Kenzaka Tsuneaki, Kumabe Ayako, Kosami Koki, Matsuoka Yasufumi, Minami Kensuke, Ninomiya Daisuke, Noda Ayako, Yahata Shinsuke
Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, Kobe, Japan; Division of General Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan.
Division of General Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan.
Respir Investig. 2018 Mar;56(2):150-157. doi: 10.1016/j.resinv.2017.12.005. Epub 2018 Jan 5.
Clinical practice guidelines for nursing- and healthcare-associated pneumonia (NHCAP) were developed for pneumonia caused by drug-resistant bacteria and pneumonia in elderly patients, particularly aspiration pneumonia. The identification of pathogenic bacteria and implementation of efforts to prevent the recurrence of aspiration pneumonia are very important in clinical practice. This study examined the extent to which clinicians have established bacteriological testing and recurrence prevention efforts for NHCAP and aspiration pneumonia.
Questionnaire surveys were mailed to the heads of internal medicine and respiratory medicine departments at 2490 Japanese hospitals. The questionnaire evaluated bacteriological testing for NHCAP or aspiration pneumonia and prevention of the recurrence of aspiration pneumonia.
A total of 350 hospitals responded. These hospitals were grouped on the basis of whether a pulmonologist provided medical care for aspiration pneumonia and whether the hospital employed an infectious disease specialist. For hospitals in which pulmonologists treated aspiration pneumonia, the response rates for "is done in nearly all cases" were 70.0%, 84.7%, 31.6%, and 48.9% for sputum gram staining, sputum culture tests, blood culture tests, and pneumococcal vaccination, respectively. In hospitals that employed an infectious disease specialist, the response rates for "is done in nearly all cases" were 72.8% and 41.3% for sputum gram staining and blood culture tests, respectively. Recurrence prevention for aspiration pneumonia (other than pneumococcal vaccination) was not actively implemented.
Sputum gram staining, sputum culture tests, and other bacteriological tests were implemented quite actively. However, physicians who treat aspiration pneumonia should implement efforts to prevent pneumonia recurrence more actively.
针对耐药菌引起的肺炎以及老年患者的肺炎，尤其是吸入性肺炎，制定了护理及医疗相关肺炎（NHCAP）的临床实践指南。在临床实践中，病原菌的鉴定以及预防吸入性肺炎复发的措施非常重要。本研究调查了临床医生对NHCAP和吸入性肺炎进行细菌学检测及预防复发措施的落实程度。
向2490家日本医院的内科和呼吸内科主任邮寄问卷调查。问卷评估了NHCAP或吸入性肺炎的细菌学检测以及吸入性肺炎复发的预防情况。
共有350家医院回复。这些医院根据是否有肺科医生诊治吸入性肺炎以及是否聘请传染病专科医生进行分组。对于有肺科医生诊治吸入性肺炎的医院，痰革兰氏染色、痰培养检测、血培养检测和肺炎球菌疫苗接种的“几乎在所有病例中都进行”的回复率分别为70.0%、84.7%、31.6%和48.9%。在聘请了传染病专科医生的医院中，痰革兰氏染色和血培养检测的“几乎在所有病例中都进行”的回复率分别为72.8%和41.3%。吸入性肺炎复发的预防（肺炎球菌疫苗接种除外）未得到积极实施。
痰革兰氏染色、痰培养检测和其他细菌学检测实施得相当积极。然而，治疗吸入性肺炎的医生应更积极地采取预防肺炎复发的措施。
Zotero 插件