MỘT SỐ ĐẶC ĐIỂM LÂM SÀNG, CẬN LÂM SÀNG, VI KHUẨN ĐỜM Ở BỆNH NHÂN VIÊM PHỔI BỆNH VIỆN ĐIỀU TRỊ TẠI BỆNH VIỆN PHẠM NGỌC THẠCH THÀNH PHỐ HỒ CHÍ MINH

Quốc Việt Trần; Thanh Sang Trần

doi:10.59354/ydth175.2022.48

Keywords:

hospital – acquired pneumoniae, ventilator-associated pneumonia, Non - Ventilator-Associated Hospital- Acquired Pneumonia

Abstract

Objectives: To describe some clinical, paraclinical and sputum bacterial characteristics of patients with hospital – acquired pneumoniae (HAP) treated at Pham Ngoc Thach hospital, Ho Chi Minh city.

Subjects: 91 patients with HAP treated at Pham Ngoc Thach hospital, Ho Chi Minh city, including 44 patients with ventilator-associated pneumonia (VAP) and 47 patients with Non - Ventilator-Associated Hospital- Acquired Pneumonia (NV- HAP).

Methods: prospective and retrospective, cross – sectional study.

Results: - NV- HAP: fever (43.2%), septic shock (25%), consciousness disorder (52.3%), dyspnea (93.2%), cough (93.2%), purulent sputum (81.6%), hemoptysis (9.1%), tachypnea/ bradypea (95.5%), moist rales, dry rales (77.3%), pulmonary coagulation syndrome (43.2%). X-ray: pulmonary infiltrates (100%), pleural effusion (2.3%), multi-lobed lesions (95.3%). Blood test: white blood cell count: 17.55 ± 8.89, leukocytosis (77.3%), increaseed CRP concentration (72.7%). Blood gas: hypoxemic respiratory failure (23.1%), hypercapnic respiratory failure (15.4%). Sputum bacteria: Gram-negative bacteria (89.4%). Bacterial species isolated: K. pneumoniae (29.55%), A. baumannii (22.73%), E. coli (18.18%), P. aeruginosa (11.36%), S. aureus (9.09%).

- VAP: fever (23.4%), septic shock (53.4%), consciousness disorder (74.5%), dyspnea (93.6%), cough (85.1%), purulent sputum (66%), hemoptysis (6.4%), tachypnea/ bradypnea (91.5%), moist rales, dry rales (83%), pulmonary coagulation syndrome (19.1%). X-ray: pulmonary infiltrates (100%), pleural effusion (6.8%), cavernous (2.3%), multi-lobed lesions (97.7%). Blood test: white blood cell count: 18.72 ± 9.87, leukocytosis (83%), increased CRP concentration (94.1%). Blood gases: hypoxemic respiratory failure (31%), hypercapnic respiratory failure (33.3%). Sputum bacteria: Gram-negative bacteria (90.9%). Bacterial species isolated: K. pneumoniae (34.04%), A. baumannii (27.66%), E. coli (8.51%), P. aeruginosa (8.51%), B. cepacia (4.26%), S. maltophia (4.26%).

Conclusion: Common clinical symptoms in patients with HAP include fever, consciousness disorder, cough, dyspnea, purulent sputum, tachypnea/ bradypea, moist rales, dry rales and pulmonary coagulation syndrome. The proportion of patients with septic shock was quite high, 53.4% in VAP patients and 25% in NV- HAP patients.

All patients have infiltrative lesions on X-ray, most patients with VAP have multi-lobed lesions. The white blood cell count, proportion of Neutrophil and average CRP concentration were increased in patients with HAP. The proportion of patients with respiratory failure in the VAP patient group was higher than that in the NV-HAP patients group.

Most of the bacteria isolated were Gram-negative bacteria. The bacterial species isolated are K. pneumoniae, A. baumannii, E. coli, P. aeruginosa, B.cepacia, S. aureus.

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