Torres A, el-Ebiary M, González J, Ferrer M, Puig de la Bellacasa J, Gené A, Martos A, Rodriguez-Roisin R
Serveis de Pneumologia and de Microbiologia, Hospital Clinic, Universitat de Barcelona, Spain.
Am Rev Respir Dis. 1993 Aug;148(2):352-7. doi: 10.1164/ajrccm/148.2.352.
We studied the interrelations between gastric, pharyngeal, proximal, and distal airway bacterial flora in ventilator-associated pneumonia (VAP) on 36 patients with nosocomial pneumonia acquired during mechanical ventilation (MV) and 27 mechanically ventilated control subjects without pulmonary infection. Gastric, pharyngeal, and endotracheal (EA) sampling for quantitative cultures were performed upon all patients, as well as fiberoptic bronchoscopy with protected specimen brush (PSB) sampling. Mean bacterial and fungi colony counts were significantly increased in pharyngeal, EA, and PSB samples in patients with VAP compared with control subjects. The overall increase in colonization was due to gram-positive cocci in all samples. In addition, gram-negative bacilli and fungi mean counts increased significantly in PSB pneumonia samples versus control samples. However, mean gastric colonization was similar in both patients with VAP and control subjects. In the former group there was an increase in coincident microorganisms isolated from gastric, pharyngeal, and EA samples in relation to PSB samples compared with control samples. Among the different quantitative cultures analyzed, only those obtained from EA significantly correlated with PSB cultures in patients with pneumonia (r = 0.67, p = 0.001). In summary, the present study shows that the coincidence between microorganisms isolated in PSB cultures and those from gastric and oropharynx increase in MV patients with pneumonia, indicating that both reservoirs play a key role in the pathogenesis of pneumonia. Conceivably, preventing both gastric and pharyngeal colonization may reduce the incidence of ventilator-associated pneumonia. From all the noninvasive samples studied only endotracheal aspirate cultures were useful for inferring the etiology of some VAP pneumonias.
我们研究了36例机械通气（MV）期间获得医院获得性肺炎的患者及27例无肺部感染的机械通气对照受试者中，呼吸机相关性肺炎（VAP）患者的胃、咽、近端和远端气道细菌菌群之间的相互关系。对所有患者进行胃、咽和气管内（EA）采样以进行定量培养，以及使用保护性标本刷（PSB）进行纤维支气管镜采样。与对照受试者相比，VAP患者的咽、EA和PSB样本中的细菌和真菌菌落平均计数显著增加。所有样本中定植的总体增加是由于革兰氏阳性球菌。此外，与对照样本相比，PSB肺炎样本中的革兰氏阴性杆菌和真菌平均计数显著增加。然而，VAP患者和对照受试者的平均胃定植情况相似。与对照样本相比，前一组中从胃、咽和EA样本中分离出的与PSB样本一致的微生物有所增加。在分析的不同定量培养物中，只有从EA获得的培养物与肺炎患者的PSB培养物显著相关（r = 0.67，p = 0.001）。总之，本研究表明，肺炎MV患者中PSB培养物中分离出的微生物与胃和口咽中分离出的微生物之间的一致性增加，表明这两个菌库在肺炎发病机制中起关键作用。可以想象，预防胃和咽部定植可能会降低呼吸机相关性肺炎的发病率。在所有研究的非侵入性样本中，只有气管内吸出物培养物有助于推断某些VAP肺炎的病因。
