每日一题_2022.08.04

A young adult is found unresponsive at a party with dried gastric contents around his mouth. His teeth are in good repair. He is intubated without difficulty for poor airway protection and empirically given clindamycin and ampicillin/sulbactam for community- acquired aspiration pneumonia. He is extubated on day two. He reports a sore throat and productive cough of clear phlegm. Oxygen saturation is 95% on 2 L/min nasal cannula. Maximal temperature is 38°C (100.4°F). Laboratory results are normal except for white blood cell count of 12,000/μL and procalcitonin level of 1.2 μg/L. Blood culture results are negative. Chest radiography reveals improved pulmonary infiltrates. He wants to sign out against medical advice.

Which of the following are the most likely diagnosis and the best recommendation regarding antibiotics?

A. Aspiration pneumonia, no antibiotics

B. Aspiration pneumonia, oral antibiotics

C. Aspiration pneumonia, parenteral antibiotics

D. Chemical (aspiration) pneumonitis, no antibiotics

E. Chemical (aspiration) pneumonitis, oral antibiotics

答案解析：

无病史的年轻、健康个体在聚会时无反应，并出现误吸体征。给予经验性抗生素治疗误吸，临床迅速改善，包括拔管、最低需氧量和缓慢改善浸润。尽管他患有白细胞增多和低热，但根据当前临床结果，认为他患有吸入性pneumonitis，而不是吸入性pneumonia。不幸的是，目前在区分这两种诊断方面还没有金标准。许多临床医生根据经验使用抗生素治疗吸入性肺炎，但如果患者患有吸入性肺炎，这不是推荐的实践。目前，重症监护中的综合征和吸入性肺炎 (SPIRE) 研究正在检查入住 ICU 需要机械通气伴昏迷患者的细菌性肺炎频率。降钙素原水平升高提示患者确实存在细菌感染，但在区分细菌性吸入性肺炎和吸入性肺炎方面没有良好的诊断价值。

正确答案：D