Abstract
BackgroundNosocomial and ventilator-associated pneumonia (VAP) are causes of significant morbidity and mortality in hospitalized patients. We analyzed a) the incidence and the outcome of pneumonias caused by different pathogens in the intensive care unit (ICU) of a medium-sized twenty-four bed community hospital and b) the incidence of complications of such pneumonias requiring surgical intervention such as thoracotomy and decortication.ResultsWe retrospectively reviewed the charts of patients diagnosed with nosocomial and ventilator-associated pneumonia in our ICU. Their bronchoalveolar lavage (BAL) and sputum cultures, antibiograms, and other clinical characteristics, including complications and need for tracheostomy, thoracotomy and decortication were studied. In a span of one year (2011–12), 43 patients were diagnosed with nosocomial pneumonia in our ICU. The median simplified acute physiology score (SAPS II) was 39. One or more gram negative organisms as the causative agents were present in 85% of microbiologic samples. The three most prevalent gram negatives were Stenotrophomonas maltophilia (34%), Pseudomonas aeurginosa (40%), and Acinetobacter baumannii (32%). Twenty eight percent of bronchoalveolar samples contained Staphylococcus aureus. Eight three percent of patients required mechanical ventilation postoperatively and 37% underwent tracheostony. Thirty five percent underwent thoracotomy and decortication because of further complications such as empyema and non-resolving parapneumonic effusions. A. baumannii, Klebsiella pneumonia extended spectrum beta lactam (ESBL) and P. aeurginosa had the highest prevalence of multi drug resistance (MDR). Fifteen patients required surgical intervention. Mortality from pneumonia was 37% and from surgery was 2%.ConclusionNosocomial pneumonias, in particular the ones that were caused by gram negative drug resistant organisms and their ensuing complications which required thoracotomy and decortication, were the cause of significant morbidity in our intensive care unit. Preventative and more intensive and novel infection control interventions in reducing the incidence of nosocomial pneumonias are strongly emphasized.
Highlights
Nosocomial and ventilator-associated pneumonia (VAP) are causes of significant morbidity and mortality in hospitalized patients
We retrospectively studied the incidence of nosocomial pneumonia, including VAP, in our hospital intensive care unit, which is a medium-sized community hospital, for a period of one year
We further studied complications caused by pneumonia requiring surgical interventions of tracheostomy, thoracotomy, and decortications
Summary
Nosocomial and ventilator-associated pneumonia (VAP) are causes of significant morbidity and mortality in hospitalized patients. Nosocomial pneumonias, including ventilator-associated, are the leading cause of infections in a hospital setting. Their economic burden is financially significant, resulting in considerable resource utilization in an era of global financial constraint [1]. Aside from economic constraints, nosocomial pneumonias could be potentially fatal because of emergence of resistance pathogens. Incidence of gram negative organisms such as P. aureoginosa, S. multophilia, and K. pneumoniae in addition to methicillin resistant Saphylococcus aureus (MRSA) are on the rise [2,3]. The numbers are alarming especially when the resistance to potent antimicrobials such as quinolones and carbapenems is escalating [4,5]
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