Rello J, Ausina V, Ricart M, Puzo C, Net A, Prats G
Dept of Intensive Care, Hospital de la S. Creu i S. Pau, Universitat, Autonoma, Barcelona, Spain.
Eur Respir J. 1992 Nov;5(10):1249-53.
The purpose of this prospective clinical study was to determine the incidence, bacteriology and outcome of lower respiratory tract infections developed among 208 consecutive, critically ill comatose patients, hospitalized in a university hospital, medical-surgical intensive care unit, over a three year period. Nosocomial pneumonia developed in 53 (25%) patients after a mean of 8.1 days (range 3-31 days). Furthermore, there were five superinfections, raising the mean incidence to 28%. One patient developed secondary bacteraemia, and another two had septic shock. Fifteen (28%) patients from the pneumonia group died, and six of these deaths were considered to be directly related to nosocomial pneumonia. Identification of the causative agent, using the protected specimen brush technique, was possible in 42 episodes; in 10 (24%) of these cases more than one microorganism was isolated. Gram-positive cocci represented 53% of isolates, and Staphylococcus aureus accounted for 78% of all Gram-positive cocci, being the most frequent microorganism in this population. In conclusion, nosocomial pneumonia is a common complication of critically ill comatose patients. Its characteristic aetiological spectrum in this population should affect antibiotic prescription. Consequently, we suggest including antimicrobial drugs which are active against S. aureus in the empirical regimen until aetiological diagnosis is established.
这项前瞻性临床研究的目的是确定在一所大学医院的内科-外科重症监护病房连续收治的208例危重症昏迷患者中，三年期间发生的下呼吸道感染的发生率、细菌学情况及转归。53例（25%）患者发生医院获得性肺炎，平均发生时间为8.1天（范围3 - 31天）。此外，有5例发生重叠感染，使平均发生率升至28%。1例患者发生继发性菌血症，另有2例发生感染性休克。肺炎组15例（28%）患者死亡，其中6例死亡被认为与医院获得性肺炎直接相关。采用保护性标本刷技术，在42次感染发作中能够鉴定出病原体；其中10例（24%）分离出不止一种微生物。革兰阳性球菌占分离菌的53%，金黄色葡萄球菌占所有革兰阳性球菌的78%，是该人群中最常见的微生物。总之，医院获得性肺炎是危重症昏迷患者的常见并发症。该人群中其特有的病原谱应影响抗生素的处方。因此，我们建议在建立病原学诊断之前，经验性治疗方案中应包括对金黄色葡萄球菌有效的抗菌药物。
