervous system (CNS), and undifferentiated infections. The primary outcome was in-hospital mortality. Results: The most common sites of infection were the lungs (31.0%), followed by intra-abdominal sites (26.3%), the urinary tract (18.4%), and soft tissue (10.9%). The characteristics of the patients with severe sepsis across seven major suspected infection sites were heterogeneous. Septic shock was more frequent among patients with intra-abdominal (72.2%) and urinary tract (70.2%) infections than other sites. The in-hospital mortality rate due to severe sepsis and septic shock of a pooled sample was 23.4% (range, 11.9% [urinary tract infection] to 47.6% [CNS infection]). After adjusting for clinical background, sepsis severity, and stratification according to the presence or absence of shock, variations in hospital mortality across seven major sites of infection remained essentially unchanged from those for crude in-hospital mortality; adjusted in-hospital mortality rates ranged from 7.7% (95%CI, - 0.3 to 15.8) for urinary tract infection without shock to 58.3% (95%CI, 21.0-95.7) for CNS infection with shock in a generalized estimating equation model. Intra-abdominal and urinary tract infections were statistically associated with less in-hospital mortality than pneumonia. Infections of the CNS were statistically associated with higher in-hospital mortality rates than pneumonia in a logistic regression model, but not in the generalized estimating equation model. Conclusions: In-hospital mortality and clinical features of patients with severe sepsis and septic shock were heterogeneous according to sites of infection.

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KOARA(リポジトリ)収録論文等 【 表示 / 非表示

研究発表 【 表示 / 非表示

  • 炎症バイオマーカーのABC.

    藤島 清太郎

    日本集中治療医学会第2回東海北陸支部学術集会 (石川県金沢市) , 2018年06月, 口頭(招待・特別), 日本集中治療医学会

  • 日本におけるARDSの解析関連多施設共同研究

    藤島 清太郎

    第58回日本呼吸器学会学術集会 (大阪府大阪市) , 2018年04月, 口頭(招待・特別)

  • 最新のガイドラインに基づくARDSの診療.

    藤島 清太郎

    第45回日本救急医学会総会・学術集会, 2017年10月, 口頭(招待・特別)

  • 日本救急医学会多施設共同研究JAAM FORECAST報告:劇症型感染症研究

    一二三亨藤島 清太郎

    第45回日本救急医学会総会・学術集会 (大阪府大阪市) , 2017年10月

  • 日本救急医学会多施設共同研究JAAM FORECAST報告:ARDS研究

    藤島 清太郎,丸藤哲,他

    第45回日本救急医学会総会・学術集会 (大阪府大阪市) , 2017年10月, 口頭(招待・特別)

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競争的資金等の研究課題 【 表示 / 非表示

  • 細胞環境改善による炎症性肺疾患発症の予防と病態改善のための研究

    2014年04月
    -
    2017年03月

    文部科学省・日本学術振興会, 科学研究費助成事業, 藤島 清太郎, 基盤研究(C), 補助金,  代表

     研究概要を見る

    1)ヒト血管内皮細胞を高濃度酸素に曝露すると、IL-8の発現が誘導され、TNF-α・細菌内毒素の共存下でさらに増強されたことから、重症患者に対する高濃度酸素療法の有害性が改めて危惧された。また、この機序に核内パターン認識受容体の関与が示唆された。2)ヒトES細胞の肺胞上皮細胞への分化誘導促進法として、空気接触下培養が有効であることを確認した。3)我々が以前認めたIL-17欠損マウスにおける急性肺損傷増悪の機序として、樹状細胞やIL-12以外を介する機序の関与が示唆された。4)急性呼吸促迫症候群の肺局所サイトカインを網羅的に解析し、IL-1β、IFN-γ、IL-17の病態への関与が示唆された。

Works 【 表示 / 非表示

  • 卒後臨床研修センター副センター長

    2004年04月
    -
    2005年09月

    その他

受賞 【 表示 / 非表示

  • 日本ワックスマン財団学術研究助成奨励賞

    1992年, 日本ワックスマン財団

    受賞区分: 出版社・新聞社・財団等の賞

  • 第13回RMCB 研究会賞

    藤島清太郎,相磯貞和,佐山宏一,山澤文裕,中村守男,副島研造,脇泰裕,仲村秀俊,堀進悟,相川直樹,川城丈夫,金沢実, 1997年01月, RMCB研究会, 高濃度酸素暴露によるヒト臍帯静脈内皮細胞のInterleukin-8遺伝子発現の検討

  • 慶應義塾大学医学研究奨励特別奨励研究賞

    藤島清太郎, 1997年, 慶應義塾医学研究奨励事業委員会, ケモカインの炎症性肺疾患病態に果たす役割の解明とこれに基づく新規治療法の開発

  • JIC Award 2014

    Fujishima S, Gando S, Saitoh D, et al. and Japanese Association for Acute Medicine Sepsis Registry (JAAM SR) Study Group, 2015年04月, 日本感染症学会/日本化学療法学会, A multicenter, prospective evaluation of quality of care and mortality in Japan based on the Surviving Sepsis Campaign guidelines

    受賞区分: 国内学会・会議・シンポジウム等の賞

 

担当授業科目 【 表示 / 非表示

  • 総合診療医学

    2019年度

担当経験のある授業科目 【 表示 / 非表示

  • 救急医学

    慶應義塾大学医学部, 2018年度

  • 感染症学

    慶應義塾大学医学部, 2018年度

  • 総合診療科実習

    慶應義塾, 2015年度, 通年, 専門科目, 実習・実験, 専任, 1時間, 10人

  • 総合診療科

    慶應義塾, 2015年度, 春学期, 専門科目, 講義, 専任, 1時間, 110人

  • 救急医学

    慶應義塾, 2013年度, 通年, 専門科目, 講義, 専任, 1時間, 110人

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