Hospital-Acquired Pneumonia in a Multipurpose Intensive Care Unit: One-Year Prospective Study.

Abstract

Hospital-acquired pneumonia continues to be a frequent complication in the intensive care unit and an important causeof admission in the intensive care unit. The aim of our study was to evaluate the demography, incidence, risk factors, causative bacterialpathogens and outcome of all episodes of Hospital-acquired pneumonia in our unit. Prospective observational study, at a tertiary university hospital during one year (2014) including all the casesof hospital-acquired pneumonia in the intensive care unit. Sixty patients were identified with pneumonia. Thirty-five (58.3%) had an intensive care unit acquired pneumonia, correspondingto 6.9 cases/1000 intubation-days. Antibiotic treatment in the previous 30 days was present in 75% of the cases. The incidence ofStaphylococcus aureus, Pseudomonas aeruginosa and Acinetobacter baumannii was 26.2%, 20.0% and 9.2%, respectively. Patientswith late-onset hospital-acquired pneumonia (≥ 7 days) showed higher frequency of non-fermenting Gram-negative bacilli isolates,and methicillin-resistant S. aureus. Combination therapy was performed in 67.0%, and de-escalation in 18.3%. The mortality rate was18.3%. The adjusted odds ratio for intensive care unit mortality in the group of patients with non-intensive care unit acquired pneumoniawas 5.2 (95% CI of 1.02 - 22.10; p = 0.046). The knowledge of local bacterial flora and resistance patterns is of crucial importance and strongly recommended. Thisevidence increases the probability of success of empiric antibiotic therapy. S. aureus was the predominant causative agent of nosocomial pneumonia. The most frequent risk factor identified forinfection with multidrug-resistant organisms was previous treatment with antibiotics. Multidrug-resistant organisms were present in 45%of documented hospital-acquired pneumonias. In admitted patients with non-intensive care unit acquired pneumonia, the intensive careunit mortality rate was nearly five times higher compared to intensive care unit acquired pneumonia.