医院获得性肺炎的研究进展

医院获得性肺炎的病原主要是革兰氏阴性杆菌及抗药性金黄色葡萄球菌,治疗棘手,死亡率高。本文主要就医院获得性肺炎的病原学诊断、预防及治疗研究进展进行综述。     

我国肺部感染的临床和研究现状与展望

一、临床和研究工作现状自１９８２年第一次全国肺部感染学术会议至今，肺部感染临床和研究工作有了长足发展，近年来每年发表有关肺部感染的论文２００～３００篇，肺部感染专著也已有多部出版。研究内容涉及病原学诊断新技术、细菌耐药性监测、医院获得性肺炎、特殊宿主肺部感染、新的抗感染药物应用及评价等。第二次全国会议制订的医院获得性支气管肺部感染诊断标准（试行草案）得到了广泛认同。第三次全国会议还拟定了社区获得性肺炎和医院获得性肺炎两个诊治指南。另一方面，应该看到我国肺部感染的临床和研究工作总体水平还比较低，譬…     

无反应肺炎

目前诊断技术虽然有了很大进展，但是大多数社区获得性肺炎（community—acquired pneumonia，CAP）的患者仍然无法获得病原学诊断。大部分CAP仍沿用经验性治疗。然而，住院CAP患者对最初经验性抗菌治疗无反应并不少见。无反应CAP患者与治疗有反应患者相比较，其病死率增加数倍。本文对无反应肺炎（nonresponding pneumonia）的定义、诊断、危险因素、病因、处理展开讨论，以求深化无反应肺炎的诊疗策略。     

医院获得性黄杆菌属肺炎

医院获得性黄杆菌属肺炎汪建新，毛宝龄医院内感染（ｎｏｓｏｃｏｍｉａｌｉｎｆｅｃｔｉｏｎｓ）是现代医学密切关注和亟待解决的一大难题。肺部感染占医院内感染率的第三位，病死率约为３０％～５０％，例如在一重症监护病房中，医院内获得性肺炎（ｎｏｓｏｃｏｍｉａｌ...     

针吸,血培养和血清学检查院外获得性肺炎病原学比较

针吸、血培养和血清学检查院外获得性肺炎病原学比较临沭县人民医院（２７６７００）王维玺为了获得肺炎患者准确的病原学诊断，我们采用针吸（经气管、经胸）方法采取其无咽部菌群污染的呼吸道标本分离病原菌，并与血培养、血清学检查院外获得性肺炎的病原学结果做对照，...     

呼吸机相关肺炎的研究进展

呼吸机相关肺炎（VAP）是机械通气患者常见且较特殊的医院内获得性肺炎，发病率及病死率较高。临床预防、早期诊断、病原学诊断和临床抗菌药物治疗仍然是VAP重症患者救治领域的难点，现将近年来VAP的研究进展做一综述。     

绿脓杆菌肺炎的治疗

绿脓杆菌（又称铜绿假单孢菌）肺炎是医院内肺炎中较为常见的一种。由于绿脓杆菌极易产生获得性耐药，加上它不易被呼吸道防御机制杀灭，所以使得绿脓杆菌肺炎的治疗仍很困难，病死率达３０％以上，绿脓杆菌败血症性肺炎病死率则高达８０％～９０％。绿脓杆菌在医院环境中...     

医院获得性肺炎的病原学及耐药趋势

医院获得性肺炎是常见的医院获得性感染,在我国医院获得性感染中居首位,其发病率及病死率高,住院时间长,医疗费用高。随着抗菌药物的滥用,免疫抑制疗法的发展及广泛应用等,引起医院获得性肺炎的病原菌更加多样化,耐药现象也越来越严峻。本文对国内外医院获得性肺炎的病原菌分布及耐药情况进行综述,为临床治疗提供参考。     

微波辅助治疗重症肺炎的疗效观察

重症肺炎根据获得环境不同分为重症社区获得性肺炎（SCAP）和重症医院获得性肺炎（SHAP）。SCAP及SHAP均有很高的患病率和病死率。流行病学调查显示SCAP患者的病死率可高达50％,而SHAP的病死率可达70％。我院ICU采用微波辅助治疗重症肺炎,疗效满意,现报道如下。     

军团菌肺炎的诊治策略

军团菌肺炎有着进展迅速、高病死率的特点，近年来发病率明显增长，文章对军团菌肺炎诊断治疗方法的国内 外研究进展进行综述。早期对军团菌肺炎患者进行临床判断并进行病原学诊断、早期应用适当的抗生素治疗是提高 军团菌肺炎诊治成功率的关键。     

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.     

Clinical practice guidelines for hospital-acquired pneumonia and ventilator-associated pneumonia in adults

Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are important causes of morbidity and mortality, with mortality rates approaching 62%. HAP and VAP are the second most common cause of nosocomial infection overall, but are the most common cause documented in the intensive care unit setting. In addition, HAP and VAP produce the highest mortality associated with nosocomial infection. As a result, evidence-based guidelines were prepared detailing the epidemiology, microbial etiology, risk factors and clinical manifestations of HAP and VAP. Furthermore, an approach based on the available data, expert opinion and current practice for the provision of care within the Canadian health care system was used to determine risk stratification schemas to enable appropriate diagnosis, antimicrobial management and nonantimicrobial management of HAP and VAP. Finally, prevention and risk-reduction strategies to reduce the risk of acquiring these infections were collated. Future initiatives to enhance more rapid diagnosis and to effect better treatment for resistant pathogens are necessary to reduce morbidity and improve survival.     

A prospective comparison of nursing home-acquired pneumonia with hospital-acquired pneumonia in non-intubated elderly

There are no prospective comparison of the etiology and clinical outcome between hospital-acquired pneumonia (HAP) and nursing home-acquired pneumonia (NHAP) in non-intubated elderly. This study prospectively evaluated the etiology of HAP and NHAP in non-intubated elderly. A prospective cohort study was carried out in a rural region of Japan where the population over 65 years of age represents 30% of the population. A total of 108 patients were enrolled. There were 33 patients with HAP and 75 with NHAP. Etiologic diagnosis was established in 78.8% of HAP and in 72% of NHAP patients. The most frequent pathogens were Chlamydophila pneumoniae followed by Streptococcus pneumoniae, Staphylococcus aureus and Influenza virus. The frequency of Streptococcus pneumoniae and Influenza virus was significantly higher, whereas the frequency of Staphylococcus aureus and Enterobacteriaceae was significantly lower in NHAP compared to HAP. Performance and nutritional status were significantly worse in patients with HAP than in those with NHAP. Hospital mortality was significantly lower in patients with NHAP compared to those with HAP. This study demonstrated that C. pneumoniae, Streptococcus pneumoniae, Staphylococcus aureus and Influenza virus are frequent causative agents of pneumonia in non-intubated elderly and that the responsible pathogens and clinical outcome differ between NHAP and HAP.     

Neumonía nosocomial

The hospital acquired pneumonia (HAP) is one of the most common infections acquired among hospitalised patients. Within the HAP, the ventilator-associated pneumonia (VAP) is the most common nosocomial infection complication among patients with acute respiratory failure. The VAP and HAP are associated with increased mortality and increased hospital costs. The rise in HAP due to antibiotic-resistant bacteria also causes an increase in the incidence of inappropriate empirical antibiotic therapy, with an associated increased risk of hospital mortality. It is very important to know the most common organisms responsible for these infections in each hospital and each Intensive Care Unit, as well as their antimicrobial susceptibility patterns, in order to reduce the incidence of inappropriate antibiotic therapy and improve the prognosis of patients. Additionally, clinical strategies aimed at the prevention of HAP and VAP should be employed in hospital settings caring for patients at risk for these infections.     

Treatment of hospital-acquired penumonia

Hospital-acquired pneumonia (HAP) remains a significant cause of morbidity and attributable mortality, especially among patients undergoing mechanical ventilation. The clinical approach to this disorder continues to evolve. Although our understanding of the epidemiology, risk factors, and pathogenesis of this disorder are expanding, consensus on diagnostic, therapeutic, and preventive strategies is lacking. Although outcome is significantly improved by the rapid introduction of appropriate antimicrobial therapy, presently available diagnostic tests rarely are able to identify a specific pathogen when antimicrobial choices are made. Thus, most therapy is by necessity empirical. The American Thoracic Society (ATS) published guidelines for the empiric treatment of HAP in 1996, this article reviews the recommendations of these guidelines and, if new information is available, updates these recommendations.     

Zystische Nierenerkrankungen: neue diagnostische Aspekte

Cystic renal diseases are a very heterogenous group of disorders with respect to etiology and clinical presentation. They encompass a large number of rare diseases as well as a few very common entities. In adult nephrology, autosomal dominant polycystic kidney disease (ADPKD) is the most important cystic nephropathy due to its high prevalence and progressive course, which often leads to end-stage renal disease. Significant advances have been made in recent years not only in the understanding of ADPKD pathophysiology but also regarding diagnostic testing. Ultrasonographic diagnostic criteria have been revised, and molecular diagnostic methods are gaining importance. The growing number of promising therapeutic options currently being tested in clinical trials emphasize the importance of screening of individuals at risk. This article summarizes the indications for imaging and molecular diagnostic testing and the current diagnostic criteria for ADPKD. The other most important cystic nephropathies are discussed in terms of their differentiation from ADPKD.     

Hepatic artery pseudoaneurysm caused by acute idiopathic pancreatitis

Hepatic artery pseudoaneurysm (HAP) is a very rare disease but in cases of complication, there is a very high mortality. The most common cause of HAP is iatrogenic trauma such as liver biopsy, transhepatic biliary drainage, cholecystectomy and hepatectomy. HAP may also occur with complications such as infections or inflammation associated with septic emboli. HAP has been reported rarely in patients with acute pancreatitis. As far as we are aware, there is no report of a case caused by acute idiopathic pancreatitis, particularly. We report a case of HAP caused by acute idiopathic pancreatitis which developed in a 61-year-old woman. The woman initially presented with acute pancreatitis due to unknown cause. After conservative management, her symptoms seemed to have improved. But eight days after admission, abdominal pain abruptly became worse again. Abdominal computed tomography (CT) was rechecked and it detected a new HAP that was not seen in a previous abdominal CT. Endoscopic retrograde cholangiopancreatography (ERCP) was performed because of a suspicion of hemobilia as a cause of aggravated abdominal pain. ERCP confirmed hemobilia by observing fresh blood clots at the opening of the ampulla and several filling defects in the distal common bile duct on cholangiogram. Without any particular treatment such as embolization or surgical ligation, HAP thrombosed spontaneously. Three months after discharge, abdominal CT demonstrated that HAP in the left lateral segment had disappeared.     

Clinical picture of VITT

This chapter explores the clinical features of vaccine-induced immune thrombotic thrombocytopenia, also called vaccine-induced immune thrombocytopenia and thrombosis (VITT). Whilst the etiology is distinct from other causes of thrombotic thrombocytopenia syndrome (TTS), presentation may be similar and hence the need for strict diagnostic criteria to ensure accurate and prompt diagnosis and early treatment. Studies have identified prognostic markers of the disease, directing therapy and management pathways, and mortality and morbidity from this rare but life-threatening and potentially disabling consequence of the ChAdOx1 nCov-19 vaccine has declined.     

儿童社区获得性肺炎与院内获得性肺炎的特点比较研究简

目的 探讨儿童社区获得性性肺炎与院内获得性肺炎的病因特点、发病机制及感染因素等.方法 选取我院儿科收住入院的107例患儿,其中院内获得性肺炎（HAP组）49例,社区获得性肺炎（CAP组）58例.分析比较两组患儿的发病年龄、合并疾病、病原学、免疫功能、预后等情况.结果 HAP组患儿年龄≤1岁39例,年龄＞1岁10例;CAP组患儿年龄≤1岁13例,年龄＞1岁45例;HAP组有基础疾病37例,CAP组有基础病7例,占比为75.5%和12%;49例HAP患儿致病菌检出率为83.7%,主要为铜绿假单胞菌、肺炎克雷伯菌等革兰阴性菌（49株）,其次耐药菌属28株,HP抗体阳性5例,真菌1例;上述各指标两组比较其差异均有统计学意义（P均＜0.01）.结论 CAP多为常见病毒、细菌等微生物综合感染所致,而HAP易感因素包括年龄、基础疾病影响、免疫水平高低、病原学因素等,其主要为革兰氏阴性菌感染,治疗常需定期、及早进行病原学监测及药敏等试验以指导临床用药,并给予营养支持、增强免疫力等综合治疗,有助于改善患儿症状获得良好治疗效果.     

Clinical features of mixed infections in patients with Streptococcus pneumoniae pneumonia]

We retrospectively analyzed the severity, the mortality and the initial antimicrobial therapy in 195 patients with Streptococcus pneumoniae pneumonia (SPP). Of these, 59 (30.3%) patients had mixed pneumonia. In patients with mixed SPP, the three most frequent pathogens were influenza virus (27 patients), Haemophilus infuluenzae (14 patients), and Mycoplasma pneumoniae (8 patients). Of these, 21 (35.5%) patients were classified as severe or very severe according to the Japanese Respiratory Society diagnostic criteria among 59 patients of mixed SPP. Severe and very severe pneumonia was significantly associated with mixed infections (P = 0.018). The initial antimicrobial therapy was classified as beta-Lactam alone (113 patients), combination therapy including a beta-Lactam (72 patients), and a fluoroquinolone alone (10 patients). If we limit out study to mild-moderate pneumonia, initial combination therapy was significantly effective in patients with mixed SPP. Even in pneumonia caused by Streptococcus pneumoniae, further efforts to identify etiology are necessary.