[Nosocomial pneumonia].

Santiago Ewig
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引用次数: 0

Abstract

Nosocomial pneumonia is defined as pneumonia occurring ≥ 48 h after hospital admission in a patient without severe immunosuppression. It can occur in spontaneously breathing patients or with noninvasive ventilation (NIV) and mechanically ventilated patients. In patients with suspected ventilator-associated pneumonia (VAP) (semi)quantitative cultures of tracheobronchial aspirates or bronchoalveolar lavage fluid should be perfomed. The initial empirical antimicrobial treatment is determined by the risk for multidrug-resistant pathogens (MDRP). The advantage of combination treatment increases with the prevalence of MDRPs. The antibiotic treatment should be adapted when the microbiological results are available. After 72 h a standardized re-evaluation including the response to treatment and also checking of the suspected diagnosis of pneumonia in a structured form is mandatory. Treatment failure can occur as a primary or secondary failure and in the case of primary progression necessitates another comprehensive diagnostic work-up before any further antibiotic treatment.

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[非典型肺炎]
非典型肺炎是指无严重免疫抑制的患者在入院后≥ 48 小时内发生的肺炎。它可发生在自主呼吸患者或使用无创通气(NIV)和机械通气的患者身上。对于疑似呼吸机相关肺炎(VAP)患者,应对气管支气管吸出液或支气管肺泡灌洗液进行(半)定量培养。最初的经验性抗菌治疗取决于耐多药病原体(MDRP)的风险。联合治疗的优势会随着耐多药病原体的流行而增加。在获得微生物学结果后,应调整抗生素治疗。72 小时后,必须进行标准化的再评估,包括对治疗的反应,以及在结构化表格中检查肺炎的疑似诊断。治疗失败可能是原发性的,也可能是继发性的,如果是原发性的,则需要在进一步使用抗生素治疗前再次进行全面的诊断检查。
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