Ramirez J A
University of Louisville School of Medicine, Kentucky 40292.
J Chemother. 1994 Apr;6 Suppl 2:47-50.
Nosocomial pneumonia has the highest crude mortality rate of all hospital-acquired infections. The choice of empirical antibiotic therapy can be based on in vitro sensitivities of sputum bacterial isolates. Organisms recovered from purulent sputum of 500 intensive care unit (ICU) patients from five hospitals in Louisville, Kentucky, had antibiotic sensitivities measured by microbroth dilution. The most common isolates were Staphylococcus aureus (26.6%), Pseudomonas species (24.8%), Enterobacter species (11.8%), Escherichia coli (7.2%), Klebsiella species (7.0%), Streptococcus species (4.4%) and Serratia species (4.0%). These organisms were tested for susceptibility to amikacin, ciprofloxacin, imipenem/cilastatin, ticarcillin/clavulanate, piperacillin, ceftriaxone and ceftazidime. The antibiotics effective against more than 80% of the seven most common isolates included amikacin (97%), imipenem (94%), ciprofloxacin (92%) and ticarcillin/clavulanate (84%). These sensitivity patterns may serve as a guide to choosing empirical antibiotics for ICU-acquired pneumonia in Louisville. When the use of a beta-lactam antibiotic alone or in combination with an aminoglycoside is preferred, imipenem or ticarcillin-clavulanate may be considered the antibiotics of choice. Studies are in progress to delineate the clinical use of ciprofloxacin alone or in combination with beta-lactam antibiotics for treating nosocomial pneumonia.
医院获得性肺炎在所有医院感染中粗死亡率最高。经验性抗生素治疗的选择可基于痰细菌分离株的体外敏感性。从肯塔基州路易斯维尔市五家医院的500名重症监护病房（ICU）患者的脓性痰中分离出的微生物，通过微量肉汤稀释法测定其抗生素敏感性。最常见的分离株为金黄色葡萄球菌（26.6%）、假单胞菌属（24.8%）、肠杆菌属（11.8%）、大肠杆菌（7.2%）、克雷伯菌属（7.0%）、链球菌属（4.4%）和沙雷菌属（4.0%）。对这些微生物进行了对阿米卡星、环丙沙星、亚胺培南/西司他丁、替卡西林/克拉维酸、哌拉西林、头孢曲松和头孢他啶的敏感性测试。对七种最常见分离株中80%以上有效的抗生素包括阿米卡星（97%）、亚胺培南（94%）、环丙沙星（92%）和替卡西林/克拉维酸（84%）。这些敏感性模式可作为路易斯维尔市ICU获得性肺炎经验性抗生素选择的指导。当单独使用β-内酰胺类抗生素或与氨基糖苷类抗生素联合使用时，亚胺培南或替卡西林-克拉维酸可被视为首选抗生素。关于单独使用环丙沙星或与β-内酰胺类抗生素联合使用治疗医院获得性肺炎的临床应用研究正在进行中。
