Solé Violán J, Rodríguez de Castro F, Lafarga Capuz B, Caminero Luna J A, Pérez Correa S, Manzano Alonso J L
Servicio de Medicina Intensiva, Hospital Ntra. Sra. del Pino, Las Palmas de Gran Canaria.
Rev Clin Esp. 1991 Jan;188(1):13-6.
Fifty-eight patients who presented clinical criteria of pneumonia (fever, leukocytosis, purulent tracheo-bronchial secretions, and lung infiltrate of recent appearance in X-ray) were prospectively studied in order to determine the cost effectiveness [correction of rentability] of quantitative culture of bronchial secretions by means of a telescopic catheter (TC) in the diagnosis of bacterial pneumonia in patients under mechanical ventilation. In 25 patients (43%) a positive culture was obtained above 10(3) UFC/ml, confirming the pneumonia diagnosis in 17 cases and detecting a false positive result in one patient. In no case with a count less than 10(3) UFC/ml pneumonia diagnosis could be confirmed, being this diagnosis excluded in 24 of 33 patients with a count lower than 10(3) UFC/ml. These results suggest that the presence of fever, purulent tracheobronchial secretions and lung infiltrate in an intubated patient under mechanical ventilation does not indicate the presence of pneumonia in a high percentage of cases and that CT scan can identify those patients who require antimicrobial treatment, and this avoiding its use in patients who do not need it, with the resulting decrease in morbidity and high cost.
对58例出现肺炎临床标准（发热、白细胞增多、脓性气管支气管分泌物以及近期胸部X线出现肺部浸润）的患者进行了前瞻性研究，以确定通过伸缩导管（TC）对支气管分泌物进行定量培养在机械通气患者细菌性肺炎诊断中的成本效益[纠正为收益性]。在25例患者（43%）中，培养结果高于10³ UFC/ml呈阳性，17例确诊为肺炎，1例检测为假阳性结果。无一例计数低于10³ UFC/ml的患者确诊为肺炎，在计数低于10³ UFC/ml的33例患者中，有24例排除了该诊断。这些结果表明，在机械通气的插管患者中，发热、脓性气管支气管分泌物和肺部浸润的存在在很大比例的病例中并不表明存在肺炎，并且CT扫描可以识别那些需要抗菌治疗的患者，从而避免在不需要的患者中使用抗菌治疗，进而降低发病率和高昂成本。
