Postoperatif pnömonide prognoz

Literatürdeki prognoz verileri postoperatif pnömoniden çok hastane kökenli pnömoni (HKP) ve ventilatör ilişkili pnömoniye (VİP) aittir. HKP ile ilişkili mortalitenin % 33-50 arasında olduğu, yoğun bakımda VİP tanılı hastalarda mortalitenin de 1.7 ile 4.4 kat daha fazla olduğu bildirilmiştir. Cerrahi hastalarda pnömoniyle ilişkilendirilen mortalite ise % 10-18 arasındadır. Bu hastalarda sigara içme öyküsü, düşük albümin düzeyi, preoperatif devrede uzun süre hastanede yatış, torasik ve üst abdomen operasyonları postoperatif pnömoni riskini artıran faktörlerdir. Postoperatif pnömoni için geliştirilen preoperatif risk indeksinin yüksek risk taşıyan hastaların belirlenmesinde yararlı olduğu bildirilmiştir. Pnömoniye bakteremi eşlik ederse, etken Pseudomonas aeruginosa ve Staphylococcus aureus ise, APACHE II skoru yüksekse, organ yetmezliği gelişirse mortalite artmaktadır. *25.ANKEM Antibiyotik ve Kemoterapi Kongresi, Yatay İnteraktif Kurs 1C sunularından (28 Nisan-02 Mayıs 2010, Kuzey Kıbrıs Türk Cumhuriyeti)

Prognosis in Postoperative Pneumonia

Data about prognosis in the literature is usually about hospital acquired pneumonia (HAP) and ventilator associated pneumonia (VAP) rather than postoperative pneumonia. It was reported that mortality in HAP was between 33-50 % and VAP in intensive care units increased mortality 1.7-4.4 times. Pneumonia related mortality in postoperative patients is between 10-18 %. In these patients, the factors increasing risk of postoperative pneumonia are smoking history, low albumin level, prolonged preoperative hospitalization, thoracic and upper abdominal surgery. It was reported that preoperative risk index for postoperative pneumonia was useful in determination of high risk patients. The factors increasing mortality are presence of bacteremia, Pseudomonas aeruginosa and Staphylococcus aureus pneumonia, high APACHE II score and presence of organ failure.

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