Pseudomonas aeruginosa pneumonia
Introduction
Introduction to Pseudomonas aeruginosa pneumonia Pseudomonas aeruginosa pneumonia (pseudomonasaeruginosapneumonia) is caused by Pseudomonas aeruginosa. It is more common in nosocomial infections, with serious illness and high mortality. It is widely found in humid environments, with underlying diseases, immunocompromised or intensive care. , mechanical ventilation patients are easy to cause. In recent years, the incidence rate has increased significantly and the mortality rate is very high. basic knowledge Sickness ratio: 0.05% Susceptible people: no specific population Mode of infection: non-infectious Complications: bacteremia, respiratory failure, renal insufficiency, pleural effusion, gastrointestinal bleeding
Cause
Cause of Pseudomonas aeruginosa pneumonia
Causes:
Pseudomonas aeruginosa is the main pathogen causing human pathogenicity in Pseudomonas. It is a Gram-negative bacillus. The extreme flagella are arranged in a single or paired manner. The flagella is found to have a heat-resistant antigen, and the cell wall has a layer of engulfment. Polysaccharide layer, although aerobic bacteria, but can grow under anaerobic conditions, grow well at 25 ~ 37 ° C, can withstand high concentrations of hydrochloric acid, disinfectants and general antibiotics, so it is a hospital infection The main pathogen, the colony is flat glassy, producing hemolysin, which is related to the formation of lung infection. 90% of Pseudomonas aeruginosa can produce extracellular protease, leading to hemorrhagic and necrotic lesions. The A toxin produced by the bacteria has The maximum virulence, for susceptible cells can inhibit the synthesis of its protein, clinically divided into two types, bacteremic pneumonia from blood or mononuclear phagocytic cells; non-bacteremia pneumonia caused by inhalation of upper respiratory secretions.
Pathogenesis:
The bacteria are widely distributed in the hospital environment. They are common in normal human skin, hand, medical equipment, especially artificial respirators and nebulizers. They are old and debilitating to the original cardiopulmonary diseases, immune defects, tumors, metabolic diseases, etc. Long-term use of antibiotics, hormones, anticancer drugs and immune function inhibitors is more likely to occur, the pathway is endogenous inhalation and exogenous inhalation, pathological changes characterized by hemorrhagic necrotizing bronchial pneumonia, alveolar septal necrosis, mainly manifested as rapid Formed lung consolidation or bronchial pneumonia, tissue necrosis caused multiple small abscesses, lesions in the lower lobe, more than half of the lung lesions, and often involving the pleura.
Prevention
Pseudomonas aeruginosa pneumonia prevention
1. Strictly implement various operations and rules and regulations, and cut off the transmission route of cross infection.
2. Strengthen the oropharyngeal care of patients with coma. If necessary, regularly apply 2% polymyxin ointment to coat the buccal and oropharyngeal mucosa to prevent respiratory infection of Pseudomonas aeruginosa.
3. Strictly sterilize medical instruments, including artificial respirators, nebulizers, and tracheal intubation.
4. Rational use of broad-spectrum antibiotics, strict use of corticosteroid indications.
Complication
Pseudomonas aeruginosa pneumonia complications Complications bacteremia respiratory failure renal insufficiency pleural effusion gastrointestinal bleeding
The complications of this disease are: bacteremia, respiratory failure, renal insufficiency, heart failure, pleural effusion, gastrointestinal bleeding.
Symptom
Pseudomonas aeruginosa pneumonia symptoms common symptoms purulent snoring dyspnea cyanosis abscess respiratory failure dizziness pleural effusion shock
Symptoms of systemic poisoning are severe, body temperature fluctuates greatly, peak is in the morning; cough, purulent sputum, a few patients are emerald green purulent sputum; difficulty breathing, cyanosis, patients with wet sputum, and 30% to 50% of empyema, condition In severe cases, confusion and easy respiratory failure, renal insufficiency, shock, electrolyte imbalance, heart failure, etc., white blood cell count can be moderately high or normal, blood biochemistry: low potassium, sodium, chlorine, liver and kidney dysfunction, Positive diagnosis of bacteria or pleural fluid can be confirmed.
X-ray findings are often diffuse bilateral bronchial pneumonia, which can involve multiple lung lobes, the following leaves are common, the lesion is a small abscess, can be combined with large infiltration, multiple small abscesses, but also with a small amount of pleural effusion.
Examine
Examination of Pseudomonas aeruginosa pneumonia
White blood cell count can be moderately high or normal, blood biochemical examination, low potassium, sodium, chlorine, liver and kidney damage can also occur.
X-ray findings are often diffuse bilateral bronchial pneumonia, which can involve multiple lung lobes, the following leaves are common, the lesion is a small abscess, can be combined with large infiltration, multiple small abscesses, but also with a small amount of pleural effusion.
Diagnosis
Diagnosis and identification of Pseudomonas aeruginosa pneumonia
The clinical manifestations and X-ray signs combined with sputum smear culture and pleural effusion culture results are easy to confirm.
It should be differentiated from Staphylococcus aureus pneumonia, Legionella pneumonia, Typhoid fever and other Gram-negative bacilli pneumonia.
