08サーベイ部会報告書v1117
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- ぜんすけ はなだて
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2 CRBSI CAUTI VAP VAP CRBSICAUTI X 2006 pilot study VAP VAP VAP VAP VAP ICN VAP VAP VAP VAP VAP. VAP 2006 VAP VAP VAP NNIS VAP VAP p8, 6 VAP [ vs , P=0.04, Mann-Whitney U test VAP ICU X ICN ICU ICU 1
3 9 ICU 13 IPPBPEEPCPAP web p27, ICU ICU ICN ICU ICD ICD [A] ICU X [B] ICN X VAP VAP X "ICU VAP" 48 ICU web 2
4 VAP PNU13 p 9 p16 p17 p18 p22 p24 p26 p26 p p34 3
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6 National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June Am J Infect Control. 2004;32:
7 . VAP VAP
8 VAP (4.83)(4.25)2575 (0, 7.74) 2004 NNIS % 26.7% 15.6% % 30.3% 27.3% 2003 NNIS 27.8% 26.9% 18.1% [Gaynes R, et al. Clin Infect Dis 2005;41:848-54] VAP X (1) 42 (2) VAP VAP ICN VAP VAP CRBSICA-UTIVAP 7
9 6. VAP 8
10 NNIS PNEU PNU Moraxella catarrhalish. influenzae S. pneumoniae (MRSA)A B RS Pneumocystis jiroveci () BAL bronchoalveolar labage EIA enzyme immunoassay FAMA fluorescent-antibody staining of membrane antigen IFA immunofluorescent antibody LRT lower respiratory tract PCR polymerase chain reaction PMN polymorphonuclear leukocyte RIA radioimmunoassay 9
11 PNEU PNEU LUNG BRON 10
12 PNU 2 1,2 / (4000/ )(12,000/ ) [PaO 2 /FiO ] PNU 2 1,2 / (4000/ ) (12,000/ ) 70 3 [PaO 2 /FiO ] 8 LRT (BAL ) BAL % ( ) (1) PMN (2) (3) Miller & Jones P2 P Geckler 5 11
13 ( ) PNU 2 1,2 / (4000/ ) (12,000/ ) 70 3 [PaO 2 /FiO ] (EIA,FAMA, Shell vial, PCR) ( ) IgG 4 PCR IF IF RIA EIA IFA EIA 12
14 PNU3 2 1,2 / [PaO 2 /FiO ] 1 14,15 LRT (BAL ) Pneumocystis jiroveci PNU2 PNU ( ) () x ,
15 ~ () 7. ( FiO 2 )( PaO 2 ) NNIS Miller & Jones Geckler RS 11. RS ( 500/mm 3 ) CD4 200 HIV 2 ( 40mg [160mg 32mg mg 200mg ])
16 1. 1g 10 4 cfu B-BAL) 10 4 cfu BAL ( B-PBAL ) 10 4 cfu ( B-PSB ) 10 3 cfu ( ) NB-BAL 10 4 cfu NB-PSB 10 3 cfu 2. Miller & Jones M1 M2 P1 1/3 P2 1/32/3 P3 2/3 3. Geckler
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31 I. Q A Q2. 13 VAP 13 A2. NNIS adult Q A Q5. A5. Q6. CHDF - A6. 2 VAP Q VAP A7. A6 48 Q A p12, Q A Q A10. 30
32 Q11. A11. BAL NNIS Miller & Jones Geckler 9 PNU2 PNU1 Q12. Geckler 4-7 A12. NNIS p12, 3 Geckler 5 48 Geckler 4, 5 5 Geckler 4 Q13. Geckler 6 G6 A13. VAP Geckler ,4,5 Geckler 5 G6 Q14. A (EIA Q15. A15. Q 16. A16. Miller & Jones Geckler PNU Q17. 5% Geckler A17. 5%20 1 Geckler Geckler PNU Q18. BAL A18. NNIS (BAL VAP 31
33 ) Q19. A19. ICU p13, 8 VAP VAP 4-1 VAP VAP VAP. Q20. A20. p13, 13 Q21. CT A21. Q22. VAP A22. VAP Q23. VAP ICU A23. VAP VAP Q24. VAP A24. VAP VAP 2 Q25. VAP VAP A25. VAP quality assurance Q26. A26. 32
34 Q27. VAP CXp(1 ) CXp(2 ) VAP A27. VAP CXp(1) CXp(2) CXp(1), (2) CXp Q28. A VAP Q29. device A VAP 48 Q30. ICU 36 ICU A30. ICU VAP 12 1 ICU Q31. ICU ICU ICU 48 ICU 24 ICU 48 VAP ICU VAP A31. ICU VAP Q32. p15 A32. 1 ICU Q33PNU1 PNU2 A33 PNU23 1 PNU13 2 Q34. A34. 33
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Microsoft Word 年VAPサーベイランスプロトコール.doc
人工呼吸器関連肺炎 (Ventilator-associated pneumonia; VAP) サーベイランス Ⅰ. 方法 1. 対象集中治療部 (ICU) において人工呼吸器を装着中の 13 歳以上の患者 間欠的陽圧呼吸 (IPPB) 経鼻的終末呼気陽圧 (PEEP) 持続的経鼻的気道内用圧 (CPAP) のような肺拡張法は 気管切開や気管内挿管を使用していない限り 人工呼吸器とはみなされない
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The clinical characteristics of Mycoplasma pneumoniae pneumonia in children younger than 6 years old Nobue Takeda1,2),Tomomichi Kurosaki1),Naruhiko Ishiwada2),Yoichi Kohno2) 1)Department of Pediatrics,Chiba
13●53頁●６－７▲院内感染対策▲.ppt
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Table 1 Bacteriae to be tested (1) Gram positive cocci Coagulase positive staphylococcus Coagulase negative staphylococcus Streptococcus pneumoniae Gr
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Key words: Legionella, urinary antigen, enzymeimmunoassay (EIA), rapid diagnosis
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第18回海岸シンポジウム報告書
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The Lancet NPPV July18, 2009 Non-invasive ventilation in acute respiratory failure ( Review)The Lancet, vol. 374, July 18, 2009 H22.9 The Lancet 2009 7 18 NPPV NIV: non-invasive ventilation review NPPV(Non-invasive