Svediene Saule, Ivaskevicius Juozas
Clinic of Anesthesiology and Intensive Care, Vilnius University, Lithuania.
Medicina (Kaunas). 2006;42(2):91-7.
Pneumonia is the most frequently reported nosocomial infection in intensive care unit patients, predominantly in mechanically ventilated individuals. Most of the studies performed in intensive care unit settings reported the estimated 15-65% of ventilator-associated pneumonia, with high mortality rates. Ventilator-associated pneumonia results in prolonged hospitalization and increase in medical care costs. In most cases, high-risk pathogens (e.g. Gram-negative bacteria, such as Pseudomonas aeruginosa, Acinetobacter spp. and Klebsiella spp. with wide spectrum resistance, as well as methicillin-resistant Staphylococcus aureus) are the predominant causative agents of increased mortality. Occurrence of ventilator-associated pneumonia correlates with the duration of mechanical ventilation, severity of illness on admission (predicted mortality), type of admission (medical, surgical, trauma), demographical factors and treatment. Effective antibiotic management programs provide the information on local patterns of antimicrobial resistance, therefore, the proper antibiotic therapy can be chosen empirically. Invasive management strategy reduces mortality, earlier prevents organ dysfunction and lower antibiotic consumption in patients with suspected ventilator-associated pneumonia. The major goal of ventilator-associated pneumonia management is to optimize antimicrobial therapy by administering correct antibiotics in adequate doses and avoiding the initial use of wide spectrum antimicrobials. The antibiotic therapy should depend on antimicrobial sensitivity testing results and the clinical patient's response. The duration of therapy should be shortened to the minimum effective period. Excessive antibiotic use is a major factor contributing to increased antibiotic-resistance of pathogens. Prevention of the ventilator-associated pneumonia by local multidisciplinary strategies may reduce mortality rates and is beneficiary both for the patients and the hospital system. The education of the nursing staff helps to decrease the occurrence of ventilator-associated pneumonia in intensive care unit setting. However, ventilator-associated pneumonia still remains a serious controversy-generating problem in intensive care unit.
肺炎是重症监护病房患者中最常报告的医院感染，主要发生在机械通气的患者中。在重症监护病房环境中进行的大多数研究报告，呼吸机相关性肺炎的估计发生率为15%-65%，死亡率很高。呼吸机相关性肺炎会导致住院时间延长和医疗费用增加。在大多数情况下，高危病原体（如革兰氏阴性菌，如具有广泛耐药性的铜绿假单胞菌、不动杆菌属和克雷伯菌属，以及耐甲氧西林金黄色葡萄球菌）是死亡率增加的主要致病因素。呼吸机相关性肺炎的发生与机械通气时间、入院时疾病严重程度（预测死亡率）、入院类型（内科、外科、创伤）、人口统计学因素和治疗有关。有效的抗生素管理计划可提供有关当地抗菌药物耐药模式的信息，因此，可以根据经验选择合适的抗生素治疗。侵入性管理策略可降低死亡率，更早预防器官功能障碍，并减少疑似呼吸机相关性肺炎患者的抗生素使用。呼吸机相关性肺炎管理的主要目标是通过给予正确剂量的抗生素并避免初始使用广谱抗菌药物来优化抗菌治疗。抗生素治疗应取决于抗菌药物敏感性测试结果和临床患者的反应。治疗时间应缩短至最短有效期限。过度使用抗生素是导致病原体抗生素耐药性增加的主要因素。通过当地多学科策略预防呼吸机相关性肺炎可能会降低死亡率，对患者和医院系统都有益。对护理人员的教育有助于减少重症监护病房环境中呼吸机相关性肺炎的发生。然而，呼吸机相关性肺炎在重症监护病房中仍然是一个引发严重争议的问题。
