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Пульмонология

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Нозокомиальная пневмония у больных хронической обструктивной болезнью легких

https://doi.org/10.18093/0869-0189-2010-4-58-65

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Аннотация

Нозокомиальная пневмония (НП) - одно из наиболее часто встречающихся в стационаре инфекционных заболеваний. Одним из фак-
торов риска развития НП является хроническая обструктивная болезнь легких (ХОБЛ). Целью исследования стало изучение особеннос-
тей НП и роли биомаркеров воспаления у больных ХОБЛ. Были обследованы 184 пациента с обострением ХОБЛ. У 22 (11,9 %) больных
пневмония развилась в условиях стационара. Среди них - 18 мужчин и 4 женщины; средний возраст составил 66,0 ± 11,02 года. Значе-
ние шкалы CPIS для всех больных ХОБЛ с НП составило 9,4 ± 2,1 балла, индекс коморбидности Charlson - 7,9 ± 2,5 балла. У 90,9 %
больных НП развилась после 5 дней пребывания в стационаре. У больных были выделены следующие микроорганизмы: Pseudomonas
aeruginosa
(5), Staphylococcus aureus (4), Streptococcus pneumoniae (4), Acinetobacter spp. (3). Проведение инвазивной вентиляции легких потре-
бовалось 13,6 %, неинвазивной вентиляции легких - 36,4 %, оксигенотерапии - 90,9 % больных. Средняя продолжительность госпита-
лизации больных ХОБЛ с НП составила 42,6 ± 20,3 дней, умерли 27,3 % пациентов. Концентрации сывороточного С-реактивного бел-
ка (СРБ) в день развития НП значительно превышали их исходные значения: 105,5 (83,3-145,8) мг / л vs 14,5 (12,0- 29,3) мг / л
(p < 0,0001). Динамика СРБ позволяла предсказать прогноз больных НП (p = 0,002).
Таким образом, НП у больных ХОБЛ характеризуется тяжелым течением, выраженной системной воспалительной реакцией и острой
дыхательной недостаточностью. Наряду со шкалой АРАСНЕ II биомаркеры воспаления позволяют определить прогноз и исходы НП.

Об авторах

С. Н. Авдеев
ФГУ "НИИ пульмонологии" ФМБА России: 105077
Россия


Г. Е. Баймаканова
ФГУ "НИИ пульмонологии" ФМБА России: 105077
Россия


П. А. Зубаирова
ФГУ "НИИ пульмонологии" ФМБА России: 105077
Россия


А. Г. Чучалин
ФГУ "НИИ пульмонологии" ФМБА России: 105077
Россия


Список литературы

1. Strausbaugh L.J. Nosocomial respiratory infections. In:Mandel G.L., Benet J.E., Dolin R., eds. Principles and practice of infectious diseases. New York: Churchill Livingstone; 2000. 3020-3028.

2. Чучалин А.Г., Гельфанд Б.Р. (ред.). Нозокомиальная пневмония у взрослых: Российские нац. рекоменда ции. М.: Боргес; 2009.

3. Craven D.E., Steger K.A. Epidemiology of nosocomial pneu monia: new perspectives on an old disease. Chest 1995; 108 (2, Suppl.): S1-S16.

4. Vincent J.L., Bihari D.J., Suter P.M. et al. The prevalence of nosocomial infection in intensive care units in Europe: results of the European Prevalence of Infection in Intensive Care (EPIC) Study. J.A.M.A. 1995; 274: 639-644.

5. Cook D.J., Walter S.D., Cook R.J. et al. Incidence of and risk factors for ventilator!associated pneumonia in critically ill patients. Ann. Intern. Med. 1998; 129: 433-440.

6. Takano Y., Sakamoto O., Suga M. et al. Prognostic factors of nosocomial pneumonia in general wards: a prospective mul tivariate analysis in Japan. Respir. Med. 2002; 96:18-23.

7. Craven D.E., Steger K.A. Ventilator!associated bacterial pneumonia: challenges in diagnosis, treatment, and preven tion. New Horiz. 1998; 6 (2, Suppl.): S30-S45.

8. Craven D.E., Steger K.A., Barber T.W. Preventing nosoco mial pneumonia: state of the art and perspectives for the 1990's. Am. J. Med. 1991; 91: 44-53.

9. McEachern R., Campbell G.D. Hospital-acquired pneumo nia: epidemiology, etiology and treatment. Infect. Dis. Clin.

10. N.Am.1998; 12: 761-779.

11. Bonten J.M., Bergmans D.C. Nosocomial pneumonia. In:Mayhall C.G., ed. Hospital epidemiology and infection control. Philadelphia, PA: Williams and Wilkins: 1999. 211-238.

12. Tablan O.C., Anderson L.H., Arden N.H. et al. Guidelines for prevention of nosocomial pneumonia. The Hospital Infection Control Practices Advisory Committee, Centers for Diseases Control and Prevention. Infect. Control. Hosp. Epidemiol. 1994; 15: 587-627.

13. Celis R., Torres A., Gatell J.M. et al. Nosocomial pneumo nia: a multivariate analysis of risk and prognosis. Chest 1988; 93: 318-324.

14. Rotstein C., Cummings K.M., Nicolau A.L. et al. Nosocomial infection rates at an oncology center. Infect. Control. 1988; 9: 13-19.

15. Hanson L.C., Weber D.J., Rutala W.A. et al. Risk factors for nosocomial pneumonia in the elderly. Am. J. Med. 1992; 92: 161-166.

16. Leu H.S., Kaiser D.L., Mori M. et al. Hospital!acquired pneumonia. Attributable mortality and morbidity. Am. J. Epidemiol. 1989; 129: 1258-1267.

17. Bartlett J.G., O'Keele P., Tally F.P. et al. Bacteriology of hos pital-acquired pneumonia. Arch. Intern. Med. 1986; 146: 868-871.

18. Louie M., Dyck B., Parker S. et al. Nosocomial pneumonia in a Canadian tertiary care center: a prospective surveillance study. Infect. Control. Hosp. Epidemiol. 1991; 12: 356-363.

19. Gomez J., Esquinas A., Agudo M.D. et al. Retrospective analysis of risk factors and prognosis in non!ventilated patients with nosocomial pneumonia. Eur. J. Clin. Microbiol. Infect. Dis. 1995; 14: 176-181.

20. Hernandez A., Capdevila J.A., Galles C. et al. Factores de riesgo de neumonía nosocomial en pacientes no ventilados. Comunicación al IX Congreso de la SEIMC (n° 257). Enf. Infecc. Microbiol. Clin. 2000; 18 (1, Suppl.): 80.

21. Sopena N., Sabria V. and the Neunos 2000 Study Group. Multicenter Study of Hospital!Acquired Pneumonia in Non-CU Patients. Chest 2005; 127: 213-219.

22. Herer B., Fuhrman C., Demontrond D. et al. Diagnosis of nosocomial pneumonia in medical ward: repeatability of the protected specimen brush. Eur. Respir. J. 2001; 18: 157-163.

23. Merino-Sanchez M., Alfageme-Michavila I., Lima-Alvarez J. Prognosis in patients with pneumonia and chronic obstruc tive pulmonary disease. Arch. Bronconeumol. 2005; 41: 607-611.

24. American College of Chest Physicians / Society of Critical Care Medicine Consensus Conference: definitions for sep sis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit. Care Med. 1992; 20: 864-874.

25. Levy M.M., Fink M., Marshall J.C. et al. 2001 SCCM / ESICM / ACCP / ATS / SIS International Sepsis Definitions Conference. Crit. Care Med. 2003; 31: 1250-1256.

26. Rangel-Frausto M.S., Pittet D., Costigan M. et al. The natu ral history of the systemic inflammatory response syndrome (SIRS): a prospective study. J.A.M.A. 1995; 273: 117-123.

27. Circiumaru B., Baldock G., Cohen J. A prospective study of fever in the intensive care unit. Intensive Care Med. 1999; 25: 668-673.

28. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI / WHO workshop report. Last updated 2008. www.goldcopd.org

29. Pugin J., Auckenthaler R., Mili N. et al. Diagnosis of ventila tor-associated pneumonia by bacteriologic analysis of bron choscopic and nonbronchoscopic "blind" bronchoalveolar lavage fluid. Am. Rev. Respir. Dis. 1991; 143: 1121-1129.

30. Luyt C.1E., Chastre J., Fagon J.1Y. Value of the clinical pul monary infection score for the identification and management of ventilator!associated pneumonia. Intensive Care Med. 2004; 30: 844-852.

31. Knaus W.A., Draper E.A., Wagner D.P., Zimmerman J.E. APACHE II: a severity of disease classification system. Crit. Care Med. 1985; 13: 818-829.

32. Charlson M.E., Pompei P., Ales K.L., MacKenzie C.R. A new method of classifying prognostic comorbidity in longitudi nal studies: development and validation. J. Chron. Dis. 1987; 40: 373-383.

33. Dellinger R.P., Levy M.M., Carlet J.M. et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit. Care Med. 2008, 36: 296-327.

34. Авдеев С.Н., Чучалин А.Г. Одышка: механизмы развития, оценка и лечение. Пособие для врачей. М.; 2002. 1-25.

35. Murray P.R., Washington J.A. Microscopic and bacteriolog ic analysis of expectorated sputum. Mayo Clin. Proc. 1975; 50: 339-344.

36. National Committee for Clinical Laboratory Standards. Performance standards for antimicrobial susceptibility test ing. Philadelphia, PA: NCCLS, 2001; 21 (1).

37. Nseir S., Di Pompeo C., Soubrier S. et al. Impact of ventila torassociated pneumonia on outcome in patients with COPD. Chest 2005; 128: 1650-1656.

38. Torres A., Aznar R., Gatell J.M. et al. Incidence, risk, and prognosis factors of nosocomial pneumonia in mechanical ly ventilated patients. Am. Rev. Respir. Dis. 1990; 142: 523-528.

39. Rello J., Ausina V., Ricart M. et al. Impact of previous antimicrobial therapy on the etiology and outcome of venti lator!associated pneumonia. Chest 1993; 104: 1230-1235.

40. Taylor G.D., Buchanan1Chell M., Kirkland T. et al. Bacteremic nosocomial pneumonia: a 7-year experience in one institution. Chest 1995; 107: 786-788.

41. Rello J., Quintana E., Ausina V. et al. Incidence, etiology and outcome of nosocomial pneumonia in mechanically ventilated patients. Chest 1991; 100: 439-444.

42. Johanson W.G., Pierce A.K., Sanford J.P. Changing pharyn geal bacterial flora of hospitalized patients. N. Engl. J. Med. 1969; 281: 1137-1140.

43. Johanson W.G., Pierce A.K., Sanford J.P. et al. Nosocomial respiratory infections with gram!negative bacilli: the signif icance of colonization of the respiratory tract. Ann. Intern. Med. 1972; 77: 701-706.

44. Carratala J., Gudiol F., Pallares R. et al. Risk factors for nosocomial Legionella pneumophila pneumonia. Am. J. Respir. Crit. Care Med. 1994; 149: 625-629.

45. Castro-Guardiola A., Armengou-Arxe A., Viejo-Rodriguez A. et al. Differential diagnosis between community-acquired pneumonia and non-pneumonia diseases of the chest in the emergency ward. Eur. J. Intern. Med. 2000; 11: 334-339.

46. Almirall J., Bolibar I., Toran P. et al. Contribution of C-reac tive protein to the diagnosis and assessment of severity of com munity-acquired pneumonia. Chest 2004; 125: 1335-1342.

47. Flanders S.A., Stein J., Shochat G. et al. Performance of a bedside C-reactive protein test in the diagnosis of commu nity-acquired pneumonia in adults with acute cough. Am. J. Med. 2004; 116: 529-535.

48. El Solh A., Pineda L., Bouquin P., Mankowski C. Determi nants of short and long term functional recovery after hospitalization for community!acquired pneumonia in the elderly: role of inflammatory markers. B.M.C. Geriatr. 2006; 6: 12.

49. Lobo S.M.A., Lobo F.R.M., Bota D.P. et al. C-reactive pro tein levels correlate with mortality and organ failure in crit ically Ill patients. Chest 2003; 123: 2043-2049.

50. Coelho L., Povoa P., Almeida E. et al. Usefulness of C-reac tive protein in monitoring severe community-acquired pneumonia clinical course. Crit. Care 2007, 11: R92.

51. Hedlund J., Hansson L.O. Procalcitonin and C-reactive pro tein levels in community!acquired pneumonia: correlation with etiology and prognosis. Infection 2000; 28: 68-73.

52. Matson A., Soni N., Sheldon J. C-reactive protein as a diag nostic test of sepsis in the critically ill. Anaesth. Intensive Care 1991; 19: 182-186.

53. Povoa P., Coelho.L, Almeida E. et al. C!reactive protein as a marker of ventilator!associated pneumonia resolution: a pilot study. Eur. Respir. J. 2005; 25: 804-812.

54. Povoa P., Coelho L., Almeida E. et al. Early identification of intensive care unit!acquired infections with daily monitor ing of C!reactive protein: a prospective observational study. Crit. Care 2006; 10: R63.

55. Pinsky M.R., Vincent J.L., Deviere J. et al. Serum cytokine levels in human septic shock: relation to multiplesystem organ failure and mortality. Chest 1993; 103: 565-575.

56. Marty C., Misset B., Tamion F. et al. Circulating interleu kin8 concentrations in patients with multiple organ failure of septic and nonseptic origin. Crit. Care Med. 1994; 22: 673-679.

57. Monton C., Torres A., El1Ebiary M. et al. Cytokine expres sion in severe pneumonia: a bronchoalveolar lavage study. Crit. Care Med. 1999; 27: 1745-1753.

58. Glynn P., Coakley R., Kilgallen I. et al. Circulating IL-6 and IL-10 in CAP. Thorax 1999; 54: 51-55.

59. Antunes G., Evans S., Lordan J., Frew A. Systemic cytokine levels in community-acquired pneumonia and their associa tion with disease severity. Eur. Respir. J. 2002; 20: 990-995.

60. Igonin A.A., Armstrong V.W., Shipkova M. et al. Circulating cytokines as markers of systemic inflammatory response in severe community!acquired pneumonia. Clin. Biochem. 2004; 37: 204-209.


Для цитирования:


Авдеев С.Н., Баймаканова Г.Е., Зубаирова П.А., Чучалин А.Г. Нозокомиальная пневмония у больных хронической обструктивной болезнью легких. Пульмонология. 2010;(4):58-65. https://doi.org/10.18093/0869-0189-2010-4-58-65

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