Baumgartner J D, Glauser M P
Schweiz Med Wochenschr. 1987 May 9;117(19):707-11.
Bacterial pneumonia is responsible for high mortality in surgical intensive care patients which is partly attributable to a high incidence of gram-negative bacillary pneumonia. In these patients alterations to epithelial cell surfaces promote colonization of the oropharynx by gram-negative bacilli. The alterations are directly related to the severity of the patients' underlying disease and not to the hospital environment. Prospective studies on prophylactic administration of antibiotics to decrease the incidence of nosocomial pneumonia are reviewed. In these studies antibiotic have been administered either locally in the respiratory tract or systemically by the i.v. route. In both cases a moderate decrease in the incidence of pneumonia was observed, but selection of resistant bacteria occurred. Pneumonia appearing despite antibiotic prophylaxis was difficult to treat and had a high mortality. Therefore, local or intravenous antibiotic administration for routine prophylaxis of pneumonia seems to do more harm than good in patients from intensive care units.
细菌性肺炎是外科重症监护患者高死亡率的原因之一，部分原因是革兰氏阴性杆菌性肺炎的高发病率。在这些患者中，上皮细胞表面的改变促进了革兰氏阴性杆菌在口咽部的定植。这些改变与患者基础疾病的严重程度直接相关，而非与医院环境有关。本文综述了关于预防性使用抗生素以降低医院获得性肺炎发病率的前瞻性研究。在这些研究中，抗生素通过呼吸道局部给药或静脉全身给药。在这两种情况下，肺炎发病率均有适度下降，但出现了耐药菌的选择。尽管进行了抗生素预防仍出现的肺炎难以治疗且死亡率很高。因此，对于重症监护病房的患者，常规预防性使用局部或静脉抗生素预防肺炎似乎弊大于利。
