Cases Of Hospital-acquired Pneumonia Research Articles

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

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.

1181. Significant Reduction of Non-Ventilator Hospital-Acquired Pneumonia (HAP) with a Prevention Bundle and Clinical and Leadership Feedback in a Large Integrated Healthcare System

BackgroundNon-Ventilator Hospital-acquired Pneumonia (HAP) is a prevalent healthcare-associated infection with mortality of 21%. HAP prevention literature is scant. We developed a definition enabling accurate surveillance to support this effort and implemented a prevention bundle based on available literature and characteristics of our high-performing centers.MethodsKaiser Permanente Northern California is an integrated healthcare system providing care for 4.4 million patients at 21 medical centers. Discharge diagnoses of HAP cases were reviewed for accuracy and factors permitting programmatic confirmation. A natural language extraction program identified new and persisting imaging findings, providing specificity. No other surveillance factors added specificity. Surgery, altered mental status, sedation, albumin <3 g/dl and tube feedings were identified as predictive risks. Seven interventions became part of a new pneumonia prevention order set for automatically identified high-risk patients: aggressive mobilization, upright posture for meals, swallowing evaluation before feeding, sedation restriction, elevated head of bed, oral care and feeding tube care. The project was fully implemented in 2015.ResultsResults were reported by 1,000 admissions and by 100,000 members served, to address a rapidly growing population. HAP decreased from 5.92 to 1.79/1000 admissions and 24.57 to 6.49/100,000 members and HAP case mortality remained stable (18–19%) while overall HAP mortality decreased from 1.05 to 0.34/1000 admissions (4.37 to 1.24 /100,000 members) (Figure 1 and 2). Carbapenem, quinolone, aminoglycoside and vancomycin use all decreased significantly (Figure 3). Benzodiazepine use decreased from 10.4% of all inpatient-days in 2014 to 8.8% of inpatient-days in 2016.ConclusionHAP rates, mortality and broad-spectrum antibiotic use were all reduced significantly, despite the absence of clinical practice guidelines or strong supportive literature for guidance. Some interventions had limited support, but most augmented basic nursing care. None had risks of adverse consequences. This supports the need to examine practices to improve care despite absent literature and even more so supports a need to study these difficult nebulous areas of care. Disclosures All authors: No reported disclosures.

Differences in microbial etiology between hospital-acquired pneumonia and ventilator-associated pneumonia: a single-center retrospective study in Guang Zhou.

Purpose: Nosocomial pneumonia is a common nosocomial infection that includes hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia(VAP). It is an important cause of morbidity and mortality in hospitalized patients. This study aimed to evaluate the differences in microbial etiology and outcomes between HAP and VAP, particularly in related risk factors of multidrug-resistant organism (MDRO) causing HAP and VAP.Patients and methods: This single-center retrospective, observational study included patients with HAP/VAP. Clinical and epidemiological data of nosocomial pneumonia confirmed by microbial etiology that occurred in the Third Affiliated Hospital of Sun Yat-sen University, China, from January 2014 to December 2017 were obtained.Results: A total of 313 HAP cases and 106 VAP cases were included. The leading pathogens of HAP and VAP were similar, including Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae. Antimicrobial susceptibility of the pathogens was low, and P. aeruginosa in VAP was less susceptible. In the multivariate logistic regression analysis, the risk factors associated with MDRO-HAP were chronic obstructive pulmonary disease, antibiotic therapy in the preceding 90 days, and prior endotracheal tracheostomy. The risk factor of MDRO-VAP was ≥5 days of hospitalization. The 30-day mortality rates of HAP and VAP were 18.5% and 42.5%.Conclusion: The leading pathogens were similar in both HAP and VAP, and antimicrobial susceptibility of the pathogens was low. The risk factors associated with MDRO infection in HAP and VAP have significant variability; hence, attention should be paid to improve prognosis. VAP was associated with poorer outcomes compared with HAP.

Monitoring of hospital acquired pneumonia in patients with severe brain injury on first access to intensive neurological rehabilitation: First year of observation.

Nosocomial or hospital acquired pneumonia (HAP) is an illness contracted during a hospital stay, generally with onset 48 hours or more after admission to hospital, or within 14 days of discharge from hospital. HAP is divided into subgroups: Ventilator-associated pneumonia (VAP), accounting for 86% of hospital acquired pneumonia, and stroke-associated pneumonia (SAP). The incidence of SAP in neurological intensive care units (NICUs) is 4.1-56.6%, in medical intensive care units (MICUs) it is 17-50%, in stroke units it is 3.9-44% and in rehabilitation it is 3.2-11%, whereas in intensive rehabilitation following severe cranial trauma, the reported incidence of HAP is between 3.9 and 12% of cases. The aim of this study is to evaluate the cases of HAP occurring in a continuous series of patients with severe acquired brain injury (sABI) admitted to intensive rehabilitation units. The data collected can help evaluate the growing complexity of early rehabilitation of these patients, starting from how lung infections interfere with hospital stays and rehabilitation outcomes. This prospective observational cohort study evaluates, from 01/01/2015 to 31/12/2015, for patients with sABI on first admission to intensive neurological rehabilitation, the frequency of HAP and its impact on patient outcomes and complexity of care. A total of 61 patients were enrolled: 39 males and 22 females, average age 59.5 years (17-88 yrs, SD 3.53), coming from critical care (n=52), medical units (n=5), neurosurgery (n=3) and surgical units (n=1). The aetiology of hospital admission was haemorrhagic in 36% of cases, traumatic in 36%, anoxic in 13.1%, infectious in 6.5%, ischaemic in 4.9%, and other causes in 3.2%. Among the patients, 93.44% had received antibiotic therapy in their unit of provenance, and in 61.27% of cases a multidrug resistant (MDR) bacterium was isolated. On enrolment, 26 patients presented respiratory insufficiency, 29 subjects were in oxygen therapy, and 4 under invasive mechanical ventilation. There were 54 tracheostomized patients, 33 patients with percutaneous endoscopic gastrostomy (PEG) tubes, and 23 with nasogastric (NG) tubes. In 2015, among these subjects admitted to neurological rehabilitation, the incidence of HAP was 13.1%. For these 8 pneumonia cases, it was possible to isolate the bacterium in 62.5% of cases, and the detected microorganisms were K. pneumoniae (n=2), P. aeruginosa (n=1), P. mirabilis (n=1), S. maltophilia (n=1), E. cloacae + MRSCoN (n=1). Compared to the literature data, the results of the first year of monitoring show a slight increase in HAP cases (13.1%) in severe brain injury patients on first admission to neurological rehabilitation. These preliminary results need to be further confirmed and monitored over time. The findings moreover confirm the criticality and complexity of care for these patients admitted to neurological rehabilitation units.

The Power of a Toothbrush

The Power of a Toothbrush

Utility of procalcitonin in predicting mortality among cases of hospital-acquired pneumonia: a North Indian study

Bckground Data regarding the role of biomarkers like procalcitonin (PCT) in predicting treatment outcomes in hospital-acquired pneumonia (HAP) are limited in an Indian setting. We set out to determine the usefulness of PCT in predicting mortality among the cases of nosocomial pneumonia, at an 800-bed, apex tertiary care centre, in Kashmir (North India). Patients and methods Of the 318 confirmed cases of HAP, 60 consenting cases were selected randomly. Quantitative determination of PCT was done using immunofluorescence assays. Levels greater than 0.5 ng/ml were taken as positive. Data were collected on clinical parameters, and Acute Physiology and Chronic Health Evaluation II (APACHE-II) scores pneumonia severity index were calculated. Appropriate blood and respiratory cultures were performed. Results Of the 60 cases included in the study, 19 (32%) died during the hospital stay, of which 14 (74%) deaths occurred in PCT-positive cases (P=0.001). The median PCT level was higher in the in-hospital mortality group (1.07 vs. 0.25), with a mean value of 1.2±2.8 vs. 1.2±2.5 in the group with no mortality (P=0.000). Using multivariate analysis, positive PCT level was strongly associated with in-hospital mortality (odds ratio: 6.767, 95%CI: 1.992–22.984, P=0.002) and APACHE-II score greater than 20 (n=14, odds ratio=4.5, 95%CI=1.448–13.984, P=0.009). Using receiver operating characteristic analysis, PCT had apropos discrimination power for in-hospital mortality (0.713 of area under the curve) and higher APACHE-II scores (0.753 of area under the curve). Using Cox regression model for mortality in PCT-positive group, the calculated hazard ratio was 3.273 (95%CI: 1.076–9.951, P=0.037). Conclusion PCT might have a vital role in the management of HAP, as a predictor of the poor treatment outcome.

The Diagnostic Yield of Noninvasive Microbiologic Sputum Sampling in a Cohort of Patients with Clinically Diagnosed Hospital‐Acquired Pneumonia

The clinical predictors of positive sputum culture have not been previously reported in hospital-acquired pneumonia (HAP), and data on yield of sputum culture in this setting are scant. Current Infectious Disease Society of America guidelines for HAP recommend noninvasive sputum sampling, though the data for this practice are limited. We assessed the yield of sputum culture in HAP cases at an academic medical center from January 2007 to July 2013. HAP cases were identifi ed by International Classifi cation of Diseases, Ninth Revision-Clinical Modifi cation codes for bacterial pneumonia and all cases were validated by chart review. Our cohort had 1172 hospitalizations with a HAP diagnosis. At least 1 sputum specimen was collected noninvasively and sent for bacterial culture after hospital day 2 and within 7 days of HAP diagnosis in 344 of these hospitalizations (29.4%), with a total of 478 sputum specimens, yielding 63 (13.2%) positive, 109 (22.8%) negative, and 306 (64.0%) contaminated cultures (>10 epithelial cells per high power fi eld). Signifi cant predictors of a positive sputum culture were chronic lung disease (relative risk [RR] = 2.0; 95% confi dence interval [CI], 1.2-3.4) and steroid use (RR = 1.8; 95% CI, 1.1-3.2). The most commonly identifi ed organisms were Gram-negative rods not further speciated (25.9%), Staphylococcus aureus (21.0%), and Pseudomonas aeruginosa (14.8%). Because of the ease of obtaining a sputum sample combined with the prevalence of commonly drug-resistant organisms, we suggest that sputum culture in HAP is a potentially useful noninvasive diagnostic technique.

Clonality of Bacterial Pathogens Causing Hospital-Acquired Pneumonia.

Hospital-acquired pneumonia (HAP) is one of the most serious complications in patients staying in intensive care units. This multicenter study of Czech patients with HAP aimed at assessing the clonality of bacterial pathogens causing the condition. Bacterial isolates were compared using pulsed-field gel electrophoresis. Included in this study were 330 patients hospitalized between May 1, 2013 and December 31, 2014 at departments of anesthesiology and intensive care medicine of four big hospitals in the Czech Republic. A total of 531 bacterial isolates were obtained, of which 267 were classified as etiological agents causing HAP. Similarity or identity was assessed in 231 bacterial isolates most frequently obtained from HAP patients. Over the study period, no significant clonal spread was noted. Most isolates were unique strains, and the included HAP cases may therefore be characterized as mostly endogenous. Yet there were differences in species and potential identical isolates between the participating centers. In three hospitals, Gram-negative bacteria (Enterobacteriaceae and Pseudomonas aeruginosa) prevailed as etiological agents, and Staphylococcus aureus was most prevalent in the fourth center.

Abstract NS3: Oral Care Program Decreases Length of Stay (LOS) and Length of Time Oral Foods and Fluids are Withheld (NPO) in Stroke Patients

Background: Nosocomial infections, specifically pneumonia have consequences financially for the hospital as well as physically and emotionally for the patient and their family. Consistent oral care, a fundamental standard of nursing care, and evaluation of ability to swallow are essential to allow patients to progress to wellness during their acute hospital stay after a stroke. Purpose: The purpose of this study was to determine the efficacy of an oral care program for stroke patients. Research Questions: 1. In non-ventilated stroke patients, will an oral care program reduce the length of NPO status? 2. In non-ventilated stroke patients, what is the effect of an oral care program on LOS? Methods: This was a quasi-experimental study using a convenience sample. The impact of oral care for stroke patients on LOS and NPO status was reviewed pre- (n=33) and post- (n=51) implementation of an oral care program. The oral care program included a Hospital-acquired Pneumonia (HAP) Risk Assessment tool and specific interventions based on the score determined by the tool. Assessment included oral, chewing/swallowing , feeding/oral self-care, and conditions that resulted in a “high risk” score. Measures included length of NPO status per 100 patient days, LOS using descriptive statistics, and the difference in means from initial to final score using a Paired Samples t-Test. Results: The length of NPO status per 100 patient days decreased from 23.07 to 3.3 (85.7%). The LOS mean decreased from 9.45 to 6.92 days (26.8%). No HAP cases were present in the pre-or post-intervention groups. The initial HAP Risk Assessment scores improved from a 1.09 mean to 0.73 for the final HAP risk score (t =1.345, p =0.185 [2-tailed], SEM =0.264, n =45). Conclusions: The program showed improvement in NPO status, a decreased LOS and improved HAP risk scores from initial to final. Further testing of the tool and interventions is indicated using a larger sample.

Post-Legionellosis Proliferative Glomerulonephritis

To the Editor: Today in developed countries, infection-related glomerulonephritides are incommon and often associated with debilitating diseases. Legionnaires’ disease (LD) is one of the most common causes of severe community-acquired acute pneumonia in Europe and in up to 40% of cases of hospital-acquired pneumonia. The acute kidney injury (AKI) in LD is a well described complication but the renal morphology has only been reported in a few cases. The Tubulointerstitial Nephritis (TIN) is the most diagnosed histological change; instead, there [...]

Risk factors for hospital-acquired pneumonia outside the intensive care unit: A case-control study

Hospital-acquired pneumonia (HAP) is one of the leading nosocomial infections and is associated with high morbidity and mortality. Numerous studies on HAP have been performed in intensive care units (ICUs), whereas very few have focused on patients in general wards. This study examined the incidence of, risk factors for, and outcomes of HAP outside the ICU. An incident case-control study was conducted in a 600-bed hospital between January 2006 and April 2008. Each case of HAP was randomly matched with 2 paired controls. Data on risk factors, patient characteristics, and outcomes were collected. The study group comprised 119 patients with HAP and 238 controls. The incidence of HAP outside the ICU was 2.45 cases per 1,000 discharges. Multivariate analysis identified malnutrition, chronic renal failure, anemia, depression of consciousness, Charlson comorbidity index ≥3, previous hospitalization, and thoracic surgery as significant risk factors for HAP. Complications occurred in 57.1% patients. The mortality attributed to HAP was 27.7%. HAP outside the ICU prevailed in patients with malnutrition, chronic renal failure, anemia, depression of consciousness, comorbidity, recent hospitalization, and thoracic surgery. HAP in general wards carries an elevated morbidity and mortality and is associated with increased length of hospital stay and increased rate of discharge to a skilled nursing facility.

Does Antibiotic De-escalation for Nosocomial Pneumonia Impact Intensive Care Unit Length of Stay?

Background Hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), and health care–associated pneumonia (HCAP) are associated with substantial morbidity, mortality, and costs in the intensive care unit (ICU). The impact of antibiotic de-escalation on resource utilization, namely, length of stay (LOS) and cost of hospitalization, was investigated. Methods A retrospective chart review was conducted from ICU admission of adult patients with a presumptive diagnosis of HAP, VAP, or HCAP in the 2009–2010 year. American Thoracic Society/Infectious Disease Society of America definitions for HAP, VAP, or HCAP were used. Eligible patients had blood and/or respiratory cultures collected before institution of empiric antibiotics. De-escalation required discontinuation of one or more empiric agent or change to narrower-spectrum antibiotic. The primary end point was the effect of antibiotic de-escalation on ICU LOS. Results One hundred thirteen patients, representing 117 cases of HCAP, HAP, and VAP, met eligibility criteria. De-escalation was performed in 73 (62%) of pneumonias. De-escalated patients were more likely to be older (65.1 [SD, 16.8] vs 57.6 [SD, 19] years, P Conclusions Although ICU LOS was not significantly different in this study, de-escalation was associated with significant reduction in resource utilization. In ICU patients with HCAP, HAP, or VAP, de-escalation affords an opportunity to improve antimicrobial stewardship and decrease resource utilization at no detriment to clinical outcome.

A Retrospective Analysis of 111 Cases of Pneumococcal Pneumonia: Clinical Features and Prognostic Factors

Streptococcus pneumoniae is an important and common pathogen of acute pneumonia. The urinary pneumococcal antigen test has been increasingly used for the diagnosis of pneumococcal pneumonia, but there have been few studies on pneumococcal pneumonia after this test became prevalent. The present study was conducted to characterize the clinical features of pneumococcal pneumonia after the introduction of the urinary antigen test. We retrospectively analyzed 111 cases from 105 patients with pneumococcal pneumonia in our hospital between 2007 and 2010, and collected data regarding background characteristics, laboratory data, isolated bacteria, and clinical courses. The cases analysed included 77 of community-acquired pneumonia (CAP), 21 of healthcare-associated pneumonia (HCAP), and 13 of hospital-acquired pneumonia (HAP). Penicillin-resistant Streptococcus pneumoniae was isolated in 12.5 and 55.6% of non-HAP and HAP cases, respectively. When the cases were divided into 5 groups according to A-DROP scores (0, 1, 2, 3 and 4 points), critical events occurred at 0, 0, 8.7, 15.4, and 75.0% in groups of cases of 0, 1, 2, 3, and 4 points, respectively. Similarly, critical events occurred at 66.7, 4.7, 3.8, and 9.1% in groups of cases according to WBC counts of <4,000, 4,000-9,999, 10,000-19,999, and ≥20,000 cells/µL, respectively. Most of the pneumococcal pneumonia cases occurred as CAP and were treated successfully. HAP cases were frequently penicillin resistant. Elevated A-DROP scores and decreased WBC counts were found to be predictive of critical events.

High Prevalence of Multidrug-Resistant Nonfermenters in Hospital-acquired Pneumonia in Asia

Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) remain important causes of morbidity and mortality. Increasing antimicrobial resistance has aroused the concern of the failure of antibiotic treatment. To determine the distribution of the bacterial isolates of HAP and VAP, their antimicrobial resistance patterns, and impact of discordant antibiotic therapy on clinical outcome in Asian countries A prospective surveillance study was conducted in 73 hospitals in 10 Asian countries from 2008-2009. A total of 2,554 cases with HAP or VAP in adults were enrolled and 2,445 bacterial isolates were collected from 1,897 cases. Clinical characteristics and antimicrobial resistance profiles were analyzed. Major bacterial isolates from HAP and VAP cases in Asian countries were Acinetobacter spp., Pseudomonas aeruginosa, Staphylococcus aureus, and Klebsiella pneumoniae. Imipenem resistance rates of Acinetobacter and P. aeruginosa were 67.3% and 27.2%, respectively. Multidrug-resistant rates were 82% and 42.8%, and extensively drug-resistant rates were 51.1% and 4.9%. Multidrug-resistant rate of K. pneumoniae was 44.7%. Oxacillin resistance rate of S. aureus was 82.1%. All-cause mortality rate was 38.9%. Discordant initial empirical antimicrobial therapy increased the likelihood of pneumonia-related mortality (odds ratio, 1.542; 95% confidence interval, 1.127-2.110). Acinetobacter spp., P. aeruginosa, S. aureus, and K. pneumoniae are the most frequent isolates from adults with HAP or VAP in Asian countries. These isolates are highly resistant to major antimicrobial agents, which could limit the therapeutic options in the clinical practice. Discordant initial empirical antimicrobial therapy significantly increases the likelihood of pneumonia-related mortality.

Impact of inappropriate antimicrobial therapy on outcome in patients with hospital-acquired pneumonia caused by Acinetobacter baumannii

The purpose of this study was to evaluate the impact of inappropriate antimicrobial therapy on the outcome of patients with hospital-acquired pneumonia (HAP) caused by Acinetobacter baumannii. All cases of HAP caused by A. baumannii from January 2000 to March 2006 at the Samsung Medical Center (Seoul, Korea) were analyzed retrospectively. A total of 116 patients with clinically significant Acinetobacter HAP were enrolled. Among the A. baumannii isolates, 60.3% showed multi-drug resistance (MDR), 16.4% were found to have imipenem resistance, and 15.5% had pan-drug resistance (PDR). The mean APACHE II score of the patients was 22.3 +/- 7.9. The overall in-hospital and pneumonia-related mortality rates were 47.4% and 37.9%, respectively. The univariate analysis showed that the factors associated with pneumonia-related mortality were: MDR, PDR, high APACHE II score, inappropriate empirical antimicrobial therapy, and inappropriate definitive antimicrobial treatment (All p < 0.05). Among these, a high APACHE II score and inappropriate definitive antimicrobial therapy were found to be independent factors associated with a high mortality, after adjustment for other variables. The appropriate definitive antimicrobial therapy should be provided in patients with HAP caused by A. baumannii.

Use of antimicrobials in aged people and patients with decreased renal function

Respiratory infections develop easily in aged people and are often difficult to treat. Renal function is poorer in aged people than in healthy adults, and the half-life of antimicrobials in blood is longer. General weight loss is present in many cases, and care needs to be taken in determining dosage. A high possibility exists for hospital-acquired pneumonia to become serious, particularly in aged people, and appropriate antimicrobials should be selected. Body weight and renal function must be considered when setting dosages, and use of 50-70% of the amount used in healthy adults is common. Side-effects are no different to those in healthy adults, but care is needed due to insufficient reserve capacity in aged people and a tendency for diseases to become serious due to the reluctance of aged patients to complain.

Adjuvant therapy with steroids or immunoglobulins

Chemotherapy with antimicrobials is the basic treatment for pneumonia. Compared with community-acquired pneumonia, more cases of hospital-acquired pneumonia develop serious complications with ALI/ARDS, disseminated intravascular coagulation (DIC) or other conditions, and in many cases a number of drugs are used as adjuvant therapies. Adjuvant therapies include steroids, immunoglobulins, granulocyte-colony stimulating (G-CSF), blood purification and neutrophil elastase inhibitors. Little evidence has been accumulated in favour of these adjuvant therapies in pneumonia and their use is left to the discretion of the physician, but the indications should be considered carefully and general use avoided.

BACTEREMIC HOSPITAL-ACQUIRED PNEUMONIA CASES FROM THE ATTAIN STUDIES

PURPOSE: The ATTAIN program compared telavancin (TLV), an investigational lipoglycopeptide antibiotic, with vancomycin (VAN) for treatment of hospital-acquired pneumonia (HAP) due to Gram-positive pathogens including MRSA. This subgroup analysis examined the baseline characteristics and clinical outcomes in bacteremic HAP cases.

Epidemiology, etiology, and diagnosis of hospital-acquired pneumonia and ventilator-associated pneumonia in Asian countries

Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are significant public health issues in Asian countries, as they are worldwide. Mortality attributable to HAP and especially VAP can be very high. The present review aims to determine whether the incidence and prevalence of HAP and VAP are higher in Asian countries than in Western countries, whether the organisms causing these nosocomial infections differ etiologically, and whether they are more difficult to treat (ie, demonstrate greater resistance). The implementation of available guidelines can be best achieved through an understanding of local epidemiology, etiology, and resistance patterns, which can facilitate optimal treatment choices. The current review presents data on epidemiology, etiology, and diagnosis of HAP and VAP drawn from an expert panel of clinicians representing 10 Asian countries.

Hospital-Acquired Pneumonia: Risk Factors, Microbiology, and Treatment

Pneumonia complicates hospitalization in 0.5 to 2.0% of patients and is associated with considerable morbidity and mortality. Risk factors for hospital-acquired pneumonia (HAP) include mechanical ventilation for > 48 h, residence in an ICU, duration of ICU or hospital stay, severity of underlying illness, and presence of comorbidities. Pseudomonas aeruginosa, Staphylococcus aureus, and Enterobacter are the most common causes of HAP. Nearly half of HAP cases are polymicrobial. In patients receiving mechanical ventilation, P aeruginosa, Acinetobacter, methicillin-resistant S aureus, and other antibiotic-resistant bacteria assume increasing importance. Optimal therapy for HAP should take into account severity of illness, demographics, specific pathogens involved, and risk factors for antimicrobial resistance. When P aeruginosa is implicated, monotherapy, even with broad-spectrum antibiotics, is associated with rapid evolution of resistance and a high rate of clinical failures. For pseudomonal HAP, we advise combination therapy with an antipseudomonal beta-lactam plus an aminoglycoside or a fluoroquinolone (eg, ciprofloxacin).