経気管吸引法による呼吸器感染症の病態解析 ： 急性感染と慢性感染の観点も含めて

Abstract

The author clinically evaluated patients with bronchopulmonary infections in whom any pathogens were isolated upon transtracheal aspiration (TTA) and the clinical criterion of respiratory infection was satisfied. The subjects were patients with bronchopulmonary infections which included acute bronchitis (77 cases, 82 episodes), pneumonia (130 cases, 136 episodes) and chronic lower respiratory tract infection (41 cases, 152 episodes). Major pathogens isolated upon TTA were H. influenzae, S. pneumoniae and M. catarrhalis in patients with acute bronchitis. S. pneumoniae was the most clinically significant pathogen in pneumonia without the prior administration of antibiotic agents. The organisms isolated upon TTA included S. aureus, P. aeruginosa and fungi in patients with nosocomial pneumonia after the prior administration of antimicrobial agents. The isolates detected most frequently were H. influenzae and P. aeruginosa during the stable phase of chronic lower respiratory tract infection. H. influenzae was the most common pathogen in patients with acute exacerbation of chronic lower respiratory tract infection. The symptoms of acute bronchitis included fever, developed in 91.5% in patients, purulent sputa and cough suffered by all patients. Prior episodes of upper respiratory inflammation related to the development of acute bacterial bronchitis in 46.3% of patients. Antibiotic agents therapy cured acute bacterial brochitis in 96.3%. Analysis of host factors showed that the number of underlying diseases per patient was greater, and that general condition was poorer in the elderly group. The prognosis was poorer and incidence of adverse reactions to antimicrobial agents tended to be greater in the elderly group. These results suggest that the reality of bronchopulmonary infections is complex and so diagnosis must be performed by the correct methods.