Incidence Of Hospital-acquired Pneumonia Research Articles

Risk factors for hospital-acquired pneumonia in hip fracture patients: A systematic review and meta-analysis.

This study aimed to comprehensively assess the prevalence and risk factors for Hospital-acquired pneumonia (HAP) in hip fracture patients by meta-analysis. Systematically searched 4 English databases and 4 Chinese databases from inception until October 20, 2022. All studies involving risk factors of HAP in patients with hip fractures will be considered. Newcastle-Ottawa Scale was used to evaluate the quality of the included studies. The results were presented through Review Manager 5.4 with the pooled odds ratio (OR) and 95% confidence interval. Of 35 articles included in this study, the incidence of HAP was 8.9%. 43 risk factors for HAP were initially included, 23 were eventually involved in the meta-analysis, and 21 risk factors were significant. Among them, the 4 most frequently mentioned risk factors were as follows: Advanced age (OR 1.07, 95% CI 1.05-1.10), chronic obstructive pulmonary disease (COPD) (OR 3.44, 95% CI 2.83-4.19), time from injury to operation (OR 1.09, 95% CI 1.07-1.12), time from injury to operation ≥ 48 hours (OR 3.59, 95% CI 2.88-4.48), and hypoalbuminemia < 3.5g/dL (OR 2.68, 95% CI 2.15-3.36). Hip fracture patients diagnosed with COPD have a 3.44 times higher risk of HAP compared to the general hip fracture patients. The risk of HAP also increases with age, with patients over 70 having a 2.34-fold higher risk and those over 80 having a 2.98-fold higher risk. These findings highlight the need for tailored preventive measures and timely interventions in vulnerable patient populations. Additionally, hip fracture patients who wait more than 48 hours for surgery have a 3.59-fold higher incidence of HAP. This emphasizes the importance of swift surgical intervention to minimize HAP risk. However, there are limitations to consider in this study, such as heterogeneity in selected studies, inclusion of only factors identified through multivariate logistic regression, and the focus on non-randomized controlled trial studies.

Risk factors for hospital-acquired pneumonia in hip fracture patients: a systematic review and meta-analysis

ObjectiveThis study aimed to systematically assess the incidence and risk factors for hospital-acquired pneumonia (HAP) in hip fracture patients by meta-analysis.MethodsSystematically searched four English databases (PubMed, EMBASE, The Cochrane Library, and Web Of Science) and four Chinese databases (CNKI, CQVIP, Sinomed, and WAN FANG) from inception until 20 November 2023. All studies involving risk factors of HAP in patients with hip fractures were considered. Newcastle-Ottawa Scale was used to evaluate the quality of the included studies. The results were presented with the pooled odds ratio (OR) and 95% confidence interval (95% CI).ResultsOf 35 articles (337,818 patients) included in this study, the incidence of HAP was 89 per 1000 cases. Twenty-three risk factors were eventually involved in the meta-analysis, and 21 risk factors were significant. Our study has identified four significant risk factors (advanced age, preoperative time, COPD, and hypoalbuminemia) associated with HAP, as follows: Advanced age as a continuous variable (OR 1.07, 95% CI 1.05–1.10), Advanced age > 70 years (OR 2.34, 95% CI 1.77–3.09), Advanced age > 80 years (OR 2.98, 95% CI 2.06–4.31), Chronic obstructive pulmonary disease (COPD) (OR 3.44, 95% CI 2.83–4.19), Time from injury to operation as a continuous variable (OR 1.09, 95% CI 1.07–1.12), Time from injury to operation ≥48 h (OR 3.59, 95% CI 2.88–4.48), Hypoalbuminemia < 3.0 g/dL (OR 3.03, 95% CI 1.93–4.73), and Hypoalbuminemia < 3.5 g/dL (OR 2.68, 95% CI 2.15–3.36). However, it is important to note that all the studies included in our research were retrospective in nature, which introduces certain limitations to the level of evidence and the ability to establish causal inferences.DiscussionPatients who have suffered hip fractures are at an increased risk of developing postoperative hospital-acquired pneumonia, which can lead to prolonged hospital stays and adverse clinical outcomes. Consequently, the identification of these risk factors offers novel insights and methodologies for healthcare professionals in terms of both prevention and treatment.Trial registrationRegistration number: INPLASY2022100091.

Association between nurse staffing level in intensive care settings and hospital-acquired pneumonia among surgery patients: result from the Korea National Health Insurance cohort.

This study examined the association between the number of nursing staff in intensive care units (ICUs) and hospital-acquired pneumonia (HAP) among surgical patients in South Korea. Data were obtained between 2008 and 2019 from the Korean National Health Insurance Service Cohort Database; 37,706 surgical patients who received critical care services were included in the analysis. Patients with a history of pneumonia 1 year prior to surgery or those who had undergone lung-related surgery were excluded. The ICU nursing management fee is an admission fee that varies based on the grading determined by nurse-to-bed ratio. Using this grading system, we classified four groups from the highest to the lowest level based on the proportion of beds to nurses (high, high-mid, mid-low, and low group). HAP was defined by the International Classification of Disease, 10th revision (ICD-10) code. Multilevel logistic regression was used to investigate the relationship between the level of ICU nurse staffing and pneumonia, controlling for variables at the individual and hospital levels. Lower levels of nurse staffing were associated with a greater incidence of HAP than higher levels of nurse staffing (mid-high, OR: 1.33, 95% CI: 1.12-1.57; mid-low, OR: 1.61, 95% CI: 1.27-2.04; low, OR: 2.13, 95% CI: 1.67-2.71). The intraclass correlation coefficient value was 0.177, and 17.7% of the variability in HAP was accounted for by the hospital. Higher ICU nursing management fee grades (grade 5 and above) in general and hospital settings were significantly associated with an increased risk of HAP compared to grade 1 admissions. Similarly, in tertiary hospitals, grade 2 and higher ICU nursing management fees were significantly associated with an increased risk of HAP compared to grade 1 admissions. Especially, a lower level of nurse staffing was associated with bacterial pneumonia but not pneumonia due to aspiration. In conclusion, this study found an association between the level of ICU nurse staffing and HAP among surgical patients. A lower level of nurse staffing in the ICU was associated with increased rates of HAP among surgical patients. This indicates that having fewer beds assigned to nurses in the ICU setting is a significant factor in preventing HAP, regardless of the size of the hospital.

Low Phase Angle and Skeletal Muscle Index Increase Hospital-Acquired Infections During Stroke Rehabilitation

ObjectivesSarcopenia is common in patients with stroke and may increase the risk of medical complications such as infection. However, assessing sarcopenia in stroke patients with consciousness disturbance, aphasia or severe paralysis is challenging. This study aimed to investigate whether a combined assessment of phase angle (PhA) and skeletal muscle index (SMI), estimated using bioelectrical impedance analysis, was associated with 2 common nosocomial infections, hospital-acquired pneumonia (HAP) and urinary tract infection (UTI), during inpatient stroke rehabilitation. DesignSingle-center retrospective observational study. Settings and ParticipantsA total of 1068 patients with stroke admitted to a rehabilitation hospital between January 2016 and September 2019 were analyzed. MethodsThe study variables included demographic characteristics, comorbidities, stroke severity, blood chemistry and urine analysis, SMI, and PhA obtained using bioelectrical impedance analysis. Patients were classified as normal, low PhA only, low SMI only, and low PhA + SMI. Multivariate Cox proportional analysis was used to determine the variables associated with HAP and UTI. ResultsA combination of low PhA + SMI was observed in 429 (40.2%) patients. Over a median follow-up duration of 46 days, HAP occurred in 187 patients (17.5%) and UTI occurred in 155 patients (14.5%). The low PhA + SMI group showed a significantly higher incidence of HAP and UTI than the normal group (32.6% vs 4.6%, P < .001, for HAP; 20.7% vs 6.2%, P < .001, for UTI). In multivariate Cox analyses, low PhA and SMI were associated with significantly higher rates of HAP [hazard ratio (HR) 3.36, 95% CI 1.796-6.304, P < .001] and UTI (HR 1.71, 95% CI 1.002-2.947, P < .05) after adjusting for confounding variables. Conclusions and ImplicationsCombination of low PhA + SMI was independently associated with a higher risk of HAP and UTI in stroke patients who underwent inpatient rehabilitation. Measuring PhA and SMI using bioelectrical impedance analysis might be helpful in establishing care plans in these population.

OGC P39 The accuracy of Hospital Acquired Pneumonia (HAP) Diagnosis after Oesophagectomy

Abstract Background Oesophagectomy is a high-risk intervention associated with significant rates of morbidity. Pneumonia is a complex spectrum of infective and non-infective aetiology, varying in severity and is common after oesophagectomy. Inconsistent definitions of pulmonary complications pose significant challenges in both the clinical and research setting. The internal Esophageal Consensus Complications Group (ECCG) have adopted the Centre for Disease Control (CDC) criteria for HAP diagnosis to address this. However, other validated diagnostic criteria are also available. This study aimed to better understand the incidence of HAP after oesophagectomy, and the accuracy of four validated diagnostic tools. Methods This was a retrospective review of all consecutive oesophagectomies undertaken at a regional OG centre serving a population of 3.5 million patients between 2014-2022. Datapoints included patient demographics; comorbidities; post-operative course and re-admissions. The timing of pneumonia diagnosis was determined in the post-operative period, alongside observations and Computed Tomography (CT) and Chest X-Ray (CXR) reports. Four diagnostic criteria (Centres for Disease control- CDC, American Thoracic Society - ATS, Utrecht and Clinical Pulmonary Infection Score - CPIS) were applied to determine the incidence of HAP in comparison to patients treated for HAP. Statistical tests were performed in STATA. Results 460 patients were included, 356 (77.40%) were male. 223 (48.5%) were treated for HAP between 2014-2022. 56 (12.2%) met the CDC criteria. Mean days to diagnosis was 5 days (SD +/- 3.72). Diagnostic sensitivity and specificity for HAP was 88.89%, and 50.15% respectively. The ATS criteria were met by 79 patients (17.2%), showing a similar sensitivity (97.53%) and specificity (92.02%) to the CDC criteria. The Utrecht criteria had the lowest specificity (75.20%) for HAP diagnosis. 192 patients had sputum samples; 158 (82.29%) were culture positive. 52 patients were re-intubated, of which 29 (55.8%) were reintubated due to respiratory failure. Conclusions HAP is a complex and nuanced diagnosis with high inter-observer variation. Currently available and validated diagnostic tools result in different rates of HAP diagnosis. These findings highlight the importance of adopting robust approaches to diagnosing HAP to avoid unnecessary treatments and to more accurately determine the effectiveness of protocolised management (such as ERAS) that target HAP. The findings also highlight important implications on outcome reporting in research, particularly with interventions (e.g. minimally invasive and robotic surgery) which aim to reduce the burden of post-operative morbidity. Further widescale studies are required to validate these findings.

OGC P48 The Relationship between Hospital Acquired Pneumonia (HAP) and Synchronous Post-Operative Complications following Oesophagectomy: An Assessment of the impact on mortality

Abstract Background Hospital Acquired Pneumonia (HAP) is a frequently occurring complication following oesophagectomy, often associated with poorer outcomes. After oesophagectomy, HAP can occur in conjunction with other pulmonary and non-pulmonary complications such as anastomotic leak. Single lung ventilation during oesophagectomy can lead to altered lung function, contributing to infective and non-infective respiratory complications. Understanding the interplay between these factors is crucial for recognizing the multifaceted nature of HAP and identifying areas of focus to reduce its incidence. This study aimed to quantify the incidence of HAP in relation to other complications, and assess the effect of pulmonary complications on long-term outcomes. Methods This was a retrospective review of all consecutive oesophagectomies undertaken at a regional OG cancer centre serving a population of 3.5 million people between 2014-2022. Data was extracted from the Electronic Patient Records. Datapoints included patient demographics; comorbidities; post-operative course and re-admissions. Clinical details and radiological reports (Computed Tomography and Chest X-Ray) on the day of HAP diagnosis (defined using the CDC criteria) were recorded, alongside evidence of pneumothorax, pleural effusion, emphysema and Acute Respiratory Distress Syndrome (ARDS). Complications were defined using the Esophagectomy Complications Consensus Group (ECCG) definitions. Survival analysis was conducted on STATA. Results 460 patients were included, 356 (77.40%) were male. 223 (48.5%) were treated for HAP - 56 (12.2%) met the CDC criteria. 125 (60.10%) patients treated for HAP had concurrent pleural effusion, 60 (28.85%) pneumothorax, &amp; 12 (5.77%) surgical emphysema. 53 patients (25.49%) had two concurrent findings. 17/53 (32%) patients with anastomotic leak also had HAP. 5-year OS between patients treated for HAP who met the CDC criteria versus those who did not meet the criteria were similar. There was no difference in OS between patients with HAP versus no respiratory complications. Patients with no complications had the highest 5-year survival. Conclusions A significant proportion of patients develop HAP after oesophagectomy, usually alongside concurrent pulmonary complications. A significantly higher number of patients were treated for HAP than met the CDC criteria, highlighting the complexity in diagnosing post-operative complications. Our results suggest that a diagnosis of HAP is not a predictor for poorer long-term survival. Further research is warranted to elucidate the underlying mechanisms and refine treatment approaches in this patient population.

Impact of Oral Care for Intensive Care Unit Patient on Pneumonia Infection Prevention: Literature Review Study

Background: Oral cavity bacteria can be mostly harmful if inhaled into the lungs. Hospital acquired pneumonia (HAP), a critical condition that presents clinically two or more days after hospitalization, which may increase the risk of mortality. Lacking oral care can lead to Hospital acquired pneumonia. Objective: to explore effective oral care consequence on hospital acquired pneumonia prevention. Methods: This review article is performed according to the PRISMA guidelines. The literature exploration was done in Google Scholar and PubMed databases for articles published between 2017 and 2020. The search words were “oral care, oral hygiene, intensive care, critical care, ICU, respiratory infection, lung infection, pneumonia, and adult". Results: A total of 6 studies were included, the studies were randomized controlled trials (RCTs) and observational studies. Oral care with tooth brushing and purified water twice daily can significantly reduce the incidence of HAP. Brushing patient mouth with chlorhexidine is also effective in decreasing the HAP incidence. Implementing oral care protocols in ICU with chlorhexidine solution and nurse education can significantly lower the incidence of HAP. Conclusions: Good oral and dental care, particularly with tooth brushing and purified water twice daily, can significantly reduce the incidence of HAP in intensive care unit patients.

Clinical Effectiveness of Total Hip Arthroplasty Compared With Hemiarthroplasty in Adults Undergoing Surgery for Displaced Intracapsular Hip Fracture: A Single-Centre Retrospective Cohort Study.

The National Institute for Health and Care Excellence (NICE) recommends offering total hip arthroplasty (THA) over hemiarthroplasty (HA) for displaced intracapsular hip fractures, taking the premorbid functionality, present co-morbidities, and functional benefit beyond two years into account. Concerns remain whether the higher surgical burden and incidence of complications in THA would outweigh the potential benefits in the elderly. This retrospective cohort study evaluates the differences in surgical outcomes of THA vs HA in 85 patients with displaced intracapsular fractures, based on the time taken for patients to ambulate to walking frame/crutches and wheelchair post-operatively and the incidence of post-operative complications. Patients who received HA were significantly older (p<0.0001, <0.05) and had poorer pre-operative ambulatory function (p=0.032, p<0.05) than those of the THA group. HA patients had a significantly faster recovery to walking frame/crutches (20.2 days) compared to THA patients (47.3 days) (Mann-Whitney U=447.500, n=46, p=0.043, <0.05 two-tailed). While no significant differences were found in deep vein thrombosis (DVT), infected prosthesis, or dislocation incidence, hospital-acquired pneumonia (HAP) was more prevalent in THA patients (p=0.044, <0.05). Time to the walking frame had a significant effect on DVT/PE (p<0.001, <p0.05), the infected prosthesis (p=0.002, <0.05), and HAP (p=0.066, <0.05) incidence, while time to a wheelchair only affected HAP incidence (p<0.001, <0.05). HA patients showed favourable outcomes in time to ambulate post-operatively and incidence of HAP among patients with advanced age and those with poorer pre-operative ambulatory function.

Association of antimicrobial use and incidence of hospital-acquired pneumonia in critically ill trauma patients with pulmonary contusion: an observational study

BackgroundPneumonia occurs in about 20% of trauma patients with pulmonary contusions. This study aims to evaluate the association between empirical antibiotic therapy and nosocomial pneumonia in this population. MethodsRetrospective cohort of adult patients admitted to a trauma-surgical ICU. The Antibiotic Therapy Group (ATG) was defined by intravenous antibiotic use for more than 48 h starting on hospital admission, while the Conservative Group (CG) was determined by antibiotic use no longer than 48 h. Primary outcome was microbiologically documented nosocomial pneumonia within 14 days after hospital admission. Logistic regression was used to estimate the association between group allocation and primary outcome. Exploratory analyses evaluating the association between resistant strains in pneumonia and antibiotic use were performed. ResultsThe study included 177 patients with chest trauma and pulmonary contusion on CT scan. ATG were more severely ill than CG, as shown by higher Injury Severity Score, SAPS3, SOFA score, higher rates, and longer duration of mechanical ventilation. In the multivariate analysis, ATG was associated with a lower incidence of primary outcome (OR = 0.25, 95% CI 0.09–0.64; p < 0.01). Similar results were found in the sensitivity analysis with another set of variables. However, each day of antibiotic use was associated with an increased risk of pneumonia by resistant bacteria (OR = 1.18 per day, 95% CI 1.05–1.36; p < 0.01). ConclusionsEmpiric antibiotic therapy was independently associated with lower incidence of nosocomial pneumonia in critically ill patients with pulmonary contusion. However, each day of antibiotic use was associated with increased resistant strains in infected patients.

Bundle management strategy in reducing hospital-acquired pneumonia in hospitalized patients with mental disorders.

The incidence of hospital-acquired pneumonia (HAP) is high in the medical setting for mental disorders. To date, effective measurements for preventing HAP in hospitalized mental disorder patients are unavailable. This study was conducted at the Large-Scale Mental Health Center of Renmin Hospital of Wuhan University (Wuhan, China) in two phases: baseline phase (January 2017-December 2019) and intervention phase (May 2020-April 2022). In the intervention phase, the HAP bundle management strategy was implemented in the Mental Health Center, and the data on HAP were collected continuously for analysis. A total of 18,795 and 9,618 patients were included in the baseline and intervention phases, respectively. The age, gender, ward admitted to, type of mental disorder, and Charlson comorbidity index did not differ significantly. After intervention, the rate of HAP occurrence decreased from 0.95 to 0.52% (P < 0.001). Specifically, the HAP rate decreased from 1.70 to 0.95% (P = 0.007) in the closed ward and from 0.63 to 0.35% (P = 0.009) in the open ward. The HAP rate in the subgroups was higher in patients with schizophrenia spectrum disorders (1.66 vs. 0.74%) and organic mental disorders (4.92 vs. 1.41%), and in those ≥65 years old (2.82 vs. 1.11%) but decreased significantly after intervention (all P < 0.05). The implementation of the HAP bundle management strategy reduced the occurrence of HAP in hospitalized patients with mental disorders.

The Relationship of Nurse and Physician Staffing in Intensive Care Units with Patient Outcomes in Postoperative Patients on Ventilators: An Analysis Using Korean National Health Insurance Data.

This study examined the associations of nurse and physician staffing in intensive care units (ICUs) with hospital-acquired pneumonia (HAP) incidence and in-hospital mortality in postoperative patients on ventilators. National Health Insurance claims data and death statistics were used to investigate the nurse staffing level and the presence or absence of a dedicated resident and specialist in each ICU. The participants were patients aged 20-85 who underwent any of 13 surgical procedures and were placed on a ventilator in the ICU after the procedure. Of 11,693 patients, 307 (2.6%) experienced HAP and 1280 (10.9%) died during hospitalization. Compared to hospitals with lower nurse-to-patient ratios, patients in hospitals with higher ratios had statistically significantly higher risks of HAP and in-hospital mortality. The presence of a dedicated resident in the ICU did not statistically significantly affect HAP incidence or in-hospital mortality. The presence of an ICU specialist was statistically significantly associated with in-hospital mortality but not HAP incidence. Our findings suggest that a higher level of nursing staff in the ICU is inversely associated with HAP incidence. The legal standards for nurse staffing in the ICU should be strengthened in order to improve the quality of care and patient safety.

Sex differences in factors influencing hospital-acquired pneumonia in schizophrenia patients receiving modified electroconvulsive therapy.

Sex differences may be presented in the clinical features or symptoms of schizophrenia patients but also affect the occurrence of hospital-acquired pneumonia (HAP). Modified electroconvulsive therapy (mECT) is a common treatment method for schizophrenia, used in combination with antipsychotics. This retrospective research explores the sex difference in HAP affecting patients with schizophrenia who have received mECT treatment during hospitalization. We included schizophrenia inpatients treated with mECT and antipsychotics between January 2015 and April 2022. Blood-related and demographic data collected on admission were analyzed. Influencing factors of HAP in male and female groups were assessed separately. A total of 951 schizophrenia patients treated with mECT were enrolled in the study, including 375 males and 576 females, of which 62 patients experienced HAP during hospitalization. The risk period of HAP in these patients was found to be the first day after each mECT treatment and the first three sessions of mECT treatment. Statistically significant differences in the incidence of HAP were identified in male vs. female groups, with an incidence in men about 2.3 times higher than that in women (P < 0.001). Lower total cholesterol (Z = -2.147, P = 0.032) and the use of anti-parkinsonian drugs (χ2 = 17.973, P < 0.001) were found to be independent risk factors of HAP in male patients, while lower lymphocyte count (Z = -2.408, P = 0.016), hypertension (χ2 = 9.096, P = 0.003), and use of sedative-hypnotic drugs (χ2 = 13.636, P < 0.001) were identified in female patients. Influencing factors of HAP in schizophrenia patients treated with mECT have gender differences. The first day after each mECT treatment and the first three sessions of mECT treatment were identified to have the greatest risk for HAP development. Therefore, it would be imperative to monitor clinical management and medications during this period according to these gender differences.

Hospital-acquired pneumonia pattern in the intensive care units of a governmental hospital: A prospective longitudinal study.

Epidemiological data on Hospital-Acquired Pneumonia (HAP) are scarce inside Intensive Care Units (ICUs). This study aims to quantify the incidence of HAP, determine the predictors of HAP, calculate HAP-related mortality risk ratio as well as pinpoint the different risk factors contributing to mortality. A prospective longitudinal study was conducted at a governmental hospital's general ICUs over 12 months. We included adult patients admitted for at least 72 h before signs appear. We utilized a logistic regression model for fatality outcome and cox proportional hazard model for HAP outcome. Of 356 patients, 133 patients developed Ventilated-Acquired Pneumonia (VAP), 76 patients with Non-Ventilated HAP (NV-HAP), as well as 147 patients did not acquire HAP. The incidence of HAP was 28 cases of HAP per 1000 person-days, as well as the mortality rate was 74 per 100 days, while the Attributable Risk Percentage (ARP) was 85%. This high fatality rate was clarified by independent predictors as reintubation (odds ratio [OR] = 8.99, P < 0.001), ICU duration ≥5 days (OR = 7.29, P = 0.02), HAP outcome (OR = 6.49, P = 0.001), diabetes mellitus (DM) (OR = 2.98, P = 0.004), APACHE II ≥17 (OR = 2.76, P = 0.004), as well as neurological diseases (OR = 2.20, P = 0.03). The most common independent HAP predictors were Pseudomonas aeruginosa (Hazard Ratio [HR] = 2.27, P < 0.001), Klebsiella pneumoniae (HR = 1.81, P = 0.003), tracheostomy (HR = 1.72, P = 0.04), and APACHE II ≥17 (HR = 1.54, P = 0.04). High incidence rate of HAP was linked with P. aeruginosa, K. pneumoniae, tracheostomy, and APACHE II ≥17. Furthermore, a high mortality rate was strongly correlated with reintubation, duration in ICU ≥5 days, HAP outcome, DM, APACHE II ≥17, and neurological diseases.

[Factors influencing pulmonary infection in elderly neurocritical patients and their predictive values: a data analysis for consecutive four-year].

To analyze the factors influencing pulmonary infections in elderly neurocritical patients in the intensive care unit (ICU) and to explore the predictive value of risk factors for pulmonary infections. The clinical data of 713 elderly neurocritical patients [age ≥ 65 years, Glasgow coma score (GCS) ≤ 12 points] admitted to the department of critical care medicine of the Affiliated Hospital of Guizhou Medical University from 1 January 2016 to 31 December 2019 were retrospectively analyzed. According to whether or not they had HAP, the elderly neurocritical patients were divided into hospital-acquired pneumonia (HAP) group and non-HAP group. The differences in baseline data, medication and treatment, and outcome indicators between the two groups were compared. Logistic regression analysis was used to analyze the factors influencing the occurrence of pulmonary infection. The receiver operator characteristic curve (ROC curve) was plotted for risk factors and a predictive model was constructed to evaluate the predictive value for pulmonary infection. A total of 341 patients were enrolled in the analysis, including 164 non-HAP patients and 177 HAP patients. The incidence of HAP was 51.91%. According to univariate analysis, compared with the non-HAP group, mechanical ventilation time, the length of ICU stay and total hospitalization in the HAP group were significantly longer [mechanical ventilation time (hours): 171.00 (95.00, 273.00) vs. 60.17 (24.50, 120.75), the length of ICU stay (hours): 263.50 (160.00, 409.00) vs. 114.00 (77.05, 187.50), total hospitalization (days): 29.00 (13.50, 39.50) vs. 27.00 (11.00, 29.50), all P < 0.01], the proportion of open airway, diabetes, proton pump inhibitor (PPI), sedative, blood transfusion, glucocorticoids, and GCS ≤ 8 points were significantly increased than those in HAP group [open airway: 95.5% vs. 71.3%, diabetes: 42.9% vs. 21.3%, PPI: 76.3% vs. 63.4%, sedative: 93.8% vs. 78.7%, blood transfusion: 57.1% vs. 29.9%, glucocorticoids: 19.2% vs. 4.3%, GCS ≤ 8 points: 83.6% vs. 57.9%, all P < 0.05], prealbumin (PA) and lymphocyte count (LYM) decreased significantly [PA (g/L): 125.28±47.46 vs. 158.57±54.12, LYM (×109/L): 0.79 (0.52, 1.23) vs. 1.05 (0.66, 1.57), both P < 0.01]. Logistic regression analysis showed that open airway, diabetes, blood transfusion, glucocorticoids and GCS ≤ 8 points were independent risk factors for pulmonary infection in elderly neurocritical patients [open airway: odds ratio (OR) = 6.522, 95% confidence interval (95%CI) was 2.369-17.961; diabetes: OR = 3.917, 95%CI was 2.099-7.309; blood transfusion: OR = 2.730, 95%CI was 1.526-4.883; glucocorticoids: OR = 6.609, 95%CI was 2.273-19.215; GCS ≤ 8 points: OR = 4.191, 95%CI was 2.198-7.991, all P < 0.01], and LYM, PA were the protective factors for pulmonary infection in elderly neurocritical patients (LYM: OR = 0.508, 95%CI was 0.345-0.748; PA: OR = 0.988, 95%CI was 0.982-0.994, both P < 0.01). ROC curve analysis showed that the area under the ROC curve (AUC) for predicting HAP using the above risk factors was 0.812 (95%CI was 0.767-0.857, P < 0.001), with a sensitivity of 72.3% and a specificity of 78.7%. Open airway, diabetes, glucocorticoids, blood transfusion, GCS ≤ 8 points are independent risk factors for pulmonary infection in elderly neurocritical patients. The prediction model constructed by the above mentioned risk factors has certain predictive value for the occurrence of pulmonary infection in elderly neurocritical patients.

Effect of Folic Acid Treatment for Patients with Traumatic Brain Injury (TBI)-Related Hospital Acquired Pneumonia (HAP): A Retrospective Cohort Study.

Hospital Acquired Pneumonia (HAP) is one of the most common complications and late causes of death in TBI patients. Targeted prevention and treatment of HAP are of great significance for improving the prognosis of TBI patients. In the previous clinical observation, we found that folic acid treatment for TBI patients has a good effect on preventing and treating HAP. We conducted this retrospective cohort study to demonstrate what we observed by selecting 293 TBI patients from two medical centers and analyzing their hospitalization data. The result showed that the incidence of HAP was significantly lower in TBI patients who received folic acid treatment (44.1% vs. 63.0%, p = 0.012). Multivariate logistic regression analysis showed that folic acid treatment was an independent protective factor for the occurrence of HAP in TBI patients (OR = 0.418, p = 0.031), especially in high-risk groups of HAP, such as the old (OR: 1.356 vs. 2.889), ICU (OR: 1.775 vs. 5.996) and severe TBI (OR: 0.975 vs. 5.424) patients. At the same time, cohort studies of HAP patients showed that folic acid also had a good effect on delaying the progression of HAP, such as reducing the chance of tracheotomy (26.1% vs. 50.8%, p = 0.041), and reduced the length of hospital stay (15 d vs. 19 d, p = 0.029) and ICU stay (5 d vs. 8 d, p = 0.046). Therefore, we believe that folic acid treatment in TBI patients has the potential for preventing and treating HAP, and it is worthy of further clinical research.

Association between Glucocorticoids and Mortality in Patients with Severe Pneumonia: A Systematic Review and Meta-Analysis Based on Randomized Controlled Trials.

Objective To explore the associations between glucocorticoid use and the clinical outcome of patients with severe pneumonia. Methods Medical databases including PubMed, EMBASE, and ScienceDirect were searched for relevant literature. Two independent researchers extracted the primary endpoint from the included literature. The Cochrane Q test and I2 statistics were used to evaluate the interstudy heterogeneity. The combined risk estimates were calculated by random effect model, and the source of heterogeneity was evaluated by subgroup analysis. Funnel plot and Egger's test were used to assess publication bias. P < 0.05 denoted statistical significance. Results A total of 12 literature, including 8171 patients with 1083 deaths, were included in this study for meta-analysis. The use of glucocorticoids significantly increased the mortality (RR = 1.44, 95% CI: 1.13, 1.84, P < 0.001), the risk of requiring mechanical ventilation (RR = 1.62, 95% CI: 1.30, 2.02, P < 0.001), and the incidence of nosocomial infection (RR = 1.36, 95% CI: 1.01, 1.82, P = 0.04) in patients with severe pneumonia as compared with the control group. In addition, the use of glucocorticoids did not seem to be associated with length of treatment in the intensive care unit (mean difference = 1.47, 95% CI: -1.04, 3.96, P = 0.25) and the length of hospital stay (mean difference = 0.55, 95% CI: -3.90, 4.99, P = 0.81). Conclusion The use of glucocorticoids may increase the mortality, the incidence of hospital-acquired pneumonia, and the need for mechanical ventilation in patients with severe pneumonia.

Risk factors for hospital-acquired pneumonia among inpatients with mental disorders in a large mental health center within a tertiary general hospital

Few researchers have investigated the incidence of and risk factors for hospital-acquired pneumonia (HAP) among inpatients with mental disorders in a general hospital. This study included patients with mental disorders hospitalized in a large mental health center (situated in a general hospital) between January 1, 2017, and July 31, 2021 (excluding January 1, 2020- May 31, 2020). Risk factors for HAP were identified by logistic regression analysis after propensity score matching (PSM, 1:4) for gender, age, duration of observation, and hospital ward. The study included 16,864 patients. HAP incidence rate was 1.15% overall, 2.11% in closed wards, 0.75% in open wards, 4.45% in patients with organic mental disorders, 1.80% in patients with schizophrenia spectrum disorders, and 0.84% in patients with mood disorders. Risk factors for HAP after PSM were hypoproteinemia, chronic liver disease, use of clozapine, hospitalization during the previous 180 days, body mass index (BMI) ≤18.5 kg/m2, cholinesterase inhibitor use, and mood stabilizer use. HAP was common among inpatients with mental disorders. Risk factors for HAP in patients with mental disorders include hypoproteinemia, chronic liver disease, hospitalization during the past 180 days, BMI ≤18.5 kg/m2, and use of clozapine, cholinesterase inhibitors, or mood stabilizers.

Association between hospital-acquired pneumonia and proton pump inhibitor prophylaxis in patients treated with glucocorticoids: a retrospective cohort study based on 307,622 admissions in China.

BackgroundProphylaxis with proton pump inhibitor (PPI) in patients treated with glucocorticoid therapy is a common phenomenon in the general wards of Chinese hospitals. Many of these prescriptions are inappropriate and lead to overuse. Hospital-acquired pneumonia (HAP) is a possible adverse effect for this combination but remains controversial.MethodsWe designed a retrospective cohort study using electronic medical record databases from multiple hospitals to investigate whether PPI prophylaxis increases the risk of HAP in hospitalized patients receiving glucocorticoid therapy. The study population was adult patients who were not critical and treated with at least 1 dose of glucocorticoid during hospitalization and the exposure factor was PPIs prophylaxis. The odds ratio of HAP between the exposed and unexposed groups was calculated based on the cohort which was established by propensity score matching. The dose-effect relationship between PPI prophylaxis and HAP was also evaluated.ResultsAmong the 307,622 admissions eligible for the study, a total of 217,460 (70.7%) admissions had a record of PPI prophylaxis. After reconstructed the cohort by propensity score matching, the exposed and unexposed groups both included 83,786 admissions. The incidence of HAP in the exposed group was higher than that in the unexposed group (2.1% vs. 1.5%, OR: 1.4, 95% CI: 1.3 to 1.5). The risk of HAP increased when the cumulative dose of PPI during hospital was more than 2 defined drug doses. Compared to the unexposed group, the adjusted odds ratio was 1.3 (95% CI: 1.2 to 1.4) in the medium-dose group (2–7 defined drug doses) and 1.9 (95% CI: 1.8 to 2.1) in the high-dose group (>7 defined drug doses).ConclusionsPPI prophylaxis increased the risk of HAP in hospitalized patients treated with glucocorticoid therapy and the risk of HAP increased as the dose of PPIs accumulated.

Electroacupuncture in Treatment of Acute Gastrointestinal Injury in Patients with Severe Traumatic Brain Injury: A Multicenter Randomized Controlled Trial.

To evaluate whether electroacupuncture (EA) would improve gastrointestinal function and clinical prognosis in patients with severe traumatic brain injury (TBI) complicocted by acute gastrointestinal injury (AGI). This multicenter, single-blind trial included patients with TBI and AGI admitted to 5 Chinese hospitals from September 2018 to December 2019. A total of 500 patients were randomized to the control or acupuncture groups using a random number table, 250 cases in each group. Patients in the control group received conventional treatment, including mannitol, nutritional support, epilepsy and infection prevention, and maintenance of water, electrolytes, and acid-base balance. While patients in the acupuncture group received EA intervention at bilateral Zusanli (ST 36), Shangjuxu (ST 37), Xiajuxu (ST 39), Tianshu (ST 25), and Zhongwan (RN 12) acupoints in addition to the conventional treatment, 30 min per time, twice daily, for 7 d. The primary endpoint was 28-d mortality. The secondary endpoints were serum levels of D-lactic acid (D-lac), diamine oxidase (DAO), lipopolysaccharide (LPS), motilin (MTL) and gastrin (GAS), intra-abdominal pressure (IAP), bowel sounds, abdominal circumference, AGI grade, scores of gastrointestinal failure (GIF), Glasgow Coma Scale (GCS), Acute Physiology and Chronic Health Evaluation (APACHE II), Sequential Organ Failure Assessment (SOFA), and Multiple Organ Dysfunction Syndrome (MODS), mechanical ventilation time, intense care unit (ICU) stay, and the incidence of hospital-acquired pneumonia. The 28-d mortality in the acupuncture group was lower than that in the control group (22.80% vs. 33.20%, P<0.05). Compared with the control group, the acupuncture group at 7 d showed lower GIF, APACHE II, SOFA, MODS scores, D-lac, DAO, LPS, IAP, and abdominal circumference and higher GCS score, MTL, GAS, and bowel sound frequency (all P<0.05). In addition, the above indices showed simillar changes at 7 d compared with days 1 and 3 (all P<0.05) in the EA group. Early EA can improve gastrointestinal function and clinical prognosis in patients with severe TBI complicated by AGI. (Registration No. ChiCTR2000032276).

Hospital-Acquired Pneumonia/Ventilator-Associated Pneumonia and Ventilator-Associated Tracheobronchitis in COVID-19.

Although few studies evaluated the incidence of hospital-acquired pneumonia (HAP) or ventilator-associated tracheobronchitis in COVID-19 patients, several studies evaluated the incidence of ventilator-associated pneumonia (VAP) in these patients. Based on the results of a large multicenter European study, VAP incidence is higher in patients with SARS-CoV-2 pneumonia (36.1%), as compared with those with influenza pneumonia (22.2%), or no viral infection at intensive care unit (ICU) admission (16.5%). Potential explanation for the high incidence of VAP in COVID-19 patients includes long duration of invasive mechanical ventilation, high incidence of acute respiratory distress syndrome, and immune-suppressive treatment. Specific risk factors for VAP, including SARS-CoV-2-related pulmonary lesions, and bacteria-virus interaction in lung microbiota might also play a role in VAP pathogenesis. VAP is associated with increased mortality, duration of mechanical ventilation, and ICU length of stay in COVID-19 patients. Further studies should focus on the incidence of HAP especially in ICU non-ventilated patients, better determine the pathophysiology of these infections, and evaluate the accuracy of currently available treatment guidelines in COVID-19 patients.