Pathogenesis and prevention of nosocomial pneumonia in a nonhuman primate model of acute respiratory failure.
Pathogenesis and prevention of nosocomial pneumonia in a nonhuman primate model of acute respiratory failure.
复制标题
非人灵长类急性呼吸衰竭模型中医院肺炎的发病机制和预防。
DOI：
10.1164/arrd.1984.130.3.502
复制
发表时间：
1984
期刊：
影响因子：
--
通讯作者：
JohansonJr,WG
中科院分区：
文献类型：
--
作者：
Crouch,TW;Higuchi,JH;Coalson,JJ;JohansonJr,WG
院内肺炎，通常由革兰氏阴性杆菌引起，在急性呼吸衰竭的研究中，连续13只接受气管插管、长时间深度镇静和瘫痪的狒狒发生。一系列细菌学研究表明，在器械安装后24至48小时内，病原菌在口咽定植，随后定植生物被吸入气管支气管树。取自肺外周的标本保持无菌状态的时间至少比近端呼吸道长24小时。尽管口咽部和气管支气管部分泌物中存在多种致病菌，但肺炎通常是由于从较近端定植的单一菌种引起的。为了预防肺炎，我们在接下来的19只动物的管理中增加了3项措施：仔细抽吸口咽分泌物，局部滴注多粘菌素B，以及从研究前3天开始预防性使用氨苄青霉素。这些措施降低了铜绿假单胞菌、肺炎克雷伯菌和金黄色葡萄球菌的定殖率，19只动物中只有3只患上了肺炎。肺炎的显著减少在一定程度上是因为防止了高度侵入性生物的定居。这些数据表明，操纵上呼吸道细菌菌群可能为预防医院内肺炎提供了一种有效的途径。
Nosocomial pneumonias, usually due to gram-negative bacilli, occurred in 13 consecutive baboons that underwent endotracheal intubation, prolonged deep sedation, and paralysis during studies of acute respiratory failure. Serial bacteriologic studies demonstrated colonization of the oropharynx by pathogenic bacteria within 24 to 48 h of instrumentation, followed by aspiration of colonizing organisms into the tracheobronchial tree. Specimens obtained from the lung periphery remained sterile for at least 24 h longer than the proximal airways. Despite the presence of multiple pathogenic species in oropharyngeal and tracheobronchial secretions, pneumonias were usually due to a single species selected from those colonizing more proximal regions. In an attempt to prevent pneumonias, we added 3 measures to the management of the next 19 animals: meticulous aspiration of oropharyngeal secretions, topical instillation of polymyxin B, and prophylactic administration of ampicillin beginning 3 days prior to study. These measures reduced the prevalence of colonization withPseudomonas aeruginosa, Klebsiella pneumoniae,andStaphylococcus aureus,and only 3 of the 19 animals developed pneumonia. This dramatic reduction of pneumonias is explained in part by prevention of colonization by highly invasive organisms. These data indicate that manipulation of the bacterial flora of the upper respiratory tract may provide an effective approach to the prevention of nosocomial pneumonias.