Risk Factors For Nosocomial Pneumonia Research Articles

NOSOCOMIAL PNEUMONIA IN ELDERLY PATIENTS FOLLOWING CARDIAC SURGERY

Summary Objective To identify modifiable risk factors of nosocomial pneumonia (NP) in elderly patients post-cardiac surgery. Design A case-control study. Setting Post-operative intensive care unit of a tertiary-level university affiliated hospital. Subjects Seventy three case-control pairs. Case patients referred to elderly patients who developed pneumonia post-cardiac surgery. Controls subjects were matched for age, gender, type of surgery, forced expiratory volume in 1s (FEV 1 ), and ejection fraction. Measurements Baseline sociodemograpahic information, Charlson Comorbidity Index score, intra- and post-operative data were collected. When suspected, the presence of NP was confirmed by quantitative culture of protected bronchoalveolar lavage fluid ⩾10 3 colony forming unit/ml or positive blood/pleural fluid culture identical to that recovered from respiratory samples. Results The incidence of NP in elderly post-heart surgery was 8.3%. The mean duration after heart surgery to the occurrence of pneumonia was 7.2±4.9 days. Four variables were found to be significantly related to the development of NP by multivariate analysis: Charlson Index >2 (adjusted odds ratio [AOR] 4.7; 95% confidence interval [CI], 1.9–11.4; P 0.001 ), reintubation (AOR 6.2; 95% CI, 1.1–36.1; P = 0.04 ), transfusion ⩾4 units of PRBC (AOR 2.8; 95% CI, 1.2–6.3; P = 0.01 ), and the mean equivalent daily dose of morphine (AOR 4.6; 95% CI, 1.4–14.6; P = 0.01 ). Conclusions Although there are limited effective measures to lessen the burden of comorbidities, avoiding reintubation, finding a substitute to allogenic blood transfusion, and improved assessment of pain management could reduce the rate of NP in the post-operative period of cardiac surgery in the elderly population.

Nosocomial pneumonia in elderly patients following cardiac surgery

To identify modifiable risk factors of nosocomial pneumonia (NP) in elderly patients post-cardiac surgery. A case-control study. Post-operative intensive care unit of a tertiary-level university affiliated hospital. Seventy three case-control pairs. Case patients referred to elderly patients who developed pneumonia post-cardiac surgery. Controls subjects were matched for age, gender, type of surgery, forced expiratory volume in 1s (FEV(1)), and ejection fraction. Baseline sociodemograpahic information, Charlson Comorbidity Index score, intra- and post-operative data were collected. When suspected, the presence of NP was confirmed by quantitative culture of protected bronchoalveolar lavage fluid 10(3) colony forming unit/ml or positive blood/pleural fluid culture identical to that recovered from respiratory samples. The incidence of NP in elderly post-heart surgery was 8.3%. The mean duration after heart surgery to the occurrence of pneumonia was 7.2+/-4.9 days. Four variables were found to be significantly related to the development of NP by multivariate analysis: Charlson Index >2 (adjusted odds ratio [AOR] 4.7; 95% confidence interval [CI], 1.9-11.4; P<0.001), reintubation (AOR 6.2; 95% CI, 1.1-36.1; P=0.04), transfusion 4 units of PRBC (AOR 2.8; 95% CI, 1.2-6.3; P=0.01), and the mean equivalent daily dose of morphine (AOR 4.6; 95% CI, 1.4-14.6; P=0.01). Although there are limited effective measures to lessen the burden of comorbidities, avoiding reintubation, finding a substitute to allogenic blood transfusion, and improved assessment of pain management could reduce the rate of NP in the post-operative period of cardiac surgery in the elderly population.

Incidence and risk factors of nosocomial pneumonia in neurosurgical intensive care unit

Incidence and risk factors of nosocomial pneumonia in neurosurgical intensive care unit

Risk factors for nosocomial pneumonia in a geriatric hospital: a control-case one-center study.

To determine the risk factors (RFs) and the incidence of nosocomial pneumonia (NP). Control/case study conducted from January 1 to April 15, 1999. Prospective enrollment. Geriatric university hospital with long-, intermediate-, and short-term care facilities. Inpatients aged 65 and older with NP. NP diagnosis relied on at least two clinical signs of respiratory infection and on chest radiography. Each NP case was randomly paired with two controls and followed up for 30 days to determine complication and mortality rates. RFs between cases and controls were compared (chi-square test, odds ratio (OR), 95% confidence interval, significance level P =.05). RFs that were significant in univariate analysis were tested using multivariate analysis and logistic regression. Seventy-five cases of NP were diagnosed in 2,142 patients. The average incidence rate was 3.5% (short-term facilities = 0.5%; intermediate-term facilities = 8.3%; long-term care facilities = 5.3%). The complication rate was 58.1%. The most frequent complications were recurrent NP, heart and respiratory failure, phlebitis, and pressure ulcers. The NP mortality rate was 12.2%. The independent RFs of NP were a history of NP during the previous 6 months (OR = 4.50) and oxygen therapy (OR = 16.15), P <.001. Additional RFs were severe malnutrition, heart failure, prescription of antibiotics during the month preceding the emerging NP, eating dependency, and feeding by nasogastric tube. The main RF for NP is a history of pneumonia. NP prevention in geriatrics should rely on early management of respiratory infections and malnutrition, surveillance of oxygen therapy and enteral feeding, rational use of antibiotics, and adaptation to the patient's dependency.

Nosocomial pneumonia.

Despite abundant literature on the management of nosocomial pneumonia, a number of aspects, from diagnosis to the therapy of nosocomial pneumonia, are still controversial. This review focuses on recent advances that can aid in the day-to-day care of these critically ill patients. The risk factors for nosocomial pneumonia in specific subsets of trauma, postoperative and burn injury patients have been identified, with emphasis on the type of pneumonia developing in these populations - early or late onset nosocomial pneumonia. Resolution of nosocomial pneumonia, in terms of improvement of clinical parameters such as oxygenation, fever, leukocytosis and bacterial eradication, has been reported, and these data can lead to a better understanding of the natural course of the disease. The importance of initial, accurate empiric therapy in improving mortality in nosocomial pneumonia has been reinforced by multiple studies. Newer techniques to study colonization and the routes of spread of pathogenic organisms in the intensive care unit are adding to our understanding of how pneumonia develops, the role of infection control measures and the types of strategies that are needed for prevention. Oral decontamination is showing promise as a technique to prevent ventilator-associated pneumonia, and noninvasive ventilation has been shown to be useful in various etiologies of respiratory failure, with the beneficial effect of reducing the incidence of ventilator-associated pneumonia and its associated mortality. The implementation of protocolized treatment guidelines and antibiotic rotation policies are emerging as useful tools for reducing the frequency of antibiotic resistance and the impact of nosocomial pneumonia. There is a better understanding of nosocomial pneumonia risk factors, mechanisms of bacterial colonization, and resolution of illness, with exciting developments in prevention and treatment emerging, and these data can help us achieve more effective management of this complex illness.

Nosocomial pneumonia in pediatric patients: practical problems and rational solutions.

Nosocomial pneumonia is a common hospital-acquired infection in children, and is often fatal. Risk factors for nosocomial pneumonia include admission to an intensive care unit, intubation, burns, surgery, and underlying chronic illness. Viruses, predominantly respiratory syncytial virus (RSV), are the most common cause of pediatric nosocomial respiratory tract infections. Gram-negative bacteria (Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa) are the predominant bacterial pathogens, and are associated with a high mortality rate. Staphylococcus aureus and Staphylococcus epidermidis are the most common Gram-positive bacteria causing nosocomial pneumonia; infections with these organisms have a better outcome than those with Gram-negative organisms. An increasing problem is the emergence of multiresistant Gram-positive and Gram-negative nosocomial pathogens. Distinguishing nosocomial pneumonia from other pulmonary processes may be difficult; diagnosis is based on clinical signs, radiological findings, and microbiological results. Recommended empiric therapy should consider factors such as the time of onset of illness, severity of disease, and specific risk factors for nosocomial pneumonia, including use of mechanical ventilation, underlying disease, or recent use of antibacterials. The resident local hospital flora should be considered when selecting therapy for nosocomial pneumonia. Early initiation of appropriate empiric therapy reduces morbidity and mortality. For empiric treatment of bacterial nosocomial pneumonia, an intravenous antibacterial regimen that includes coverage of Gram-negative bacilli and Gram-positive organisms should be used. A carbapenem or ureidopenicillin derivative (piperacillin) plus a beta-lactamase inhibitor should be used where extended spectrum beta-lactamase-producing Enterobacteriaceae are endemic. Therapy should be modified when a specific pathogen and its antimicrobial susceptibility are identified. Effective prevention of nosocomial pneumonia requires infection control measures that affect the environment, personnel, and patients. Of these, hand hygiene, appropriate infection control policies, and judicious use of antibacterials are essential.

Incidence of and risk factors for nosocomial pneumonia in patients with tetanus.

From June 1998 through July 2000, 28 patients with tetanus admitted to the Intensive Care Unit for Tetanus and Infectious Diseases at the Hospital das Clínicas of University of Medicine at São Paulo, Brazil, were evaluated to establish what the incidence of nosocomial pneumonia was and what their risk factors were. The degree of severity of tetanus was assessed in all patients by means of APACHE II scores. The mortality rate was 3.6%. There were 63 hospital infections in 20 patients; among these, there were 10 cases of nosocomial pneumonia in 8 patients. Nosocomial pneumonia was associated in univariate analysis with the degree of severity of tetanus, dysautonomy, use of neuromuscular blockers, use of higher doses of diazepam, and lower arterial oxygen and oxygen fractions. In the multiple logistical regression, significance was found for dysautonomy (relative risk, 31.67; 95% confidence interval, 2.68-373.74; P=.006). Dysautonomy was an independent risk factor for pneumonia in patients with tetanus.

Risk factors for nosocomial pneumonia in critically ill trauma patients.

To determine risk factors for nosocomial pneumonia in critically ill trauma patients. Prospective cohort study. The trauma intensive care unit (ICU) of a 1500-bed tertiary-care hospital. All critically ill trauma patients (n = 103) admitted consecutively between November 1995 and October 1996. A comparison of data recorded at the time of ICU admission and during the clinical evolution in patients with (n = 23) and without (n = 80) nosocomial pneumonia was made. Data referred mainly to possible risk factors were recorded; they also included factors related to pneumonia etiology and evolutive factors. Predictors of nosocomial pneumonia were assessed by logistic regression analysis. The presence of significant growth on quantitative cultures of the protected specimen brush (> or = 103 colony forming units/mL) was required to accept pneumonia as microbiologically proven, as well as the concurrence of a cohort of clinical and radiologic signs. Twenty-three (22.3%) patients developed nosocomial pneumonia. The mean age of these patients was 41.7 yrs; 18 of them (78.3%) were men. The microorganisms isolated in significant concentrations were Acinetobacter baumanii (ten cases), Staphylococcus aureus (11 cases), Pseudomonas aeruginosa (five cases), Haemophilus influenzae (two cases), and Klebsiella pneumoniae, Citrobacter freundii, Serratia marcescens, Enterococcus spp., Enterobacter spp., coagulase-negative Staphylococcus, and Streptococcus intermedius (one case each one). Risk factors for pneumonia by univariate analysis included nasogastric tube; continuous enteral feeding; prolonged mechanical ventilation (>1 day); use of H2-receptor antagonist, sucralfate, muscle relaxants, corticosteroids, barbiturates, and inotropic agents; positive end-expiratory pressure; intense sedation; re-intubation; tracheotomy; urgent brain computed tomography (CT) scan; craniotomy; iatrogenic event; and hyperventilation. The mortality rate was 43.5% (10 of 23) in the nosocomial pneumonia group and 18.8% in patients without nosocomial pneumonia (p =.02). Also, the mean stay in the ICU, the therapeutic charge (measured with total and mean punctuation of the Therapeutic Intervention Scoring System) and the complications, infectious and noninfectious, of the clinical evolution were significantly more frequent in patients with nosocomial pneumonia than in those without pneumonia (p <.05). In the multivariate analysis, continuous enteral feeding, craniotomy, prolonged mechanical ventilation (>24 hrs), use of positive end-expiratory pressure, and corticotherapy were independent predictors of nosocomial pneumonia. It seems that factors related to the patient's clinical course, rather than variables registered on the first days of ICU admission, are those that would exert an influence on the development of nosocomial pneumonia in critically ill trauma patients. In this way, from our point of view, in our study the main risk factors are the use of prolonged mechanical ventilation (>4 hrs) and positive end-expiratory pressure. At the same time, we can conclude that the reduction of this infection incidence could decrease the mean stay in the ICU, the therapeutic charge, and the prognosis in terms of mortality and morbidity.

A semirecumbent body position led to a lower rate of nosocomial pneumonia than a supine position in mechanically ventilated adults

(1999) Lancet 354, 1851. Drakulovic MB, Torres A, Bauer TT . , et al. . Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a...

Risk Factors for Nosocomial Pneumonia in Critically Ill Trauma Patients

Nosocomial pneumonia is the most common pulmonary complication in trauma patients and the leading cause of death in nosocomial infections. A comprehensive review of pneumonia studies is provided. The Centers for Disease Control's nosocomial pneumonia pathogenesis model is reviewed and was used to guide the selection of risk factors evaluated in this study. The purposes of this research were to identify underlying dimensions (factors) of variables that increase the risk of nosocomial pneumonia and to identify predictors of nosocomial pneumonia in critically ill trauma patients.

A semirecumbent body position produced a lower rate of nosocomial pneumonia than did a supine position in mechanically ventilated adults

Source Citation Drakulovic MB, Torres A, Bauer TT, et al. Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial. Lancet. 1999;354:18...

Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial

Risk factors for nosocomial pneumonia, such as gastro-oesophageal reflux and subsequent aspiration, can be reduced by semirecumbent body position in intensive-care patients. The objective of this study was to assess whether the incidence of nosocomial pneumonia can also be reduced by this measure. This trial was stopped after the planned interim analysis. 86 intubated and mechanically ventilated patients of one medical and one respiratory intensive-care unit at a tertiary-care university hospital were randomly assigned to semirecumbent (n=39) or supine (n=47) body position. The frequency of clinically suspected and microbiologically confirmed nosocomial pneumonia (clinical plus quantitative bacteriological criteria) was assessed in both groups. Body position was analysed together with known risk factors for nosocomial pneumonia. The frequency of clinically suspected nosocomial pneumonia was lower in the semirecumbent group than in the supine group (three of 39 [8%] vs 16 of 47 [34%]; 95% CI for difference 10.0-42.0, p=0.003). This was also true for microbiologically confirmed pneumonia (semirecumbent 2/39 [5%] vs supine 11/47 [23%]; 4.2-31.8, p=0.018). Supine body position (odds ratio 6.8 [1.7-26.7], p=0.006) and enteral nutrition (5.7 [1.5-22.8], p=0.013) were independent risk factors for nosocomial pneumonia and the frequency was highest for patients receiving enteral nutrition in the supine body position (14/28, 50%). Mechanical ventilation for 7 days or more (10.9 [3.0-40.4], p=0.001) and a Glasgow coma scale score of less than 9 were additional risk factors. The semirecumbent body position reduces frequency and risk of nosocomial pneumonia, especially in patients who receive enteral nutrition. The risk of nosocomial pneumonia is increased by long-duration mechanical ventilation and decreased consciousness.

Importance of position in which patients are nursed in intensive-care units

A Europe-wide study 1 Vincent JL Bihari DJ Suter PM et al. The prevalence of nosocomial infection in intensive care units in Europe: results of the European Prevalence of Infection in Intensive Care (EPIC) study. JAMA. 1995; 274: 639-644 Crossref PubMed Scopus (2224) Google Scholar has shown a high prevalence of infections acquired in intensive-care units (ICU). 4501 patients (44·8%) had one or more infections on the study day, and 3039 (30·3%) of these had been acquired either in hospital or on the intensive-care unit itself. More than half of the infections were of the respiratory tract. This high prevalence of infections contributes significantly to the ICU mortality rate, and several studies specifically examining risk factors for nosocomial pneumonias have shown an increased mortality among those patients with nosocomial pneumonia. 2 Kollef MH Silver P Murphy DM Trovillion E The effect of late-onset ventilator-associated pneumonia in determining patient mortality. Chest. 1995; 108: 1655-1662 Crossref PubMed Scopus (360) Google Scholar , 3 Kollef MH Ventilator-associated pneumonia: a multivariate analysis. JAMA. 1993; 270: 1965-1970 Crossref PubMed Scopus (617) Google Scholar , 4 Torres A Anzar R Gatell JM et al. Incidence, risk, and prognosis factors of nosocomial pneumonia in mechanically ventilated patients. Am Rev Respir Dis. 1990; 142: 523-528 Crossref PubMed Scopus (784) Google Scholar Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trialThe semirecumbent body position reduces frequency and risk of nosocomial pneumonia, especially in patients who receive enteral nutrition. The risk of nosocomial pneumonia is increased by long-duration mechanical ventilation and decreased consciousness. Full-Text PDF

Chronic Obstructive Pulmonary Disease and Infection

Patients with chronic obstructive pulmonary disease (COPD) are especially prone to bronchial colonization and acute infection, including acute infectious exacerbations and community-acquired as well as nosocomial pneumonia. Bacterial colonization may promote bronchial inflammation, predispose to acute exacerbations, and thereby contribute to respiratory decline. Haemophilus influenzae and Streptococcus pneumoniae are the most frequently encountered pathogens in both stable disease as well as acute exacerbations. The role of bacterial infection in acute exacerbations remains subject to controversy; however, evidence is in favor of regular antimicrobial treatment in patients with severe exacerbations. COPD represents an important risk factor for community-acquired pneumonia (CAP). Microbial patterns for CAP differ from exacerbations in that S. pneumoniae and “atypical” bacterial pathogens predominate. Similarly, COPD has been recognized as an important risk factor for nosocomial pneumonia. Initial empiric antimicrobial treatment of both severe acute exacerbations and pneumonia should take into account regional drug resistance rates to penicillin of S. pneumoniae and should cover Gram-negative enteric bacilli. The additional treatment of atypical bacterial pathogens and Pseudomonas aeruginosa should be considered individually.

Nosocomial infections in critically ill infectious disease patients: Results of a 7-year focal surveillance

An incidence study on nosocomial infections in critically ill infectious disease patients was carried out in the intensive care unit (ICU) of a university hospital for infectious diseases over a 7-year period (1 January 1990 to 31 December 1996). A total of 660 patients who stayed in the ICU for over 48 h were prospectively observed. The patients were divided into two groups: one with central nervous system infections (442 patients) and the other with other severe infections (218 patients). The risk of nosocomial sepsis and pneumonia was significantly higher in patients suffering from severe central nervous system infections. The incidence of sepsis was 24.2% vs 11.4% (relative risk 1.95; 95% confidence interval 1.32-2.89); the incidence of pneumonia was 30.5% vs 14.7% (relative risk 2.09; 95% confidence interval 1.47-2.96). The incidence of urinary tract infection was 14.3% vs 13.3% (relative risk 1.07; 95% confidence interval 0.71-1.61). Density rates of nosocomial septic episodes were 21.1 +/- 37.1 vs 11.7 +/- 32.4 episodes/100 central venous-line days (P < 0.006). Nosocomial pneumonia occurred only in mechanically ventilated patients (36.9 +/- 61.2 vs 28.5 +/- 65.8 episodes per 1000 ventilatory days, P = 0.012). Nosocomial urinary tract infection occurred only in patients with urinary catheters (11.6 +/- 60.7 episodes/1000 urinary catheter days vs 18.7 +/- 90.1, P = 0.886). Multivariate regression analysis identified age, diagnosis of CNS infection, duration of urinary tract catheterization, the use of central venous lines and mechanical ventilation as independent risk factors of nosocomial sepsis. Duration of mechanical ventilation, use of steroids and diagnosis of CNS infection were independent risk factors of nosocomial pneumonia. A subanalysis identified tetanus patients to be at particular risk of nosocomial infections.

Nosocomial pneumonia experienced in a community hospital

To clarify the characteristic features of nosocomial pneumonia in a community hospital, we performed a clinical analysis of 147 patients (155 episodes) with nosocomial pneumonia. The following results were obtained. 1, Regarding the risk factors for nosocomial pneumonia, factors such as the patient whose age was over 65 years, a duration of admission of over one month, performance status 4 and underlying respiratory diseases associated with the appearance of nosocomial pneumonia. 2, The causative microorganism isolated from the sputum of the patient with nosocomial pneumonia was frequently a multi-drug resistant microorganism such as Methicillin-resistant Staphylococcus aureus (MRSA). 3, regarding treatment, although several antibiotics were administered for a long time, mechanical ventilation was used on 31% of the patients, and steroid pulse therapy was carried out on 24%. The clinical efficacy was poor with a 50% mortality rate. The reason why treatment of nosocomial pneumonia was difficult is thought to be been related to the general condition of these inpatients and to the appearance of a multi-drug resistant, polymicrobial microorganisms.

Risk factors for nosocomial pneumonia: comparing adult critical-care populations.

The purpose of the study was to examine risk factors for nosocomial pneumonia in the surgical and medical/respiratory intensive care unit (ICU) populations. In a public teaching hospital, all cases of nosocomial pneumonia in the surgical and medical/respiratory ICUs (n = 20, respectively) were identified by prospective surveillance during a 5-yr period from 1987-1991. Each group of ICU cases was compared with 40 ICU control patients who did not acquire pneumonia, and analyzed for 25 potential risk factors. Surgical ICU patients were found to have consistently higher rates of nosocomial pneumonia than medical ICU patients (RR = 2.2). The strongest predictor for nosocomial pneumonia in both the surgical and medical/respiratory ICU groups was found to be prolonged mechanical ventilation (> 1 d) resulting in a 12-fold increase in risk over nonventilated patients. APACHE III score was found to be predictive of nosocomial pneumonia in the surgical ICU population, but not in the medical/respiratory ICU population. We conclude that certain groups deserve special attention for infection control intervention. Surgical ICU patients with high APACHE scores and receiving prolonged mechanical ventilation may be at the greatest risk of acquiring nosocomial pneumonia of all hospitalized patients.

Risk factors for nosocomial pneumonia comparing adult critical-care populations

Risk factors for nosocomial pneumonia comparing adult critical-care populations

Nosocomial infections in a burn intensive care unit

Although many studies have reviewed burn wound infections (BWIs) in burn patients, few have prospectively surveyed other nosocomial infections. Seriously burned patients are clearly at increased risk for infection due to the nature of the burn injury itself, immunocompromising effects of burn injury, prolonged hospital stays, and invasive diagnostic and therapeutic procedures. Over 6 months, we prospectively reviewed all patients admitted to our burn intensive care unit (BICU) for nosocomial infections. We used standard CDC definitions of nosocomial infections (NIs). Because we had previously documented a high incidence of nosocomial pneumonias in these patients, we were particularly interested in determining risk factors for nosocomial pneumonia. The total census during the study period was 57. There were 40 discharges and deaths. Surveillance demonstrated 36 nosocomial infections in 26 patients, for a total of 90 nosocomial infections per 100 discharges and deaths, or 32.3 NIs/1000 patient days. Infections included 22 pneumonias, 10 urinary tract infections, two bacteraemias, one BWI and one episode of cellulitis. Intubation was strongly associated with nosocomial infection, particularly with pneumonia, BWI and bacteraemia. Sixty per cent of all patients were intubated at some time during their BICU stay, but 88 per cent of those who developed a nosocomial infection were intubated ( P < 0.001). Inhalation injury was less significant than intubation in the development of nosocomial infection. All patients who developed pneumonia or a BWI were intubated. One-half of nosocomial infections were attributed to gram-positive cocci (GPC) and 13 per cent to fungi ( Candida albicans), consistent with reports from burn units and other intensive care unit settings of increasing incidence of nosocomial infections due to these types of organisms.

Risk factors for nosocomial pneumonia in the elderly: Hanson LC, Weber DJ, Rutala WA, Samsa GP. Am J Med 1992;92:161–166. Reprint requests: Laura C. Hanson, MD, Robert Wood Johnson Clinical Scholars Program, University of North Carolina, CB #7105, Chapel Hill, NC 27599-7105

Risk factors for nosocomial pneumonia in the elderly: Hanson LC, Weber DJ, Rutala WA, Samsa GP. Am J Med 1992;92:161–166. Reprint requests: Laura C. Hanson, MD, Robert Wood Johnson Clinical Scholars Program, University of North Carolina, CB #7105, Chapel Hill, NC 27599-7105