Zeliaś Aleksander, Budak Alicja, Włodarczyk Dorota, Wodziński Paweł
Oddział Intensywnej Terapii i Anestezjologii WSzS w Krakowie.
Anestezjol Intens Ter. 2009 Apr-Jun;41(2):100-4.
Nosocomial pneumonia is defined as a pneumonia developing within 48 hours of admission, in a patient with previously normal lung tissue. Ventilator-associated pneumonia (VAP) due to migration of microorganisms from the nose, throat and digestive tract is typical in ITU patients. Microbiological diagnosis is difficult, and there is no single method approved for VAP diagnosis. We have assessed the usefulness of Quantitative Endotracheal Aspirate (QETA) for this purpose, basing on its reported high sensitivity (mean 76% +/- 9%) and specificity (mean 75 +/- 28%).
Endotracheal aspirates were sampled from ITU patients fulfilling the following criteria: (1) New or progressive infiltrations in the lungs plus hyperthermia (>38.3 degrees C) or hypothermia (<36 degrees C); (2) leukocytosis (>12 G L(-1)) or leukopenia (<4 G L(-1)); or (3) purulent sputum.
Nosocomial pneumonia was diagnosed in 40 out of 312 patients treated in the ITU during the study period. VAP was diagnosed in 33 patients. Multi-drug resistant bacteria: Pseudomonas aeruginosa (16), Acinetobacter baumannii (19), ESBL pathogens (8) and MRSA (1) were cultured from QETA in 32 patients. The sensitivity of QETA was 86%.
The results allowed for early and accurate diagnosis of nosocomial pneumonia and institution of the best possible treatment.
医院获得性肺炎被定义为在入院48小时内发生的肺炎，患者先前肺组织正常。在重症监护病房（ITU）患者中，因微生物从鼻、咽喉和消化道迁移导致的呼吸机相关性肺炎（VAP）很常见。微生物学诊断困难，且尚无单一方法被批准用于VAP诊断。基于定量气管内吸出物（QETA）报告的高敏感性（平均76%±9%）和特异性（平均75±28%），我们评估了其在这方面的实用性。
从符合以下标准的ITU患者中采集气管内吸出物样本：（1）肺部出现新的或进行性浸润，伴有发热（>38.3℃）或体温过低（<36℃）；（2）白细胞增多（>12 G L⁻¹）或白细胞减少（<4 G L⁻¹）；或（3）脓性痰液。
在研究期间，ITU治疗的312例患者中有40例被诊断为医院获得性肺炎。33例患者被诊断为VAP。从32例患者的QETA中培养出多重耐药菌：铜绿假单胞菌（16例）、鲍曼不动杆菌（19例）、产超广谱β-内酰胺酶病原体（8例）和耐甲氧西林金黄色葡萄球菌（1例）。QETA的敏感性为86%。
这些结果有助于早期准确诊断医院获得性肺炎并实施最佳治疗。
