Author/Editor		Šegota, Nikša; Kovačič, Dragan; Božanić, Vinko; Skale, Rafael; Papuga, Vesna
Title		Vloga bronhoskopije v diagnostiki in zdravljenju bolnišničnih pljučnic
Translated title		Bronhoscopy in the diagnosis and therapy of nosocomial pneumonia
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 70, št. Suppl 1
Publication year		2001
Volume		str. I-23-6
Language		slo
Abstract		Background. The aim of our study was to evaluate the role of bronchoscopy in the diagnosis and treatment of hospital pneumonias by microbiological cultures obtained from bronchial aspirates. Methods. We included all patients treated for hospital pneumonias during 1999 in General Hospital Celje (Division of cardiology and pulmonary medical care, internal and surgical intensive care unit) in whom bronchoscopy was performed. Only the patients with obtained microbiological cultures (isolation and bacterial sensitivity to antibiotics) were studied. Results. We performed 112 bronchoscopies. Sixty-nine (62%) patients were males and 43 (38%) of female. Microbiological cultures were positive in 95 (85%) and negative in 17 (15%) specimens. Mortality rate was 32% and average length of stay was 14 days. The most frequently isolated bacteria was Pseudomonas aeruginosa (20 patients - 26%), followed by methicillin sensitive Staphylococcus aureus-MSSA in 14 patients. E. coli was present in 14 cultures and Streptococcus pneumoniae in 12 patients. Methicillin resistant Staphylococcus aureus-MRSA was found in 10 patients. Blood and central venous catheter clutures were positive in 10 patients. The same bacteria were also isolated in other specimens in 26 patients. Conclusions. Bronchoscopy is an important aid in diagnosing hospital pneumonias. In high percentage it provides microbiological evaluation of bronchial aspirate, and has major impact in selection of an appropriate antibiotic treatment.
Summary		Izhodišča. V retrogradni študiji smo ovrednotili vlogo bronhoskopije pri diagnostiki in zdravljenju bolnišničnih pljučnic (BP). Predvsem so nas zanimali rezultati mikrobiološke osamitve bronhialnih izpirkov (BI) pri bolnikih z BP. Metode. Obdelali smo podatke bolnikov, ki so bili v letu 1999 zdravljeni v Splošni bolnišnici Celje na oddelku za bolezni srca, pljuč in ožilja, v enoti intenzivne medicine operativnih strok in na oddelku za intenzivno interno medicino. Vsi so imeli BP, bronhoskopirani pa so bili v diagnostične (odvzem materiala) in terapevtske (razrešitev atelektaze) namene. V študiji smo zajeli le tiste, pri katerih je bil BI mikrobiološko pregledan (osamitev in občutljivost bakterij na antibiotike). Rezultati. V letu 1999 smo v bolnišnici bronhoskopirali 112 bolnikov z BP. Pri vseh smo mikrobiološko pregledali BI. Moških je bilo 69 (62%), žensk 43 (38%). Povprečna starost je bila 66,5 leta. Od 112 BI smo pri 95 (85%) osamili bakterije, pri 17 (15%) bolnikih bakterij v BI nismo uspeli osamiti. Povprečna ležalna doba bolnikov je bila 14 dni, umrljivost pa 32%. Najpogostejše izolirana bakterija je bila Pseudomonas aeruginosa (26%), sledi ji na meticilin občutljivi Staphylococcus aureus (MSSA) v 14 primerih. E. coli je bila izolirana v 14 primerih, Streptococcus pneumoniae pa v 12 primerih. Na meticilin odporen Staphylococcus aureus (MRSA) je bil prisoten v 10 primerih. Ostale bakterije so bile prisotne redkeje. Pri 10 (11,2%) bolnikih je bila pozitivna hemokultura oz. kultura notranjosti konice centralnega venskega kanala. pri 26 bolnikih (23%) so bile tudi v drugih kužninah osamljene enake bakterije. Zaključki. Bronhoskopija pripomore k etiološki razjasnitvi BP. V naši bolnišnici predstavlja BP pomemben diagnostični in terapevtski problem. Z mikrobiološkim pregledom BI ugotavljamo povzročitelje bolnišničnih pljučnic. Občutljivost na antibiotike pomaga pri izbiri primernega antibiotičnega zdravljenja.
Descriptors		PNEUMONIA BRONCHOSCOPY CROSS INFECTION BRONCHOALVEOLAR LAVAGE FLUID INTENSIVE CARE UNITS ANTIBIOTICS DRUG RESISTANCE, MICROBIAL PSEUDOMONAS AERUGINOSA STAPHYLOCOCCUS AUREUS ESCHERICHIA COLI STREPTOCOCCUS PNEUMONIAE