Fagon J Y, Trouillet J L, Chastre J
Service de Réanimation médicale, Hôpital Broussais, Paris.
Presse Med. 1996 Oct 19;25(31):1441-6.
Nosocomial pneumonia is associated with substantial morbidity and mortality. Patients treated with mechanical ventilation have the highest risk for developing this intensive care unit acquired infection. Gram-negative bacilli are the predominant organisms responsible for pneumonia in this setting. However, Staphylococcus aureus has recently emerged as a significant isolate. Nosocomial pneumonia is difficult to diagnose clinically in ventilated patients because fever, lung infiltrate on chest X-ray, leukocytosis are frequent in severely ill patients under mechanical ventilation whatever lung infection is present or not and because lower respiratory tract of such patients is colonized by potentially pathogenic bacteria independently of the presence of true lung infection; thus, different diagnostic strategies are proposed. Our personal bias is that using bronchoscopic techniques to obtain bronchoalveolar lavage and protected-brush specimens permits us to devise a therapeutic strategy that is superior to one based only on clinical evaluation. Measures for prevention of nosocomial infection are essential to decrease the incidence of nosocomial pneumonia and the emergence of multiresistant pathogens.
医院获得性肺炎与严重的发病率和死亡率相关。接受机械通气治疗的患者发生这种重症监护病房获得性感染的风险最高。革兰氏阴性杆菌是导致这种情况下肺炎的主要病原体。然而，金黄色葡萄球菌最近已成为一种重要的分离菌。医院获得性肺炎在机械通气患者中很难通过临床诊断，因为无论是否存在肺部感染，机械通气下的重症患者经常出现发热、胸部X线肺部浸润、白细胞增多，而且这些患者的下呼吸道被潜在致病菌定植，与是否存在真正的肺部感染无关；因此，提出了不同的诊断策略。我们个人的观点是，使用支气管镜技术获取支气管肺泡灌洗和保护性毛刷标本，使我们能够制定出一种优于仅基于临床评估的治疗策略。预防医院感染的措施对于降低医院获得性肺炎的发病率和多重耐药病原体的出现至关重要。
