Diagnosis And Treatment Of Severe Pneumonia After Thoracotomy

Objective: Explore the risk factors of cardiothoracic surgery intensive care unit with severe pneumonia after thoracotomy and formulate the empirical treatment of pneumonia after thoracotomy strategy by analyzing pathogens under intensive care changes and changes in drug sensitivity. And to further explore the Pan-thoracotomy resistant Acinetobacter baumannii severe pneumonia, treatment and prognosis.Methods: Retrospective analysis of the First Affiliated Hospital of Soochow University, Cardiothoracic Surgery Intensive Care Unit from October 2006 to January 2010 158 patients after thoracotomy and a definite diagnosis can be pathogenic cases of pneumonia after thoracotomy information, which analyzed 58 information on cases of severe pneumonia cases. Logistic regression analysis to find the development of pneumonia after thoracotomy related risk factors; analysis of 158 cases of pneumonia after thoracotomy and drug resistance of pathogenic bacteria, and to explore reasonable empirical treatment strategies. While 19 cases for which the Pan-resistant Acinetobacter baumannii cases of severe pneumonia information, analysis and treatment and prognostic factors.Results: The incidence of severe pneumonia after thoracotomy was 1.99%, mortality rate was 37.93%. In severe pneumonia risk factors Logistic regression analysis, gender (male), age≥70 years, smoking index≥400 in support, low lung function, indwelling nasogastric tube, after antacids≥3d, situation before the 3rd postoperative pain (VAS score)≥5, there is surgery related complications, diabetes, obesity, and other indicators of operation time≥4h P> 0.05, overall poor health status (American Society of Anesthesiologists ASA classification≥Ⅲ) and inappropriate initial treatment P value <0.05. 2. thoracotomy in the pathogenesis of pneumonia, accounting for 74.48% Gram-negative bacteria, Gram-positive bacteria accounted for 13.54%, fungi accounted for 11.98% . Gram-negative pathogens in order to Acinetobacter, Klebsiella pneumoniae, Enterobacter, Pseudomonas aeruginosa, XM sp, Burkholderia cepacia is the most important of the six pathogens, antibiotic sensitivity analysis showed that these pathogens to cefazolin, ciprofloxacin, ceftazidime, cefepime, amikacin resistance has been more than 50%; October 2008 Pan-resistant Acinetobacter baumannii occurred bacillus pneumonia, carbapenems such bacteria have been largely ineffective. In addition to Acinetobacter baumannii other Gram-negative bacteria outside the current piperacillin-tazobactam and cefoperazone sulbactam resistance is relatively low.Conclusion: 1. The overall poor health status (ASA≥Ⅲ) and inappropriate initial treatment plan is developed pneumonia after thoracotomy common independent risk factors for severe pneumonia. 2. Gram-negative bacteria are major pathogens of pneumonia after thoracotomy, Gram-positive bacteria and fungi, the proportion of the rise. 3. Reduce carbapenem use increased anti-Pseudomonas penicillin class use, the incidence of Acinetobacter baumannii increased dosage or when the increase sulbactam combined minocycline is my current thoracic Intensive Care Unit Division postoperative pneumonia and empirical treatment strategies.