【讨论】这个病例算院内感染吗？

木瓜 · 发表于 2007-4-15 01:04

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p>前段时间碰到一个病例：外科ICU的一位气管插管的病人，2月、3月中连续做了7－8次谈培养，结果都是铜绿假单孢菌++或+++，但患者体温不高，肺部呼吸音清或粗，血白细胞计数及中性粒细胞比例均正常，胸片也无异常。根据院内下呼吸道感染感染诊断标准“经筛选的痰液连续两次分离到相同的病原体”这一条就可作HAP的病原学诊断了,但个人觉得这个病例不像是发生了HAP。不知道各位老师对这个病例有什么看法？

绿谷 · 发表于 2007-4-15 02:11

p>木瓜:你好!      这个病例根据你目前提供的病史,CPIS评分未超过6分,应该不算HAP.铜绿假单孢菌是一株条件致病菌.

一枝梅 · 发表于 2007-4-15 05:22

【转贴】关于丽水所说的“临床肺部感染评分(CPIS)”临床肺部感染评分（ＣＰＩＳ）是一项综合了临床、影像学和微生物学标准等来评估感染严重程度，预测患者使用抗菌素时应该是调整或者停止的评分系统，目的是减少不必要的抗生素暴露。这些指标共７项，包括：体温、白细胞计数、气管分泌物、氧合情况、Ｘ线胸片、肺部浸润影的进展情况和气管吸取物培养。最高评分为１２分，当≤６分时可以停用抗生素。其他一些临床指南也提供了一些优化降阶梯治疗第二阶段的治疗方案，并可缩短抗生素疗程。可以考虑采用计算机辅助抗生素处理系统，以有效帮助临床医师选择抗生素，降低治疗费用，减少药物不良反应。

一枝梅 · 发表于 2007-4-15 05:28

[此贴子已经被作者于2007-4-15 16:06:28编辑过]

CPIS.exe.rar (5.3 KB, 下载次数: 78041)

临床肺部感染评分系统.rar (9.26 KB, 下载次数: 121637)

[ 本帖最后由木瓜于 2007-5-26 16:39 编辑 ]

swx920510 · 发表于 2007-4-15 15:08

请问教授:在医院分娩过程中发生窒息,引起吸入性肺炎,诊断为医院感染有标准依据吗?                                                                      夕照彩云

木瓜 · 发表于 2007-4-16 01:38

<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: #ece9d8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #ece9d8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #ece9d8; WIDTH: 467pt; PADDING-TOP: 0.75pt; BORDER-BOTTOM: windowtext 1pt solid; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent; mso-border-bottom-alt: solid windowtext .5pt;">临床CPIS系统</td></tr><tr style="HEIGHT: 14.25pt; mso-yfti-irow: 1;"><td valign="bottom" nowrap="nowrap" style="BORDER-RIGHT: #ece9d8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #ece9d8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #ece9d8; PADDING-TOP: 0.75pt; BORDER-BOTTOM: windowtext 1pt solid; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent; mso-border-bottom-alt: solid windowtext .5pt;">项目</td><td valign="bottom" nowrap="nowrap" style="BORDER-RIGHT: #ece9d8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #ece9d8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #ece9d8; PADDING-TOP: 0.75pt; BORDER-BOTTOM: windowtext 1pt solid; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent; mso-border-bottom-alt: solid windowtext .5pt;">0分</td><td valign="bottom" nowrap="nowrap" style="BORDER-RIGHT: #ece9d8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #ece9d8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #ece9d8; PADDING-TOP: 0.75pt; BORDER-BOTTOM: windowtext 1pt solid; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent; mso-border-bottom-alt: solid windowtext .5pt;">1分</td><td valign="bottom" nowrap="nowrap" style="BORDER-RIGHT: #ece9d8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #ece9d8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #ece9d8; PADDING-TOP: 0.75pt; BORDER-BOTTOM: windowtext 1pt solid; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent; mso-border-bottom-alt: solid windowtext .5pt;">2分</td></tr><tr style="HEIGHT: 14.25pt; mso-yfti-irow: 2;"><td nowrap="nowrap" style="BORDER-RIGHT: #ece9d8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #ece9d8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #ece9d8; PADDING-TOP: 0.75pt; BORDER-BOTTOM: #ece9d8; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent;">体温(12小时平均值，℃)</td><td nowrap="nowrap" style="BORDER-RIGHT: #ece9d8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #ece9d8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #ece9d8; PADDING-TOP: 0.75pt; BORDER-BOTTOM: #ece9d8; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent;">36～38</td><td nowrap="nowrap" style="BORDER-RIGHT: #ece9d8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #ece9d8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #ece9d8; PADDING-TOP: 0.75pt; BORDER-BOTTOM: #ece9d8; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent;">38～39</td><td nowrap="nowrap" style="BORDER-RIGHT: #ece9d8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #ece9d8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #ece9d8; PADDING-TOP: 0.75pt; BORDER-BOTTOM: #ece9d8; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent;">＞39或＜36</td></tr><tr style="HEIGHT: 14.25pt; mso-yfti-irow: 3;"><td nowrap="nowrap" style="BORDER-RIGHT: #ece9d8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #ece9d8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #ece9d8; PADDING-TOP: 0.75pt; BORDER-BOTTOM: #ece9d8; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent;">白细胞计数(×109/L)</td><td nowrap="nowrap" style="BORDER-RIGHT: #ece9d8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #ece9d8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #ece9d8; PADDING-TOP: 0.75pt; BORDER-BOTTOM: #ece9d8; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent;">4～11</td><td nowrap="nowrap" style="BORDER-RIGHT: #ece9d8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #ece9d8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #ece9d8; PADDING-TOP: 0.75pt; BORDER-BOTTOM: #ece9d8; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent;">11～17</td><td nowrap="nowrap" style="BORDER-RIGHT: #ece9d8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #ece9d8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #ece9d8; PADDING-TOP: 0.75pt; BORDER-BOTTOM: #ece9d8; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent;">＜4或＞17</td></tr><tr style="HEIGHT: 14.25pt; mso-yfti-irow: 4;"><td nowrap="nowrap" style="BORDER-RIGHT: #ece9d8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #ece9d8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #ece9d8; PADDING-TOP: 0.75pt; BORDER-BOTTOM: #ece9d8; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent;">分泌物(24小时吸出物性状数量)</td><td nowrap="nowrap" style="BORDER-RIGHT: #ece9d8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #ece9d8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #ece9d8; PADDING-TOP: 0.75pt; BORDER-BOTTOM: #ece9d8; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent;">无痰或少许</td><td nowrap="nowrap" style="BORDER-RIGHT: #ece9d8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #ece9d8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #ece9d8; PADDING-TOP: 0.75pt; BORDER-BOTTOM: #ece9d8; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent;">中～大量，非脓性</td><td nowrap="nowrap" style="BORDER-RIGHT: #ece9d8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #ece9d8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #ece9d8; PADDING-TOP: 0.75pt; BORDER-BOTTOM: #ece9d8; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent;">中～大量，脓性</td></tr><tr style="HEIGHT: 14.25pt; mso-yfti-irow: 5;"><td nowrap="nowrap" style="BORDER-RIGHT: #ece9d8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #ece9d8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #ece9d8; PADDING-TOP: 0.75pt; BORDER-BOTTOM: #ece9d8; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent;">气体交换指数(PaO2/FiO2,kPa)</td><td nowrap="nowrap" style="BORDER-RIGHT: #ece9d8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #ece9d8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #ece9d8; PADDING-TOP: 0.75pt; BORDER-BOTTOM: #ece9d8; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent;">＞33</td><td nowrap="nowrap" style="BORDER-RIGHT: #ece9d8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #ece9d8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #ece9d8; PADDING-TOP: 0.75pt; BORDER-BOTTOM: #ece9d8; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent;">　</td><td nowrap="nowrap" style="BORDER-RIGHT: #ece9d8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #ece9d8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #ece9d8; PADDING-TOP: 0.75pt; BORDER-BOTTOM: #ece9d8; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent;">＜33</td></tr><tr style="HEIGHT: 14.25pt; mso-yfti-irow: 6; mso-yfti-lastrow: yes;"><td nowrap="nowrap" style="BORDER-RIGHT: #ece9d8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #ece9d8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #ece9d8; PADDING-TOP: 0.75pt; BORDER-BOTTOM: windowtext 1pt solid; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent; mso-border-bottom-alt: solid windowtext .5pt;">X线胸片侵润影</td><td nowrap="nowrap" style="BORDER-RIGHT: #ece9d8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #ece9d8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #ece9d8; PADDING-TOP: 0.75pt; BORDER-BOTTOM: windowtext 1pt solid; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent; mso-border-bottom-alt: solid windowtext .5pt;">无</td><td nowrap="nowrap" style="BORDER-RIGHT: #ece9d8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #ece9d8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #ece9d8; PADDING-TOP: 0.75pt; BORDER-BOTTOM: windowtext 1pt solid; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent; mso-border-bottom-alt: solid windowtext .5pt;">斑片状</td><td nowrap="nowrap" style="BORDER-RIGHT: #ece9d8; PADDING-RIGHT: 0.75pt; BORDER-TOP: #ece9d8; PADDING-LEFT: 0.75pt; PADDING-BOTTOM: 0cm; BORDER-LEFT: #ece9d8; PADDING-TOP: 0.75pt; BORDER-BOTTOM: windowtext 1pt solid; HEIGHT: 14.25pt; BACKGROUND-COLOR: transparent; mso-border-bottom-alt: solid windowtext .5pt;">融合片状</td></tr></tbody></table></div><div align="center"></div>谢谢一支梅不辞辛苦弄来的资料，但这个评分表里只有5项，最高分怎么有12分呢？

木瓜 · 发表于 2007-5-9 08:06

下面的东东是胡教授刚上传的“美国胸科协会和美国感染病协会对医院内获得性肺炎 诊治指南的修订”里头的东东，和我们以前看到的有点不一样，大家赶快学习呀！<img src="attachments/dvbbs/2007-5/200759072754705.jpg" border="0" onload="if(this.width>screen.width*0.7) {this.resized=true; this.width=screen.width*0.7; this.alt=\'Click here to open new window\nCTRL+Mouse wheel to zoom in/out\';}" onmouseover="if(this.width>screen.width*0.7) {this.resized=true; this.width=screen.width*0.7; this.style.cursor=\'hand\'; this.alt=\'Click here to open new window\nCTRL+Mouse wheel to zoom in/out\';}" onclick="if(!this.resized) {return true;} else {window.open(\'attachments/dvbbs/2007-5/200759072754705.jpg\');}" onmousewheel="return imgzoom(this);" alt="" />

[此贴子已经被作者于2007-5-9 0:09:14编辑过]

chaichai · 发表于 2007-10-31 22:34

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!

木瓜 · 发表于 2007-10-31 22:57

呵呵，和我一开始所的那个情况有点类似，感觉不太像，动态监测看看。:)

桃子妖妖 · 发表于 2007-11-16 11:16

ＣＰＩＳ正如梅主说转贴的：“临床肺部感染评分（ＣＰＩＳ）的目的是减少不必要的抗生素暴露，因此用ＣＰＩＳ评分对上面2例做出是否有医院感染的诊断不妥。首先对痰标本是否进行了筛选？这是最基本的。影响痰培养的因素很多，但不管怎样都应该结合病人的临床表现和相关的其它实验室检查，也许这是最重要的是吗？我觉得就目前的情况不能诊断院内感染。:$