The role of surveillance cultures in guiding ventilator-associated pneumonia therapy
The role of surveillance cultures in guiding ventilator-associated pneumonia therapy
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监测培养在指导呼吸机相关肺炎治疗中的作用
DOI：
10.1097/qco.0000000000000042
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发表时间：
2014
影响因子：
3.9
通讯作者：
A. Raimondi
中科院分区：
文献类型：
--
作者：
C. Luna;Ignacio Bledel;A. Raimondi
综述目的呼吸机相关肺炎(VAP)是ICU获得性医院感染中最常见的死亡原因。常规监测机械通气患者的气管内吸液(ETA)培养可预测VAP的病因。我们的目的是回顾有关监测ETA培养在指导VAP抗菌治疗中的作用的现有经验。最近的发现微生物通过从口咽或胃反流吸入、从邻近感染延伸、空气污染或通过血液播撒进入下呼吸道。呼吸道细菌定植导致VAP的发展，并可能是口咽或胃分泌物吸入的结果。最近的研究表明，在通过支气管肺泡灌洗液培养最终诊断为VAP的患者中，多达95%的患者在等待培养结果的同时，监测培养可以为开出适当的抗生素提供依据。然而，一些作者观察到，用这些常规监测培养指导治疗会导致产生VAP的病原体覆盖率低得令人无法接受。摘要这篇文章描述了支持使用常规ETA培养来开出适当的初步经验性治疗的证据，与指南规定的当前实践相比较。
Purpose of review Ventilator-associated pneumonia (VAP) is the most frequent cause of death among the nosocomial infections acquired in the ICU. Routine surveillance endotracheal aspirate (ETA) cultures in patients on mechanical ventilation have been proposed to predict the cause of VAP. Our aim is to review the available experience regarding the role of surveillance ETA cultures in guiding VAP antimicrobial therapy. Recent findings Microorganisms arrive in the lower respiratory tract by aspiration from the oropharynx or gastric reflux, extension from a contiguous infection, air contamination or by hematogenous seeding. Bacterial colonization of the airway leads to the development of VAP and may result from the aspiration of oropharyngeal or gastric secretions. Recent studies have suggested that surveillance cultures could provide a rationale for prescribing appropriate antibiotics, while waiting for culture results, in up to 95% of patients in whom VAP is ultimately diagnosed by bronchoalveolar lavage fluid culture. However, some authors observed that guiding therapy with those routine surveillance cultures leads to unacceptably low coverage of the pathogens producing VAP. Summary This article describes the evidence supporting the use of routine ETA cultures to prescribe appropriate initial empirical therapy compared with the current practice dictated by guidelines.
诊断机械通气创伤患者的肺炎：气管内抽吸与支气管肺泡灌洗。
DOI：
10.1097/00005373-199310000-00003
发表时间：
1993
期刊：
The Journal of trauma
影响因子：
--
作者：
Sauaia,A;Moore,FA;Moore,EE;Haenel,JB;Kaneer,L;Read,RA
通讯作者：
Read,RA