Diagnosis and Treatment of Nosocomial Pneumonia

Abstract

The usual concept of nosocomial pneumonia (NP) includes pneumonias in noncritically immunosuppressed patients initiating more than 48 h after hospital admission. Due to the differences in the clinical picture, microbial patterns, diagnostic strategies and antibiotic therapy, NP is divided into three types [1]: (1) hospital-acquired pneumonia (HAP) is defined as a new infection of the lung parenchyma while the patient is hospitalised. (2) Ventilator-associated pneumonia (VAP) refers to pneumonia that arises more than 48–72 h after endotracheal intubation. By contrast, ventilator-associated tracheobronchitits (VAT) is characterised by the presence of signs of respiratory infection, such as an increase in the volume and purulence of respiratory secretions, fever and leucocytosis in patients undergoing mechanical ventilation; however, unlike VAP, radiological infiltrates suggestive of consolidation on chest X-ray are not observed. (3) Health-care-associated pneumonia (HCAP) is a recently described term referring to patients who contract pneumonia while receiving health care in an outpatient facility. In an important study, Friedman et al. [2] showed that healthcare-associated bloodstream infections are more similar to nosocomial infections than to community-acquired infections. Kollef and colleagues [3] carried out a retrospective cohort study based on a large inpatient database of 4543 patients and found that the mortality of HCAP was 19.8%, similar that of HAP (18.8%), but not to that of CAP (10%).KeywordsRespir CritNosocomial PneumoniaRespiratory SecretionQuantitative CultureClinical Pulmonary Infection ScoreThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.