健康护理相关性肺炎的研究进展

健康护理相关性肺炎代表一种新的肺炎种类,有别于社区获得性肺炎和医院获得性肺炎.尽管健康护理相关性肺炎患者描述为来自于社区,但其流行病学、细菌学特征和l临床表现与社区获得性肺炎有明显差异.本文综述近年来健康护理相关性肺炎的研究进展,旨在提高临床医师对健康护理相关性肺炎的认识和深入了解.     

C反应蛋白在社区获得性肺炎诊治中的意义

目的探讨C反应蛋白（CRP）在社区获得性肺炎的诊断治疗中的意义。方法应用日立全7080型自动生化分析仪测定社区获得性肺炎200例（住院80例、门诊治疗120例）及健康体检者80例中的CRP水平。结果住院的社区获得性肺炎、门诊治疗的社区获得性肺炎及健康人群之间均存在着显著性差异。结论住院的社区获得性肺炎、门诊治疗的社区获得性肺炎及健康人群之间的CRP存在着阶梯性显著差异。血清CRP水平可一定程度上反映出社区获得性肺炎的严重程度，对患者的治疗及预后评估起到重要作用。     

利奈唑胺在革兰阳性球菌肺炎中的临床应用

 革兰阳性（G⁺）球菌是医院和社区获得性肺炎的重要病原菌。以往认为,医院获得性G⁺菌肺炎以金黄色葡萄球菌（以下简称金葡菌）为主,而社区获得性G⁺菌肺炎以肺炎链球菌为主。然而,近年来随着全球抗菌药物的广泛应用,耐药G⁺球菌日益增多,尤其是甲氧西林耐药的金葡菌（MRSA）已成为医院获得性肺炎的重要致病菌之一,其在社区获得性肺炎中的比例也在不断上升^［1-2］。特别是在院内呼吸机相关性肺炎患者分离的金葡菌中, MRSA检出率可达40%～70%^［3］。而在亚洲8个国家和地区进行的一项调查显示,医院获得性MRSA和社区获得性MRSA的检出率分别为67.4%和25.5%^［4］。由于MRSA对多种抗菌药物耐药,医院获得性MRSA肺炎和社区获得性MRSA肺炎住院时间延长,治疗费用增加,且预后不佳,因此早期合理的经验性抗菌治疗显得尤为重要。长期以来,糖肽类的万古霉素一直是治疗MRSA感染的主要抗菌药物,但随着使用时间的延长和应用范围拓宽,糖肽类药物的最低抑菌浓度（MIC）值向上爬升。虽然目前万古霉素耐药的金葡菌（VRSA）较少,但万古霉素中介的金葡菌（VISA）、异质性万古霉素中介的金葡菌（hVISA）等的不断出现,仍然给临床MRSA肺炎治疗带来了新的挑战。     

重症社区获得性肺炎克雷伯杆菌肺炎临床分析

目的 探讨肺炎克雷伯杆菌引起重症社区获得性肺炎的特点及治疗.方法 报道重症社区获得性肺炎克雷伯杆菌肺炎4例发病特点、影像学表现及治疗疗效.结果 4例患者均有2次以上痰或血培养结果提示肺炎克雷伯杆菌,1例ESBLs阳性,4例患者均出现呼吸衰竭、休克、多脏器功能衰竭(MOF),其中3例患者接受有创机械通气治疗,2例患者治疗后好转出院.结论 克雷伯杆菌引起的获得性肺炎进展迅速,重症社区获得性肺炎在暂无细菌学证据情况下,仍宜尽早应用能覆盖肺炎克雷伯杆菌的药物,早期给予呼吸支持对改善预后具有一定帮助.     

铜绿假单胞菌肺炎的最新进展

铜绿假单胞菌属于条件致病菌,可引起社区获得性肺炎、医院获得性肺炎(特别是呼吸机相关性肺炎)及囊性纤维化患者中的下呼吸道感染,具有较高的死亡率。本文将对铜绿假单胞菌肺炎主要类型、发病机理、微生物学诊断、抗生素治疗及预防的最新进展进行综述。     

重症肺炎初期的抗生素降阶梯治疗策略

重症肺炎是指除肺炎常见呼吸系统症状外,尚有呼吸衰竭和其它系统明显受累的表现[1]。重症肺炎既可发生于社区获得性肺炎(CAP),亦可发生于医院获得性肺炎(HAP),在HAP中以医疗机构相关性肺炎(HCAP)、重症监护病房(ICU)里的获得性肺炎和呼吸机相关肺炎(VAP)常见。如何对重症肺炎进     

神经疾病并发医院获得性肺炎的危险因素分析

目的研究神经疾病患者医院获得性肺炎的危险因素,为临床患者提供干预和治疗策略。方法分析我院神经内科入住的88例患者,通过单因素分析获得性肺炎与神经疾病患者的危险因素相关分析。结果高龄、意识、吸烟史与神经疾病患者感染获得性肺炎的关系密切。结论高龄、意识、吸烟史危险因素与获得性肺炎有着直接的发病关系,我们采取相应措施加强防护,可减少医院获得性肺炎发生并改善患者预后。     

老年获得性肺炎患者不动杆菌感染的临床和细菌耐药分析

严重影响着患者的生活质量,甚至会危害患者的生命[1].获得性肺炎又分为医院获得性肺炎和社区获得性肺炎(CAP).细菌获得性肺炎是获得性肺炎中的一种,尤其是不动杆菌,当机体抵抗力降低时易引起机体感染,是引起医院内感染的重要机会致病菌之一[2].该菌可引起呼吸道感染、败血症、脑膜炎、心内膜炎、伤口及皮肤感染、泌尿生殖道感染等,如何及时诊断及治疗成为人们研究的重点[3].本研究主要探讨老年获得性肺炎患者不动杆菌感染的临床和细菌耐药分析.     

颅脑外伤者院内获得性肺炎664例

医院获得性肺炎（院内肺炎）是颅脑外伤者最常见的医院感染之一.目前国内少见颅脑外伤住院患者获得性肺炎情况分析的相关报道.本文对我院颅脑外伤患者医院获得性肺炎的相关影响因素进行了回顾性分析,报告如下.     

医疗机构相关性肺炎和社区获得性肺炎的病原学、治疗及转归比较

目的 比较医疗机构相关性肺炎与社区获得性肺炎二者病原学特点、治疗及转归的差异.方法 收集2007年1月至2009年12月我院呼吸科住院的264例肺炎患者病例,分析比较医疗机构相关性肺炎与社区获得性肺炎的病原学特点、治疗及转归.结果 264例肺炎患者中,医疗机构相关性肺炎101例(38.26％)、社区获得性肺炎163例(...     

高龄社区获得性肺炎的细菌学及药敏分析

目的 分析高龄社区获得性肺炎的细菌学及药敏情况.方法 选取我院收治的高龄社区获得性肺炎患者210例为实验组,同期收治的高龄医院获得性肺炎患者210例作为对照组,取两组患者的痰标本进行病原菌分离培养,分析致病菌的分布及其耐药性.结果 高龄社区获得性肺炎患者感染的致病菌中主要为肺炎克雷伯氏菌和铜绿假单胞菌,医院获得性肺炎患者感染的病原菌中,革兰阴性菌占37.14%,革兰阳性菌占56.67%,其它病原体占6.19%,且其致病菌耐药性均明显高于高龄社区获得性肺炎,P＜0.05,差异具有统计学意义.结论 高龄社区获得性肺炎患者感染的致病菌主要为革兰阴性菌,且其致病菌耐药性明显低于高龄医院获得性肺炎.     

70岁以上老年肺炎患者临床特征探索

目的：分析第三军医大学西南医院近3年老年肺炎的发病特征和并发症,为指导老年肺炎的临床合理综合治疗提供依据。方法分析2007年1月至2009年12月在第三军医大学西南医院老年科病房住院、年龄＞70岁112例老年肺炎患者的临床特征及并发症,了解社区获得性肺炎和医院获得性肺炎的症状、体征、影像学特点,以及常见的并发症、肺部感染诱发因素。结果＞70岁老年肺炎患者中,医院获得性肺炎比例有增加趋势,共占54.6%,症状体征多不典型,病情明显较社区获得性肺炎重,死亡率高,并发症多,影像学特点多变。最常见的前5位并发症分别为多器官功能衰竭、心力衰竭、呼吸衰竭、混合性电解质紊乱、营养性贫血。常见的前5位诱因依次为误吸、反流、脑梗死、心力衰竭、外科手术。结论3年来第三军医大学西南医院老年肺炎有逐年增加的趋势,尤以医院获得性肺炎发病率更高,症状体征多不典型,易合并严重并发症,及时防治诱因和合理综合治疗非常重要。     

Chronic community-acquired Acinetobacter pneumonia that responded slowly to rifampicin in the anti-tuberculous regime

Acinetobacter baumannii is a well-known cause of hospital-acquired pneumonia. Occasionally, it can present as an acute community-acquired pneumonia with a fulminant course. However, the occurrence of the chronic form of community-acquired Acinetobacter pneumonia is yet to be highlighted. We describe a 62-year-old, HIV negative, non-diabetic male, who was referred for evaluation of consolidation and cavitation in the apicoposterior segment of the left upper lobe for 4 months. For this, he had received anti-tuberculous therapy, which included rifampicin. On investigation, a diagnosis of chronic community-acquired pneumonia due to Acinetobacter baumannii was made. The steady clinico-radiologic improvement observed was attributed to rifampicin in the anti-tuberculous regime. Subsequently, an aspergilloma formed in the cavity.     

Prognostic and risk factors in patients hospitalized with bacterial pneumonia

We studied 316 adults with community-and hospital-acquired bacterial pneumonia admitted from January 1998 to July 2003. Of these, 66 (20.9%) died. Classified by age, none under 70 died, but mortality increased to 22.6% in the 70-79 age group, 31.6% in the 80-89 age group and 24.2% in the group over 90. Mortality was 3.4% (6/177) for mild pneumonia, 32.0% (24/75) for moderate pneumonia, and 56.3% (36/64) for severe pneumonia. Mortality in hospital-acquired pneumonia (69.1%) was significantly higher than that in community-acquired pneumonia (10.7%). This may result from the higher percentage of moderate by and severe by ill patients who contracted hospital-acquired pneumonia, since 80% of those with hospital-acquired pneumonia were in the moderate and severe group compared to 36.4% of those with community-acquired pneumonia. For antibiotic regimens, mortality was 18.2% to 36.4% for patients who underwent Penicillins-Cephems therapy compared with 51.6% to 66.7% for Carbapenems-Quinolones therapy. The reasons for these differences remain unclear. Our study indicates that severity of illness, age, and antibiotic therapy were factors correlated with death from pneumonia. Underlying diseases such as respiratory failure, chronic heart failure, cerebrovascular disease, renal failure, malignancy, and senile dementia may also be associated with mortality.     

Targeted bacteremia surveillance throughout a year--comparison of community-acquired and hospital-acquired infection

To keep an eye on severe nosocomial infection and to evaluate the clinical difference of blood-stream infection between community-acquired and hospital-acquired infection, a survey of blood culture was performed in National Tokyo Medical Center from the period between November 2000 and October 2001. There were 252 episodes detected in 219 patients (80 community-acquired episodes in 80 patients and 172 hospital-acquired episodes in 139 patients). The three most common foci of infection/pathogens were as follows: in the community-acquired cases; urinary tract, pneumonia, infective endocarditis/Escherichia coli, viridant group of streptococci, Streptococcus pneumoniae, and in the hospital-acquired cases; intra-venous catheter, urinary tract, neutropenia-related bacteremia/Staphylococcus aureus, coagulase negative Staphylococcus, Enterococcus. Fifteen patients with community-acquired bacteremia and 37 patients with hospital-acquired bacteremia had been died within a month of the episode; the mortality was not significantly different between the both. The average of peak serum concentrations of C-reactive protein during the episodes of community-acquired bacteremia was higher than that of hospital-acquired bacteremia. These findings probably show that life threatening bloodstream infections seemed to be more common in the community. The rate of nosocomial bacteremia was approximately 1%, and no outbreak was observed during the period. Targeted bacteremia surveillance is maybe useful and efficient method to detect severe hospital-acquired infections.     

Pneumonia due to Pseudomonas aeruginosa: part I: epidemiology, clinical diagnosis, and source

Pseudomonas aeruginosa is an uncommon cause of community-acquired pneumonia (CAP), but a common cause of hospital-acquired pneumonia. Controversies exist for diagnostic methods and antibiotic therapy. We review the epidemiology of CAP, including that in patients with HIV and also in hospital-acquired pneumonia, including ventilator-associated pneumonia (VAP) and bronchoscope-associated pneumonia. We performed a literature review of clinical studies involving P aeruginosa pneumonia with an emphasis on treatment and prevention. Pneumonia due to P aeruginosa occurs in several distinct syndromes: (1) CAP, usually in patients with chronic lung disease; (2) hospital-acquired pneumonia, usually occurring in the ICU; and (3) bacteremic P aeruginosa pneumonia, usually in the neutropenic host. Radiologic manifestations are nonspecific. Colonization with P aeruginosa in COPD and in hospitalized patients is a well established phenomenon such that treatment based on respiratory tract cultures may lead to overtreatment. We present circumstantial evidence that the incidence of P aeruginosa has been overestimated for hospital-acquired pneumonia and reflex administration of empirical antipseudomonal antibiotic therapy may be unnecessary. A diagnostic approach with BAL and protected specimen brush using quantitative cultures for patients with VAP led to a decrease in broad-spectrum antibiotic use and improved outcome. Endotracheal aspirate cultures with quantitative counts are commonly used, but validation is lacking. An empirical approach using the Clinical Pulmonary Infection Score is a pragmatic approach that minimizes antibiotic resistance and leads to decreased mortality in patients in the ICU. The source of the P aeruginosa may be endogenous (from respiratory or GI tract colonization) or exogenous from tap water in hospital-acquired pneumonia. The latter source is amenable to preventive measures.     

Radiological imaging in pneumonia: recent innovations

PURPOSE OF REVIEW: Pneumonia is one of the major infectious diseases responsible for significant morbidity and mortality throughout the world. Radiological imaging plays a prominent role in the evaluation and treatment of patients with pneumonia. This paper reviews recent innovations in the radiologic diagnosis and management of suspected pulmonary infections. RECENT FINDINGS: Chest radiography is the most commonly used imaging tool in pneumonias because of availability and an excellent cost-benefit ratio. Computed tomography is mandatory in unresolved cases or when complications of pneumonia are suspected. A specific radiologic pattern can suggest a diagnosis in many cases. Bacterial pneumonias are classified into four main groups: community-acquired, aspiration, healthcare-associated and hospital-acquired pneumonia. The radiographic patterns of community-acquired pneumonia may be variable and are often related to the causative agent. Aspiration pneumonia involves the lower lobes with bilateral multicentric opacities. The radiographic patterns of healthcare-associated and hospital-acquired pneumonia are variable, most commonly showing diffuse multifocal involvement and pleural effusion. SUMMARY: Combination of pattern recognition with knowledge of the clinical setting is the best approach to the radiologic interpretation of pneumonia. Radiological imaging will narrow the differential diagnosis of direct additional diagnostic measures and serve as an ideal tool for follow-up examinations.     

The current definition,epidemiology, animal models and a novel therapeutic strategy for aspiration pneumonia

In the 21st century, aspiration pneumonia (ASP) is very common in older patients, and has a high mortality rate. ASP is diagnosed following confirmation of inflammatory findings in the lungs and overt aspiration or the existence of dysphagia. It is dominant in hospitalized community-acquired pneumonia (CAP), nursing and healthcare-associated pneumonia (NHCAP), and hospital-acquired pneumonia (HAP). The incidence of ASP is increasing every year. The human and experimental animal data revealed that micro-aspiration due to dysphagia during the night is the central mechanism of ASP. Therefore, the precise assessment of swallowing function is the key to diagnose ASP. From a therapeutic point of view, an appropriate administration of antibiotics, as well as a comprehensive approach for dysphagia plays a pivotal role in the prognosis and recovery from ASP. The non-pharmacologic approach, including swallowing rehabilitation and oral care, and a pharmacologic approach including ACE inhibitors and bronchodilators, are essential modalities for treatment and prevention of ASP. The clinical data of NHCAP provides us with a promising treatment strategy for ASP.     

不同类型老年吸入性肺炎的病原学、抗生素应用及临床转归

目的 比较老年社区获得性吸入性肺炎(CAP)、医疗相关性吸入性肺炎(HCAP)及医院获得性吸入性肺炎(HAP,包括呼吸机相关性吸入性肺炎)三者病原学、抗生素应用及治疗转归的关系.方法 收集2005年1月一2010年12月北京二炮总医院呼吸科住院的216例老年吸人性肺炎患者病例,分析其病原学结果、抗生素应用的及治疗转归.结果 三种吸入性肺炎的病原学有显著差异,与CAP和HCAP相比,HAP患者G-杆菌的感染比例明显增多(P<0.001);抗生素应用方案有明显差异,CAP组病人未调整抗生素应用比率明显高于HCAP组与HAP组(P<0.001);抗生素应用策略不同,所致死亡率有明显差异,以升阶梯方案为最高,以降阶梯治疗为最低(P=0.03).结论 三种吸入性肺炎在感染病原菌种类、抗生素应用策略及治疗转归上有明显差异,应根据不同类型的老年吸入性肺炎特点合理经验性使用抗菌药物.