[讨论]痰培养出新的病原菌是医院感染吗？

水中花

<font size="3">根据医院感染诊断标准“<font face="宋体">在原感染已知病原体基础上又分离出新的病原体的感染（排除污染和原来的混合感染）列为医院感染”，但在呼吸内科和ICU的患者中经常看到这种情况：每做一次新的痰培养就经常会出现与上次培养结果不同的病原菌，有时候就是在第二天送痰培养时也会出现这种情况，那么每出现一次新的病原体就要算一次医院感染吗？不知各位同行在诊断呼吸道的医院感染病例时是如何掌握标准的？</font></font>[em09]

绿谷

<p><font size="5">水中花：您好！</font></p><p><font size="5">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 这个问题比较复杂。首先要区分是定植菌还是感染菌，其次是看看痰培养半定量结果与临床意义，CPIS评分是否超过6分（包括气道分泌物、胸片、体温、白细胞、PaO2/FiO2、细菌培养）等综合考虑。</font></p>

水中花

丽水：您好！首先感谢你总是在第一个回答我的问题，这确实是一个令我困扰的问题，可能在你们医院，做痰标本的半定量培养是家常便饭，但在我们医院，却是不做痰的半定量培养的（当然，培养前对标本是否合格还是要判断的），所以对是污染菌或是感染菌的判断增加了难度，因此对是否医院感染也不好判断。此外，你所说的GPIS评分能否说得详细一点？或是有什么书籍可以推荐？[em17]

绿谷

<div align="left">水中花 ：您好！请问你们医院等级是几级？哪个省？临床CPIS评分超过6分有意义，考虑感染菌。</div><p class="MsoNormal" align="center" style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: center; mso-pagination: widow-orphan;"></p><div align="center"><table class="MsoNormalTable" cellspacing="0" cellpadding="0" width="623" border="0" style="WIDTH: 467pt; BORDER-COLLAPSE: collapse; mso-padding-alt: 0cm 0cm 0cm 0cm;"><tbody><tr style="HEIGHT: 14.25pt; mso-yfti-irow: 0; mso-yfti-firstrow: yes;"><td valign="bottom" nowrap="nowrap" width="623" colspan="4" style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #d4d0c8; WIDTH: 467pt; PADDING-TOP: 0.75pt; BORDER-BOTTOM: windowtext 1pt solid; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent; mso-border-bottom-alt: solid windowtext .5pt;"><p class="MsoNormal" align="center" style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: center; mso-pagination: widow-orphan;"><b><span style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt;"></span></b></p><p class="MsoNormal" align="center" style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: center; mso-pagination: widow-orphan;"><b><span style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt;">临床<span lang="EN-US">CPIS</span>评分</span></b></p></td></tr><tr style="HEIGHT: 14.25pt; mso-yfti-irow: 1;"><td valign="bottom" nowrap="nowrap" style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #d4d0c8; PADDING-TOP: 0.75pt; BORDER-BOTTOM: windowtext 1pt solid; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent; mso-border-bottom-alt: solid windowtext .5pt;"><p class="MsoNormal" align="center" style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: center; mso-pagination: widow-orphan;"><span style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt;">项目<span lang="EN-US"><p></p></span></span></p></td><td valign="bottom" nowrap="nowrap" style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #d4d0c8; PADDING-TOP: 0.75pt; BORDER-BOTTOM: windowtext 1pt solid; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent; mso-border-bottom-alt: solid windowtext .5pt;"><p class="MsoNormal" align="center" style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: center; mso-pagination: widow-orphan;"><span lang="EN-US" style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt;">0</span><span style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt;">分<span lang="EN-US"><p></p></span></span></p></td><td valign="bottom" nowrap="nowrap" style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #d4d0c8; PADDING-TOP: 0.75pt; BORDER-BOTTOM: windowtext 1pt solid; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent; mso-border-bottom-alt: solid windowtext .5pt;"><p class="MsoNormal" align="center" style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: center; mso-pagination: widow-orphan;"><span lang="EN-US" style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt;">1</span><span style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt;">分<span lang="EN-US"><p></p></span></span></p></td><td valign="bottom" nowrap="nowrap" style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #d4d0c8; PADDING-TOP: 0.75pt; BORDER-BOTTOM: windowtext 1pt solid; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent; mso-border-bottom-alt: solid windowtext .5pt;"><p class="MsoNormal" align="center" style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: center; mso-pagination: widow-orphan;"><span lang="EN-US" style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt;">2</span><span style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt;">分<span lang="EN-US"><p></p></span></span></p></td></tr><tr style="HEIGHT: 14.25pt; mso-yfti-irow: 2;"><td nowrap="nowrap" style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #d4d0c8; PADDING-TOP: 0.75pt; BORDER-BOTTOM: #d4d0c8; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent;"><p class="MsoNormal" align="left" style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: left; mso-pagination: widow-orphan;"><span style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt;">体温<span lang="EN-US">(12</span>小时平均值，℃<span lang="EN-US">)<p></p></span></span></p></td><td nowrap="nowrap" style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #d4d0c8; PADDING-TOP: 0.75pt; BORDER-BOTTOM: #d4d0c8; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent;"><p class="MsoNormal" align="center" style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: center; mso-pagination: widow-orphan;"><span lang="EN-US" style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt;">36</span><span style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt;">～<span lang="EN-US">38<p></p></span></span></p></td><td nowrap="nowrap" style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #d4d0c8; PADDING-TOP: 0.75pt; BORDER-BOTTOM: #d4d0c8; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent;"><p class="MsoNormal" align="center" style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: center; mso-pagination: widow-orphan;"><span lang="EN-US" style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt;">38</span><span style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt;">～<span lang="EN-US">39<p></p></span></span></p></td><td nowrap="nowrap" style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #d4d0c8; PADDING-TOP: 0.75pt; BORDER-BOTTOM: #d4d0c8; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent;"><p class="MsoNormal" align="center" style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: center; mso-pagination: widow-orphan;"><span style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt;">＞<span lang="EN-US">39</span>或＜<span lang="EN-US">36<p></p></span></span></p></td></tr><tr style="HEIGHT: 14.25pt; mso-yfti-irow: 3;"><td nowrap="nowrap" style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #d4d0c8; PADDING-TOP: 0.75pt; BORDER-BOTTOM: #d4d0c8; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent;"><p class="MsoNormal" align="left" style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: left; mso-pagination: widow-orphan;"><span style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt;">白细胞计数<span lang="EN-US">(</span>×<span lang="EN-US">109/L)<p></p></span></span></p></td><td nowrap="nowrap" style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #d4d0c8; PADDING-TOP: 0.75pt; BORDER-BOTTOM: #d4d0c8; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent;"><p class="MsoNormal" align="center" style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: center; mso-pagination: widow-orphan;"><span lang="EN-US" style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt;">4</span><span style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt;">～<span lang="EN-US">11<p></p></span></span></p></td><td nowrap="nowrap" style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #d4d0c8; PADDING-TOP: 0.75pt; BORDER-BOTTOM: #d4d0c8; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent;"><p class="MsoNormal" align="center" style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: center; mso-pagination: widow-orphan;"><span lang="EN-US" style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt;">11</span><span style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt;">～<span lang="EN-US">17<p></p></span></span></p></td><td nowrap="nowrap" style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #d4d0c8; PADDING-TOP: 0.75pt; BORDER-BOTTOM: #d4d0c8; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent;"><p class="MsoNormal" align="center" style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: center; mso-pagination: widow-orphan;"><span style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt;">＜<span lang="EN-US">4</span>或＞<span lang="EN-US">17<p></p></span></span></p></td></tr><tr style="HEIGHT: 14.25pt; mso-yfti-irow: 4;"><td nowrap="nowrap" style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #d4d0c8; PADDING-TOP: 0.75pt; BORDER-BOTTOM: #d4d0c8; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent;"><p class="MsoNormal" align="left" style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: left; mso-pagination: widow-orphan;"><span style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt;">分泌物<span lang="EN-US">(24</span>小时吸出物性状数量<span lang="EN-US">)<p></p></span></span></p></td><td nowrap="nowrap" style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #d4d0c8; PADDING-TOP: 0.75pt; BORDER-BOTTOM: #d4d0c8; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent;"><p class="MsoNormal" align="center" style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: center; mso-pagination: widow-orphan;"><span style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt;">无痰或少许<span lang="EN-US"><p></p></span></span></p></td><td nowrap="nowrap" style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #d4d0c8; PADDING-TOP: 0.75pt; BORDER-BOTTOM: #d4d0c8; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent;"><p class="MsoNormal" align="center" style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: center; mso-pagination: widow-orphan;"><span style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt;">中～大量，非脓性<span lang="EN-US"><p></p></span></span></p></td><td nowrap="nowrap" style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #d4d0c8; PADDING-TOP: 0.75pt; BORDER-BOTTOM: #d4d0c8; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent;"><p class="MsoNormal" align="center" style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: center; mso-pagination: widow-orphan;"><span style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt;">中～大量，脓性<span lang="EN-US"><p></p></span></span></p></td></tr><tr style="HEIGHT: 14.25pt; mso-yfti-irow: 5;"><td nowrap="nowrap" style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #d4d0c8; PADDING-TOP: 0.75pt; BORDER-BOTTOM: #d4d0c8; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent;"><p class="MsoNormal" align="left" style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: left; mso-pagination: widow-orphan;"><span style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt;">气体交换指数<span lang="EN-US">(PaO2/FiO2,kPa)<p></p></span></span></p></td><td nowrap="nowrap" style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #d4d0c8; PADDING-TOP: 0.75pt; BORDER-BOTTOM: #d4d0c8; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent;"><p class="MsoNormal" align="center" style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: center; mso-pagination: widow-orphan;"><span style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt;">＞<span lang="EN-US">33<p></p></span></span></p></td><td nowrap="nowrap" style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #d4d0c8; PADDING-TOP: 0.75pt; BORDER-BOTTOM: #d4d0c8; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent;"><p class="MsoNormal" align="center" style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: center; mso-pagination: widow-orphan;"><span style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt;">　<span lang="EN-US"><p></p></span></span></p></td><td nowrap="nowrap" style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #d4d0c8; PADDING-TOP: 0.75pt; BORDER-BOTTOM: #d4d0c8; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent;"><p class="MsoNormal" align="center" style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: center; mso-pagination: widow-orphan;"><span style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt;">＜<span lang="EN-US">33<p></p></span></span></p></td></tr><tr style="HEIGHT: 14.25pt; mso-yfti-irow: 6; mso-yfti-lastrow: yes;"><td nowrap="nowrap" style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #d4d0c8; PADDING-TOP: 0.75pt; BORDER-BOTTOM: windowtext 1pt solid; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent; mso-border-bottom-alt: solid windowtext .5pt;"><p class="MsoNormal" align="left" style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: left; mso-pagination: widow-orphan;"><span lang="EN-US" style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt;">X</span><span style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt;">线胸片侵润影<span lang="EN-US"><p></p></span></span></p></td><td nowrap="nowrap" style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #d4d0c8; PADDING-TOP: 0.75pt; BORDER-BOTTOM: windowtext 1pt solid; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent; mso-border-bottom-alt: solid windowtext .5pt;"><p class="MsoNormal" align="center" style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: center; mso-pagination: widow-orphan;"><span style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt;">无<span lang="EN-US"><p></p></span></span></p></td><td nowrap="nowrap" style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #d4d0c8; PADDING-TOP: 0.75pt; BORDER-BOTTOM: windowtext 1pt solid; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent; mso-border-bottom-alt: solid windowtext .5pt;"><p class="MsoNormal" align="center" style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: center; mso-pagination: widow-orphan;"><span style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt;">斑片状<span lang="EN-US"><p></p></span></span></p></td><td nowrap="nowrap" style="BORDER-RIGHT: #d4d0c8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #d4d0c8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #d4d0c8; PADDING-TOP: 0.75pt; BORDER-BOTTOM: windowtext 1pt solid; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent; mso-border-bottom-alt: solid windowtext .5pt;"><p class="MsoNormal" align="center" style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: center; mso-pagination: widow-orphan;"><span style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-bidi-font-family: 宋体; mso-font-kerning: 0pt;">融合片状<span lang="EN-US"><p></p></span></span></p></td></tr></tbody></table></div>

safihu

是不是说一定要临床CPIS评分超过6分才能说有意义??

绿谷

<p><font size="4">safihu ：您好！<br/>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; CPIS的敏感性为77％，但CPIS可用动态监测。</font></p>

safihu

哦,明白了,下载学习ING,,,,,我们现在在ICU前瞻性监测里用了APACHE III不知道大家有什么好的建议.

[此贴子已经被作者于2007-4-18 10:34:04编辑过]

水中花

<p>回复丽水</p><p>丽水：您好！谢谢！</p><p>&nbsp;&nbsp; 我所在的医院是位于长江中游的一所地市级的三级医院，你可能会奇怪象这样的医院检验科细菌室不会做痰的半定量培养，不过这是事实，国家应该对细菌室所应达到的水平有一个具体要求，这样才会对他们的工作有所促进。</p>

木瓜

<p>&nbsp;SIFIC知识大奖赛中的一道题：</p><div class="O1" vshape="_x0000_s1026"><div style="mso-char-wrap: 1; mso-kinsoku-overflow: 1; mso-line-spacing: '100 20 0'; mso-margin-left-alt: 624;"><span style="FONT-SIZE: 133%; COLOR: aqua; FONT-FAMILY: 'Times New Roman'; mso-color-index: 5;"><span style="LEFT: -5.83%; POSITION: absolute; mso-special-format: bullet;">–</span>
                                <p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><font size="3"><font color="#000000"><b><span style="FONT-FAMILY: 宋体; mso-hansi-font-family: 'Times New Roman'; mso-ascii-font-family: 'Times New Roman';">医院肺炎病人咳痰半定量培养结果，其中病原体判断正确的是：</span></b></font></font></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><font size="3"><font color="#000000"><span lang="EN-US" style="mso-bidi-font-weight: bold;">a. </span><span style="FONT-FAMILY: 宋体; mso-hansi-font-family: 'Times New Roman'; mso-ascii-font-family: 'Times New Roman'; mso-bidi-font-weight: bold;">表皮葡萄球菌</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="FONT-FAMILY: 宋体; mso-hansi-font-family: 'Times New Roman'; mso-ascii-font-family: 'Times New Roman'; mso-bidi-font-weight: bold;">＋（同时伴有草绿色链球菌</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">2</span><span style="FONT-FAMILY: 宋体; mso-hansi-font-family: 'Times New Roman'; mso-ascii-font-family: 'Times New Roman'; mso-bidi-font-weight: bold;">＋，奈瑟球菌</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">2</span><span style="FONT-FAMILY: 宋体; mso-hansi-font-family: 'Times New Roman'; mso-ascii-font-family: 'Times New Roman'; mso-bidi-font-weight: bold;">＋）</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><p></p></span></font></font></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><font size="3"><font color="#000000"><span lang="EN-US" style="mso-bidi-font-weight: bold;">b. </span><span style="FONT-FAMILY: 宋体; mso-hansi-font-family: 'Times New Roman'; mso-ascii-font-family: 'Times New Roman'; mso-bidi-font-weight: bold;">粪肠球菌</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="FONT-FAMILY: 宋体; mso-hansi-font-family: 'Times New Roman'; mso-ascii-font-family: 'Times New Roman'; mso-bidi-font-weight: bold;">＋（同时伴有草绿色链球菌</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="FONT-FAMILY: 宋体; mso-hansi-font-family: 'Times New Roman'; mso-ascii-font-family: 'Times New Roman'; mso-bidi-font-weight: bold;">＋，白色念珠菌</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="FONT-FAMILY: 宋体; mso-hansi-font-family: 'Times New Roman'; mso-ascii-font-family: 'Times New Roman'; mso-bidi-font-weight: bold;">＋）</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><p></p></span></font></font></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><font size="3"><font color="#000000"><span lang="EN-US" style="mso-bidi-font-weight: bold;">c. </span><span style="FONT-FAMILY: 宋体; mso-hansi-font-family: 'Times New Roman'; mso-ascii-font-family: 'Times New Roman'; mso-bidi-font-weight: bold;">白色念珠菌</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">2</span><span style="FONT-FAMILY: 宋体; mso-hansi-font-family: 'Times New Roman'; mso-ascii-font-family: 'Times New Roman'; mso-bidi-font-weight: bold;">＋（同时伴有嗜麦芽窄食单胞菌</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">2</span><span style="FONT-FAMILY: 宋体; mso-hansi-font-family: 'Times New Roman'; mso-ascii-font-family: 'Times New Roman'; mso-bidi-font-weight: bold;">＋）</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><p></p></span></font></font></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><font size="3"><font color="#000000"><span lang="EN-US" style="mso-bidi-font-weight: bold;">d. </span><span style="FONT-FAMILY: 宋体; mso-hansi-font-family: 'Times New Roman'; mso-ascii-font-family: 'Times New Roman'; mso-bidi-font-weight: bold;">草绿色链球菌</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">4</span><span style="FONT-FAMILY: 宋体; mso-hansi-font-family: 'Times New Roman'; mso-ascii-font-family: 'Times New Roman'; mso-bidi-font-weight: bold;">＋（同时伴有奈瑟球菌</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">2</span><span style="FONT-FAMILY: 宋体; mso-hansi-font-family: 'Times New Roman'; mso-ascii-font-family: 'Times New Roman'; mso-bidi-font-weight: bold;">＋）</span></font></font></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><font size="3"><font color="#000000"><span style="FONT-FAMILY: 宋体; mso-hansi-font-family: 'Times New Roman'; mso-ascii-font-family: 'Times New Roman'; mso-bidi-font-weight: bold;"></span></font></font>&nbsp;</p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><font size="3"><font color="#000000"><span style="FONT-FAMILY: 宋体; mso-hansi-font-family: 'Times New Roman'; mso-ascii-font-family: 'Times New Roman'; mso-bidi-font-weight: bold;">这道题的答案是a、b、c、d 都是错的。</span></font></font></p></span></div></div>[em06][em06][em06][em06][em06][em06][em06][em06][em06][em06][em06]

safihu

<div class="quote"><b>以下是引用<i>水中花</i>在2007-4-18 21:29:50的发言：</b><br/><p>回复丽水</p><p>丽水：您好！谢谢！</p><p>&nbsp;&nbsp; 我所在的医院是位于长江中游的一所地市级的三级医院，你可能会奇怪象这样的医院检验科细菌室不会做痰的半定量培养，不过这是事实，国家应该对细菌室所应达到的水平有一个具体要求，这样才会对他们的工作有所促进。</p></div><p>哎,,,同感,,我们细菌室的根本不懂半定量培养让我大吃一惊.......</p>

hty

同意水中花的观点。我院也是一家大的三级医院，检验科细菌室不会做痰的半定量培养，奇怪！国家应该对细菌室所应达到的水平有一个具体要求，这样才会对他们的工作有所促进。

木瓜

是CPIS（clinical pulmonary infection score）了，以前也不知道有这个东东，后来发现对那些主观很难判断的病例，用一用这种客观的指标还是有帮助的。

野渡无人

　　较为客观的评分系统是一个比较直观的依据，但是，尽信书不如无书！如一个下呼吸道感染的病人，所有的评分系统中的条件都满足且大于６分，而临床用阿齐霉素治疗效果很好，可细菌半定量培养出铜绿假单胞菌！该病人是否为铜绿假单胞菌引起的院内感染可能就得打一个问号！此病人很可能是由流感嗜血杆菌或支原体引起的感染．铜绿假单胞菌为污染菌！所以，任何脱离临床实际的东西首先要抱以怀疑的态度可能要更好一些！一点不成熟意见仅供大家参考，望指正！！:handshake :handshake

chaichai

今天看病历有一份病例我真的有点看不准请各位帮忙:肝癌手术后两天患者不发烧白细胞及中性都不高,也没有临床表现,但是痰培养有铜绿假单胞菌.我能算他院内感染吗?谢谢!

绿谷

考虑是定植菌。

太阳风123

感谢绿谷版主，让我了解到CPIS标准.

jyl97392

谢谢斑竹，长知识了

金碧辉煌

临床上判别是有些困难，我们有时会把一些不是很明确的病倒也归到感染病例，以后要加强这方面学习

yfbj65

痰的半定量培养标本受很多因素影响,如是否及时送检＼留取方法是否正确等，因此还得结合临床．

GLYT

今天临床医生打电话来咨询：病人6月10日颅脑外伤、血气胸、鼻漏入院，病人在6月10-6月18日期间间断低热，肺部一直有罗音，19日出现痰多，体温超过38°，痰多，22日痰培养：鲍曼不动杆菌，该病人是否属院内感染。