Lower respiratory tract colonization and infection during severe acute respiratory distress syndrome - Incidence and diagnosis
Lower respiratory tract colonization and infection during severe acute respiratory distress syndrome - Incidence and diagnosis
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DOI：
10.1164/ajrccm.156.4.9701065
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发表时间：
1997-10-01
影响因子：
24.7
通讯作者：
BrunBuisson, C
中科院分区：
文献类型：
--
作者：
Delclaux, C;Roupie, E;BrunBuisson, C
呼吸机相关性肺炎（VAP）是一种很难发现的疾病，常被误诊为成人呼吸窘迫综合征（ARDS）。我们前瞻性地评估了30例严重ARDS患者（Pa-O2/Fi（O2）比值< 150 mm Hg）的下呼吸道（LRT）定植和感染，使用重复定量培养法对ARDS发作后每48至72 h通过气管内导管盲取的插管套管导管（PTC）标本进行定量培养。除一名患者外，所有患者均接受抗生素治疗。当根据感染的临床标准怀疑VAP时，在给予任何新的抗菌剂之前，重复PTC和（如可能）支气管肺泡灌洗（BAL）;生长大于或等于10（3）cfu/ml（PTC）或大于或等于10（4）cfu/ml（BAL）的样本被认为是感染的诊断。18例患者（60%的患者或4.2/100呼吸机日）在ARDS发作后平均9.8 ± 5.7 d诊断出24次VAP发作。记录了18次LRT定植事件; 24次VAP事件中有16次（66%）在LRT定植之前（2至6天）使用相同的微生物，只有两次定植事件之后没有VAP。我们的结论是，虽然VAP是相对迟发性的严重ARDS，其发病率是远远高于其他条件，可以低估。下呼吸道定植始终是其次是感染相同的生物体和之前的VAP在三分之二的事件。重复盲取受保护标本可能提供一种预测感染的有用方法，因此可以对弥漫性肺损伤的高危患者进行早期抗菌治疗。
Ventilator-associated pneumonia (VAP) is difficult to detect and Is often unsuspected duping adult respiratory distress syndrome (ARDS). We prospectively evaluated lower respiratory tract (LRT) colonization and infection in 30 patients with severe ARDS (Pa-O2/Fi(O2) ratio < 150 mm Hg), using repeated quantitative cultures of plugged telescopic catheter (PTC) specimens taken blindly via the endotracheal tube every 48 to 72 h after onset of ARDS. All patients except one were receiving antibiotics. When VAP was suspected on the presence of clinical criteria for infection, a repeated PTC and, when possible, a bronchoalveolar lavage (BAL) were obtained before any new antimicrobials were administered; samples growing greater than or equal to 10(3) cfu/ml (PTC) or greater than or equal to 10(4) cfu/ml (BAL) were considered diagnostic of infection. Twenty-four VAP episodes were diagnosed in 18 patients (60% of patients or 4.2/100 ventilator-days) a mean of 9.8 +/- 5.7 d after onset of ARDS. Eighteen LRT colonization episodes were recorded; 16 of 24 (66%) VAP episodes were preceded (by 2 to 6 d) by LRT colonization with the same organism(s), and only two episodes of colonization were not followed by VAP. We conclude that although VAP is of relatively late-onset during severe ARDS, its incidence is much higher than in other conditions and can be underestimated. Lower airways colonization is consistently followed by infection with the same organisms and precedes VAP in two thirds of episodes. Repeated protected specimens taken blindly may provide a useful means to predict infection and therefore allow early antimicrobial therapy in high-risk patients with diffuse lung injury.