Аннотация
Нозокомиальная пневмония (НП) — непреходящая проблема многопрофильных стационаров, особенно отделений реанимации и интенсивной терапии (ОРИТ), в которых инвазивные методы диагностики и терапии, полипрагмазия, сложные условия ухода способствуют появлению потенциально опасных очагов колонизации нозокомиальной флоры. В профильных отделениях важную роль в профилактике НП могут играть особенности патологии, тактика ведения пациентов и ухода за ними, возможность участия самого пациента. Примерно в одном из десяти случаев смерть от пневмонии может быть предотвращена путём улучшения гигиены полости рта. Идентификация пациентов с инсультом по степени риска возникновения НП и сравнительная оценка эффективности методов обработки полости рта может улучшить профилактику у этой категории пациентов. В статье представлен обзор современных данных по возможностям и перспективам профилактики НП у пациентов с острыми нарушениями мозгового кровообращения.
-
1.
Виленский Б.С. Инсульт: профилактика, диагностика и лечение. СПб.; 1999. С. 10-15.
-
2.
Гусев Е.И. Эпидемиология инсульта в России. Журн неврол психиатр. Прил.: Инсульт; 2003,8: 4-9.
-
3.
Скворцова В. И., Евзельман М. А. Ишемический инсульт. Орел; 2006: 4-19.
-
4.
Суслина З. А., Пирадов М. А., ред. Инсульт: диагностика, лечение, профилактика. М.: МЕДпресс-информ; 2008: 11-15, 61-66.
-
5.
Sever P.S., Dahlöf B., Poulter N.R, et al. Scandinavian Cardiac Outcomes Trial – Lipid Lovering Arm (ASOT– LLA): a multicentre randomised controlled trial. Lancet 2003; 361:1149-58.
-
6.
Emsley H.C., Hopkins S.J. Acute ischaemic stroke and infection: recent and emerging concepts. Lancet Neurol 2008; 7:341-53.
-
7.
Vermeij F.H., Scholte op Reimer W.J, de Man M.P., et al. Stroke-associated infection is an independent risk factor for poor outcome after acute ischemic stroke: data from the Netherlands Stroke Survey. Cerebrovasc Dis 2009; 27:465-71.
-
8.
Katzan I.L., Cebul R.D., Husak S.H., Dawson N.V., Baker D.W. The effect of pneumonia on mortality among patients hospitalized for acute stroke. Neurology 2003; 60:620-25.
-
9.
Westendorp W.F., Nederkoorn P.J., Vermeij J.-D., et al. Post-stroke infection: A systematic review and metaanalysis. BMC Neurology 2011; 11:110.
-
10.
van der Kooi T.I., Mannien J., Wille J.C., van Benthem B.H. Prevalence of nosocomial infections in the Netherlands, 2007-2008: results of the first four national studies. J Hosp Infect 2010; 75:168-72.
-
11.
Stott D.J., Falconer A., Miller H., Tilston J.C., Langhorne P. Urinary tract infection after stroke. QJM 2009; 102:243-9.
-
12.
Davenport RJ, Dennis MS, Wellwood I, Warlow CP. Complications after acute stroke. Stroke 1996; 27:415-20.
-
13.
Georgilis K, Plomaritoglou A, Dafni U, Bassiakos Y, Vemmos K. Aetiology of fever in patients with acute stroke. J Intern Med 1999; 246:203-9.
-
14.
Hilker R., Poetter C., Findeisen N., et al. Nosocomial pneumonia after acute stroke: implications for neurological intensive care medicine. Stroke 2003; 34:975-81.
-
15.
Hassan A., Khealani B.A., Shafqat S., et al. Strokeassociated pneumonia: microbiological data and outcome. Singapore Med J 2006, 47:204-7.
-
16.
Horan T.C., Andrus M., Dudeck M.A. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008, 36:309-32.
-
17.
Aslanyan S., Weir C.J., Diener H.C., Kaste M., Lees K.R. Pneumonia and urinary tract infection after acute ischemic stroke: a tertiary analysis of the GAIN International trial. Eur J Neurol 2004, 11:49-53.
-
18.
Hinchey J.A., Shephard T., Furie K., et al. Formal dysphagia screening protocols prevent pneumonia. Stroke 2005, 36:1972-6.
-
19.
Kwon H.M., Jeong S.W., Lee S.H., Yoon B.W. The pneumonia score: a simple grading scale for prediction of pneumonia after acute stroke. Am J Infect Control 2006, 34:64-8.
-
20.
Adnet F., Baud F. Relation between Glasgow Coma Scale and aspiration pneumonia. Lancet 1996, 348:123-4
-
21.
Martino R., Foley N., Bhogal S., et al. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke 2005, 36:2756-63.
-
22.
Walter U., Knoblich R., Steinhagen V., et al. Predictors of pneumonia in acute stroke patients admitted to a neurological intensive care unit. J Neurol 2007, 254:1323-9.
-
23.
Harms H., Prass K., Meisel C., et al. Preventive antibacterial therapy in acute ischemic stroke: a randomized controlled trial. PLoS One 2008, 3:e2158
-
24.
Ovbiagele B., Hills N.K., Saver J.L., Johnston S.C. Frequency and determinants of pneumonia and urinary tract infection during stroke hospitalization. J Stroke Cerebrovasc Dis 2006, 15:209-13.
-
25.
Chamorro A., Amaro S., Vargas M., et al. Interleukin 10, monocytes and increased risk of early infection in ischaemic stroke. J Neurol Neurosurg Psychiatry 2006, 77:1279-81.
-
26.
Haeusler K.G., Schmidt W.U., Fohring F., et al. Cellular immunodepression preceding infectious complications after acute ischemic stroke in humans. Cerebrovasc Dis 2008, 25:50-8.
-
27.
Vogelgesang A., Grunwald U., Langner S., et al. Analysis of lymphocyte subsets in patients with stroke and their influence on infection after stroke. Stroke 2008, 39:237- 41.
-
28.
Millns B., Gosney M., Jack C.I., et al. Acute stroke predisposes to oral gram-negative bacilli – a cause of aspiration pneumonia? Gerontology 2003; 49:173-6.
-
29.
Gosney M., Martin M.V., Wright A.E. The role of selective decontamination of the digestive tract in acute stroke. Age Ageing 2006; 35:42-7.
-
30.
Jones R.N. Microbial etiologies of hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia. Clin Infect Dis 2010; 51:1114.
-
31.
Marik P.E., Careau P. The role of anaerobes in patients with ventilatorassociated pneumonia and aspiration pneumonia: a prospective study. Chest 1999; 115:178-83.
-
32.
Marik P.E. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med 2001; 344:665-71.
-
33.
Spratt N., Wang Y., Levi C., et al. A prospective study of predictors of prolonged hospital stay and disability after stroke. J Clin Neurosci 2003; 10:665-9.
-
34.
Iadecola C., Anrather J. The immunology of stroke: from mechanisms to translation. Nat Med 2011; 17:796-808.
-
35.
Govan L., Langhorne P., Weir C.J. Does the prevention of complications explain the survival benefit of organized inpatient (stroke unit) care?: further analysis of a systematic review. Stroke 2007; 38:2536-40.
-
36.
van de Beek D., Wijdicks E.F., Vermeij F.H., et al. Preventive antibiotics for infections in acute stroke: a systematic review and meta-analysis. Arch Neurol 2009; 66:1076-81.
-
37.
Nederkoorn P.J., Westendorp W.F., Hooijenga I.J., et al. Preventive antibiotics in stroke study: rationale and protocol for a randomised trial. Int J Stroke 2011; 6:159-63.
-
38.
Kanimozhi B.E, Kumari G. Effectiveness of chlorhexidine oral decontamination in reducing the incidence of ventilator associated pneumonia: A meta-analysis. BJMP 2012; 5(1):a512.
-
39.
DeRiso A.J. II, Ladowski J.S., Dillon T.A., Justice J.W., Peterson A.C. Chlorhexidine gluconate 0.12% oral rinse reduces the incidence of total nosocomial respiratory infection and nonprophylactic systemic antibiotic use in patients undergoing heart surgery. Chest 1996; 109(6):1556-61.
-
40.
Fourrier F., Cau-Pottier E., Boutigny H., et al. Effects of dental plaque antiseptic decontamination on bacterial colonization and nosocomial infections in critically ill patients. Intensive Care Med 2000; 26(9):1239-47.
-
41.
Houston S., Hougland P., Anderson J.J., et al. Effectiveness of 0.12% chlorhexidine gluconate oral rinse in reducing prevalence of nosocomial pneumonia in patients undergoing heart surgery. Am J Crit Care 2002; 11:567- 70.
-
42.
MacNaughton P., Bailey J., Donlin N. A randomized controlled trial assessing efficacy of oral chlorhexidine in ventilated patients: European Society of Intensive Care Medicine 2004; 30(suppl):S5-S18.
-
43.
Fourrier F., Dubois D., Pronnier P. Effect of gingival and dental plaque antiseptic decontamination on nosocomial infections acquired in the intensive care unit: a doubleblind placebo-controlled multicenter study. Crit Care Med 2005; 33(8):1728-35.
-
44.
Segers P., Speekenbrink R.G., Ubbink D.T., van Ogtrop M.L., de Mol B.A. Prevention of nosocomial infection in cardiac surgery by decontamination of the nasopharynx and oropharynx with chlorhexidine gluconate: a randomized controlled trial. JAMA 2006; 296(20), 2460-6.
-
45.
Bopp M., Darby M., Loftin K.C., Broscious S.Effects of daily oral care with 0.12% chlorhexidine gluconate and a standard oral care protocol on the development of nosocomial pneumonia in intubated patients: a pilot study. J Dent Hyg 2006; 80(3):9.
-
46.
Koeman M., van der Ven A.J., Hak E. Oral decontamination with chlorhexidine reduces the incidence of ventilatorassociated pneumonia. Am J Respir Crit Care Med 2006; 173(12):1348-55.
-
47.
Tantipong H., Morkchareonpong C., Jaiyindee S., Thamlikitkul V. Randomized controlled trial and metaanalysis of oral decontamination with 2% chlorhexidine solution for the prevention of ventilator-associated pneumonia. Infect Control Hospital Epidemiol 2008; 29(1):345-50.
-
48.
Johanson W.G. Jr, Pierce A.K., Sanford J.P. Changing pharyngeal bacterial flora of hospitalized patients: emergence of gram-negative bacilli. N Engl J Med 1969; 281:1137-40.
-
49.
Johanson W.G. Jr, Pierce A.K., Sanford J.P., Thomas G.D. Nosocomial respiratory infections with Gramnegative bacilli: the significance of colonization of the respiratory tract. Ann Intern Med 1972; 77:701-6.
-
50.
Bonten M.J.M., Bergmans D.C., Ambergen A.W., et al. Risk factors for pneumonia, and colonization of respiratory tract and stomach in mechanically ventilated ICU patients. Am J Respir Crit Care Med 1996; 154:1339-46.
-
51.
Garrouste-Org M., Chevret S., Arlet G., et al. Oropharyngeal or gastric colonization and nosocomial pneumonia in adult intensive care unit patients: a prospective study based on genomic DNA analysis. Am J Respir Crit Care Med 1997; 156:1647-55.
-
52.
Viola´n J.S., Ferna´ndez J.A., Bordes-Benı´tez A., Cardenosa-Cendrero J.A., de Castro F.R. Impact of quantitative invasive diagnostic techniques in the management and outcome of mechancally ventilated patients with suspected pneumonia. Crit Care Med 2000; 28:2737-41.
-
53.
Russell A.D., Day M.J. Antibacterial activity of chlorhexidine. J Hosp Infect 1993; 25:229-38.
-
54.
Chan E.Y., Ruest A., Meade M.O., Cook D.J. Oral decontamination for prevention of pneumonia in mechanically ventilated adults: systematic review and meta-analysis. BMJ 2007; 334:861.
-
55.
Berry A.M., Davidson P.M. Beyond comfort: oral hygiene as a critical nursing activity in the intensive care unit. Intensive and Critical Care Nursing 2006; 22: 318-28.
-
56.
Trieger N. Oral care in the intensive care unit. Am J Crit Care 2004; 13(1): 24.
-
57.
Furr A.L., Binkley C.J., McCurren C., Carrico R. Factors affecting quality of oral care in intensive care units. Journal of Advanced Nursing 2004; 48(5): 454-62.
-
58.
Jones H., Newton J.T., Bower E.J. A survey of the oral care practices of intensive care nurses. Intensive and Critical Care Nursing 2004; 20: 69-76.
-
59.
Hunter R.V., Clarkson J.E., Fraser H.W., MacWalter R.S. A preliminary investigation into tooth care, dental attendance, and oral health related quality of life in adult stroke survivors in Tayside, Scotland. Gerodontology 2006; 23:140-8.
-
60.
Brandl B., Bitondo C.D., Heisler C.J., et al. Elder abuse detection and intervention. New York: Springer Publishing Company; 2007.
-
61.
Friedlander A.H., Kawakami K.K., Ganzell S., Fitten L.J. Dental management of the geriatric patient with major depression. Spec Care Dentist 1993; 13:249-53.
-
62.
Ueda K., Toyosato A., Nomura S. A study on the effects of short-, medium- and long-term professional oral care in elderly persons requiring long-term nursing care at a chronic or maintenance stage of illness. Gerodontology 2003; 20:50-6.
-
63.
Talbot A., Brady M., Furlanetto D.L., et al. Oral care and stroke units. Gerodontology 2005; 22:77-83.
-
64.
Preston A.J., Punekar S., Gosney M.A. Oral care of elderly patients: nurses’ knowledge and views. Postgrad Med J 2000; 76:89-91.
-
65.
Wårdh I., Andersson L., Sörensen S. Staff attitudes to oral health care: a comparative study of registered nurses, nursing assistants and home care aides. Gerodontology 1997; 14:28-32.
-
66.
Frenkel H., Harvey I., Needs K. Oral health care education and its effect on caregivers’ knowledge and attitudes: a randomized controlled trial. Commun Dent Oral Epidemiol 2002; 30:91-100.
-
67.
Adams R. Qualified nurses lack adequate knowledge related to oral health, resulting in inadequate oral care of patients on medical wards. J Adv Nurs 1996; 24:552-60.
-
68.
Brady M.C., Furlanetto D.L., Hunter R.V., et al. Improving oral hygiene in patients after stroke. Stroke 2007; 38:1115-6.
-
69.
Cutler C.J., Davis N. Improving oral care in patients receiving mechanical ventilation. Am J Crit Care 2005; 14(5):389-94.
-
70.
Grap M.J., Munro C.L., Ashtiani B., Bryant S. Oral care interventions in critical care: frequency and documentation. Am J Crit Care 2003; 12(2):113-8.
-
71.
Mahul P., Auboyer C., Jospe R., et al. Prevention of nosocomial pneumonia in intubated patients: respective role of mechanical subglottic secretions drainage and stress ulcer prophylaxis. Intensive Care Med 1992; 18(1):20-5.
-
72.
Muscedere J., Rewa O., McKechnie K., et al. Subglottic secretion drainage for the prevention of ventilatorassociated pneumonia: a systematic review and metaanalysis. Crit. Care Med. 2011; 39(8):1985-91.
-
73.
Kollef M.H., Afessa B., Anzueto A., et al.; NASCENT Investigation Group. Silver-coated endotracheal tubes and incidence of ventilator-associated pneumonia: the NASCENT randomized trial. JAMA 2008; 300(7):805- 13.
-
74.
Chlebicki M.P., Safdar N. Topical chlorhexidine for prevention of ventilator-associated pneumonia: a metaanalysis. Crit. Care Med 2008; 35(2):595-602.
-
75.
Zack J.E., Garrison T., Trovillion E., et al. Effect of an education program aimed at reducing the occurrence of ventilator-associated pneumonia. Crit. Care Med 2002; 30(11):2407-12.
-
76.
Uchida M., Stone P.W., Conway L.J., et al. Exploring infection prevention: policy implications from a qualitative study, Policy Polit Nurs Pract 2011; 12(2):82-9.
-
77.
Babcock H.M., Zack J.E., Garrison T., et al. An educational intervention to reduce ventilator-associated pneumonia in an integrated health system: a comparison of effects. Chest 2004; 125(6):2224-31.
-
78.
Kress J.P., Pohlman A.S., O’Connor M.F., Hall J.B. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 2000; 342(20):1471-7.
-
79.
IHI proposes six patient safety goals to prevent 100,000 annual deaths. Qual Lett Healthc Lead 2005; 17(1):11-2.
-
80.
Girard T.D., Kress J.P., Fuchs B.D., et al. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial. Lancet 2008; 371(9607):126-34.
-
81.
Schweickert W.D., Gehlbach B.K., Pohlman A.S., Hall J.B., Kress J.P. Daily interruption of sedative infusions and complications of critical illness in mechanically ventilated patients. Crit Care Med 2004; 32(6):1272-6.
-
82.
Dries D.J., McGonigal M.D., Malian M.S., Bor B.J., Sullivan C. Protocol-driven ventilator weaning reduces use of mechanical ventilation, rate of early reintubation, and ventilator-associated pneumonia. J Trauma 2004; 56(5):943-51.
-
83.
Plant P.K., Owen J.L., Elliott M.W. Early use of noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards: a multicentre randomised controlled trial. Lancet 2000; 355(9219):1931-5.
-
84.
Masip J., Roque M., Sánchez B., et al. Noninvasive ventilation in acute cardiogenic pulmonary edema: systematic review and meta-analysis. JAMA 2005; 294(24):3124-30.
-
85.
Nava S., Hill N. Non-invasive ventilation in acute respiratory failure. Lancet 2009; 374(9685):250-9.
-
86.
Rocker G.M., Mackenzie M.G., Williams B., Logan P.M. Noninvasive positive pressure ventilation: successful outcome in patients with acute lung injury/ARDS. Chest 1999; 115(1):173-7.
-
87.
Cheung T.M., Yam L.Y., So L.K., et al. Effectiveness of noninvasive positive pressure ventilation in the treatment of acute respiratory failure in severe acute respiratory syndrome. Chest 2004; 126(3):845-50.
-
88.
Kubicka Z.J., Limauro J., Darnall R.A. Heated, humidified high-flow nasal cannula therapy: yet another way to deliver continuous positive airway pressure? Pediatrics 2008; 121(1):82-8.
-
89.
Sztrymf B., Messika J., Mayot T., Lenglet H., Dreyfuss D., Ricard J.D. Impact of high-flow nasal cannula oxygen therapy on intensive care unit patients with acute respiratory failure: a prospective observational study. J Crit Care 2012; 27(3):324.e9-324.13.
-
90.
Jones R.N. Resistance patterns among nosocomial pathogens: trends over the past few years. Chest 2001; 119(Suppl. 2):397S-404S.
-
91.
National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2003, issued August 2003. Am. J. Infect Control, 2003; 31(8):481-98.
-
92.
Dellit T.H., Owens R.C., McGowan J.E. Jr, et al.; Infectious Diseases Society of America; Society for Healthcare Epidemiology of America. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007; 44(2):159-77.
-
93.
Pakyz A.L., MacDougall C., Oinonen M., Polk R.E. Trends in antibacterial use in US academic health centers: 2002 to 2006. Arch Intern Med 2008; 168(20):2254-60.
-
94.
Edwards J.E., McEwan N.R., Wallace R.J. Adaptation to flavomycin in the ruminal bacterium, Prevotella bryantii. J Appl Microbiol 2008; 104(6):1617-23.
-
95.
Doron S., Davidson L.E. Antimicrobial stewardship. Mayo Clin Proc 2011; 86(11):1113-23.
-
96.
Kaki R., Elligsen M., Walker S., et al. Impact of antimicrobial stewardship in critical care: a systematic review. J Antimicrob Chemother 2011; 66(6):1223-30.
-
97.
Bergmans D.C., Bonten M.J., Gaillard C.A., et al. Prevention of ventilator-associated pneumonia by oral decontamination: a prospective, randomized, doubleblind, placebo-controlled study Am J Respir Crit Care Med 2001; 164(3):382-8.
-
98.
Kollef M., Pittet D., Sánchez García M., et al. Prevention of Pneumonia Study (POPS-1) Trial Group. A randomized double-blind trial of iseganan in prevention of ventilator-associated pneumonia, Am J Respir Crit Care Med 2006; 173(1):91-7.
-
99.
Laggner A.N., Tryba M., Georgopoulos A., et al. Oropharyngeal decontamination with gentamicin for longterm ventilated patients on stress ulcer prophylaxis with sucralfate? Wien Klin Wochenschr 1994; 106(1):15-9.