医院内肺炎和呼吸机相关肺炎.pptVIP

* * * * * * * Slide * To contrast clinical diagnosis, invasive diagnostic methods, including quantitative cultures of specimens obtained by bronchoscopic protected specimen brush or bronchoalveolar lavage, have been evaluated. A recent randomized study of invasive and non-invasive (clinical) strategies for diagnosing HAP demonstrated that quantitative bronchoscopic specimen cultures (invasive) lead to more appropriate use of antibiotics (i.e. fewer inappropriate treatments and shorter treatment courses), which was followed by improved survival. However, it is important to note that these invasive bronchoscopic procedures are also technically challenging and are not universally available to health care institutions. __ __ __ __ __ __ * * * * * * * * * * * * VAP-causing pathogens vary with respect the time of disease onset relative to the time of hospital admission. If VAP symptoms appear within five days of hospital admission, patients were likely infected with either S. pneumoniae, H. influenzae, Methacillin-sensitive Staphylococcus aureus or gram-negative bacteria. Alternatively, if signs of infection only appear five days or more, patients will be more likely to be infected with P. aeruginosa, Acinetobacter, or Methicillin-resistant Staphylococcus aureus. * * * * * * * * * * * * * * * * * * * * ? *mild-moderate presentation: no hypotension, intubation, sepsis syndrome, rapid progression of infiltrates or multiple organ dysfunction.  HAP: Group 1 – Mild-Moderate Presentation*, Early Onset ( 5 days), and No Risk Factors for Resistance. ? Potential Pathogens Streptococcus pneumoniae Streptococcus spp. Methicillin-susceptible Staphylococcus aureus Haemophilus influenzae Enterobacteriaeceae Escherichia coli Klebsiella pneumoniae Enterobacter spp. Proteus spp. Serratia spp. Treatment of HAP: Group 1 No risk factors for resistance+ mild-moderate presentation Treatment: 3rd generation non-pseudomonal