Аспирационная пневмония | КМАХ

Аспирационная пневмония

Клиническая Микробиология и Антимикробная Химиотерапия. 2008; 10(3):216-234

​ Авдеев С.Н.
аспирационная пневмония анаэробная инфекция обзор
Раздел
Болезни и возбудители
Тип
Журнальная статья
Публикация
Клиническая Микробиология и Антимикробная Химиотерапия. 2008; 10(3):216-234

Аннотация

Аспирация определяется как случайное попадание орофарингеального или желудочного содержимого (эндогенные субстанции) или жидкости и твёрдых частиц (экзогенные субстанции) в нижние дыхательные пути. Клинический ответ на аспирацию зависит от характера аспирированного материала и факторов защиты больного. Аспирационные синдромы включают в себя три вида состояний, которые различаются клинически и морфологически: (1) аспирационный пневмонит; (2) механическая обструкция дыхательных путей инородными телами; (3) аспирационная пневмония. Состояния, которые пред­располагают к развитию аспирации, включают: снижение уровня сознания, неврологические заболевания, нарушение глотания, болезни пищевода, зондовое питание, интубация трахеи, плохое гигиеническое состояние полости рта и др. Микробиология аспирационной пневмонии тесно связана с анаэробной флорой, обитающей в полости рта. Недавно проведённые исследования продемонстрировали также роль более вирулентных аэробов у больных отделений интенсивной терапии, что говорит о том, что у тяжёлых больных причины аспирационной пневмонии могут быть иными. Выбор антибактериальной терапии аспирационных пневмоний зависит от тяжести заболевания, его формы (вне- или внутрибольничная), наличия факторов риска колонизации грамотрицательными микроорганизмами. Препаратами выбора при аспирационной пневмонии являются «защищённые» бета-лактамы, карбапенемы, бета-лактамы в комбинации с клиндамицином или метронидазолом, моксифлоксацин.

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