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題名 | 呼吸器相關的肺炎:實證醫學及治療準則=Ventilator Associated Pneumonia: Evidence and Guideline |
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作者 | 萬樹人; | 書刊名 | 中華民國重症醫學雜誌 |
卷期 | 6:2 民93 |
頁次 | 頁182-191 |
分類號 | 415.463 |
關鍵詞 | 呼吸器相關的肺炎; 院內感染性肺炎; 抗生素抗藥性; 降階式的抗生素治療; Ventilator-associated pneumonia; Nosocomial pneumonia; Antibiotic resistance; Antimicrobial de-escalation; |
語文 | 中文(Chinese) |
中文摘要 | 呼吸器相關的肺炎是最常見的院內感染性肺炎,它是指接受呼吸器通氣的病患在氣管插管後併發的肺炎。依其發生的時間不同,可區分為早發型(early-onset)及遲發型(late-onset)感染;此種分型有助於病菌的推論。早發型感染是指在氣管插管後48小時之內發生的肺炎,其致病機轉通常是在氣管抽管過程中,發生吸入性的併發症,其致病菌為社區常見的病原菌(community acquired pathogens),例如oxacillin敏感的金黃色葡萄球菌(oxacillin-sensitive staphylococcus aureus,OSSA)、流感嗜血桿菌(Haemophilus influenzae),以及肺炎雙球菌(Streptococcus pneumoniae),其預後通常比遲發型肺炎好。這是因為引起遲發型VAP的致病菌,有較高的比例對抗生素有抗藥性,例如oxacillin抗藥的金黃色葡萄球菌(oxacillin-resistant S. aureus,ORSA),綠膿桿菌(Pseudomonas aeruginosa),以及不動桿菌屬(Acinetobacter spp.),造成抗生素治療的困難。預防呼吸器相關肺炎發生的方法雖然很多,但是實在證醫學下通過驗證的卻不多;而毫無節制的抗生素治療,無可避免地會增加抗藥性細菌的產生,因此如何合理地使用抗生素來治療呼吸器相關的肺炎,是本文的重點。 |
英文摘要 | Ventilator-associated pneumonia (VAP) is the most common hospital-acquired pneumonia, occurring in patients intubated for mechanical ventilation. VAP is typically categorized as either early-onset or late-onset, and this distinction is important microbiologically. Early-onset VAP usually occurs within 48 houres afte intubation, and is thought to develop from the aspiration of oropharyngeal secretions containing potentially pathogenic organisms. The etiology is commonly caused by community-acquired organisms which are mostly antibiotic-susceptible (e.g., methicillin-sensitive Staphylococcus aureus, Haemophilus influenzase, and Streptococcus pneumoniae). On the other hand, late-onset VAP is commonly caused by antibiotic-resistant nosocomial pathogens (e.g., methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, and Acinetobacter speies). This causes difficulty in choosing initial antimicrobial therapy, and hence poor patients’s outcome. Although many methods have been reported to prevent ventilator-associated pneumonia, but few are evidence-based. Unrestricted use of antimicrobial agents will inevitably increase antimicrobial resistance. Therefore, the focus of this article is on the appropriate use of antibiotics in the treatment of ventilator-associated pneumonia. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。