特集名 | 透析患者の呼吸器合併症 | |
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題名 | 肺炎 (2) 院内肺炎 | |
発刊年月 | 2008年 07月 | |
著者 | 吉川 晃司 | 神奈川県立汐見台病院内科 |
【 要旨 】 | 院内肺炎は,入院後48時間以上経過してから発症した肺炎と定義され,死亡率が高い.原因微生物は入院早期では耐性菌が少ないが,入院後期になると緑膿菌,腸内細菌やメチシリン耐性黄色ブドウ球菌が多数を占め,検出菌の多くが耐性菌となる.入院患者に発熱などの臨床所見がみられ,胸部X線で新たな浸潤影がみられた場合,院内肺炎が疑われる.empiric therapyはガイドラインにより多少異なるが,治療開始の遅れや不適切な治療は死亡率の増加につながるため,できるだけ早期に開始し,多剤耐性菌のリスクがある場合は広域スペクトルの抗菌薬を十分量投与する.原因菌・薬剤感受性判明後は照準を絞った狭域の抗菌薬に変更し,早期に治療を中止する (de-escalation療法). |
Theme | Complications of Respiratory Organs in Dialysis Patients | |
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Title | Hospital-acquired pneumonia | |
Author | Koji Yoshikawa | Kanagawa Prefectural Shiomidai Hospital Internal Medicine |
[ Summary ] | Hospital-acquired pneumonia (HAP) is defined as pneumonia that occurs 48 hours or more after admission. HAP is a frequent cause of nosocomial infection that is associated with higher mortality rates than other hospital-acquired infections. Early-onset HAP is more likely to be caused by antibiotic-sensitive bacteria, but late-onset HAP is more likely to be caused by multidrug-resistant pathogens. A diagnosis of HAP is suspected if the patient has a radiographic infiltrate that is new or progressive, along with clinical findings suggesting infection, which include new onset of fever, purulent sputum, leukocytosis, or a decline in oxygenation. Inappropriate therapy is a major risk factor for excess mortality. Early, appropriate, broad-spectrum, antibiotic therapy should be prescribed with adequate doses to optimize antimicrobial efficacy. The responding patient should receive a de-escalating regimen of antibiotics, narrowing therapy to the most focused regimen possible on the basis of culture data. |