Baughman R P, Tapson V, McIvor A
Department of Medicine, University of Cincinnati Medical Center, OH 45267, USA.
Diagn Microbiol Infect Dis. 1999 Feb;33(2):131-9. doi: 10.1016/s0732-8893(98)00161-8.
Pneumonia is the second most common type of nosocomial infection and is most prevalent in patients who are mechanically ventilated. Nosocomial pneumonia (NP) is the leading contributor to mortality in patients, accounting for approximately 50% of deaths in patients with hospital-acquired infections. Several factors place patients at risk for developing NP, including prolonged length of hospital stay and local epidemiology. Gram-positive pathogens such as Streptococcus pneumoniae and, more recently, Staphylococcus aureus, as well as atypical organisms such as Legionella spp are increasingly associated with NP. Emerging antimicrobial resistance among these organisms confounds treatment interventions. Lack of local definitive information and patient comorbidities further complicate the physician's treatment decisions. The role of invasive pulmonary diagnostic techniques remains problematic and controversial. Studies, however, have shown that early initiation of appropriate empiric therapy is essential to improving patient outcome and reducing mortality. This article will review therapeutic options and appropriate antimicrobial agents for use in the treatment of nosocomial pneumonia in the era of emerging drug resistances.
肺炎是第二常见的医院感染类型，在接受机械通气的患者中最为普遍。医院获得性肺炎（NP）是患者死亡的主要原因，约占医院获得性感染患者死亡人数的50%。有几个因素使患者有发生NP的风险，包括住院时间延长和当地流行病学情况。革兰氏阳性病原体如肺炎链球菌以及最近的金黄色葡萄球菌，还有非典型病原体如军团菌属越来越多地与NP相关。这些病原体中不断出现的抗菌药物耐药性使治疗干预变得复杂。缺乏当地的确切信息和患者的合并症进一步使医生的治疗决策复杂化。侵入性肺部诊断技术的作用仍然存在问题且存在争议。然而，研究表明，尽早开始适当的经验性治疗对于改善患者预后和降低死亡率至关重要。本文将综述在出现耐药性的时代用于治疗医院获得性肺炎的治疗选择和合适的抗菌药物。
