Risk Factors For Nosocomial Pneumonia Research Articles

Comparative aspects of the influence of exogenous risk factors on the occurrence of nosocomial pneumonia among patients infected with COVID-19 in intensive care units and surgical and therapy departments of a large multidisciplinary hospital

The problem of lung damage in viral infection caused by COVID-19 due to high frequency is relevant for anesthesiologists, resuscitators and epidemiologists. According to scientific research, when a patient is on a ventilator, the risk of an adverse outcome can reach 42 %. This is determined by the widespread use of invasive diagnostic manipulations in patients with COVID-19, which may be associated with bacterial and viral contamination of the environment. This article presents the results of a study of the influence of exogenous risk factors on the development of nosocomial pneumonia in 164 patients infected with COVID-19 in intensive care units and departments of surgical and therapeutic profile of a large multidisciplinary hospital. The number of exogenous risk factors for nosocomial pneumonia among patients infected with COVID-19 in intensive care units exceeded by 7.3 times their presence in surgical departments with a predominance of artificial lung ventilation (90.2 %), tracheostomy (87.8 %), oxygen therapy (68.3 %). The negative impact was determined by the untimely change of air filters during artificial lung ventilation — 16.2 % and tracheal sanitation –8.1 %, poor hand treatment of medical personnel,before tracheal sanitation — 39.2 %.

Evaluation of the Risk Factors of Nosocomial Pneumonia and the Prevalence of Antibiotic Resistance in Trauma Patients in Need of Immediate Intervention

Background: Pneumonia is the most common nosocomial infection reported worldwide in intensive care units. This study aimed to evaluate the risk factors of nosocomial pneumonia and the frequency of antibiotic resistance in trauma patients who need immediate intervention. Patients and Methods: This prospective cohort study was conducted in Shahid Rajaei Trauma Hospital in Shiraz between 2020 and 2021. All the trauma patients who needed immediate intervention (levels 1 and 2 based on the Canadian Emergency Department Triage and Acuity Scale) and had no symptoms of infection were included. Patients who were discharged or died before 48 hours were excluded. Results: The results demonstrated that major trauma (Injury Severity Score [ISS] ≥16), intubation, and use of invasive mechanical ventilation increase nosocomial pneumonia and death rate. The most common causes of nosocomial infections were Acinetobacter baumannii (23%) and coagulase-negative staphylococcus (18.5%). The highest levels of antibiotic resistance were related to cefoxitin, erythromycin, ciprofloxacin, and trimethoprim-sulfamethoxazole. Conclusions: Major trauma, intubation, and invasive mechanical ventilation were the effective factors in the development of nosocomial pneumonia. Continuous monitoring for mentioned risk factors and strict surveillance of antibiotic prescription can decrease the prevalence of nosocomial infections and subsequent deaths.

Clinical Outcomes and Prolonged SARS-CoV-2 Viral Shedding in ICU Patients with Severe COVID-19 Infection and Nosocomial Bacterial Pneumonia: A Retrospective Cohort Study.

This study explored the clinical outcomes and association of prolonged severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) shedding in patients with severe coronavirus disease 2019 (COVID-19) infection who developed nosocomial pneumonia. This was a retrospective study conducted in a medical center in Taiwan. From May to September 2021, patients from four intensive care units were enrolled after SARS-CoV-2 was confirmed through quantitative polymerase chain reaction and all cases were compatible with the definitions of severe COVID-19 infection. Baseline characteristics, disease severity, clinical outcomes, and times of viral shedding were recorded. A total of 72 patients were diagnosed as having severe COVID-19 infection and 30 developed nosocomial pneumonia, comprising hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP). The patients with severe COVID-19 infection and concomitant HAP/VAP had longer intensive care unit (ICU) stays and fewer ventilator-free days at Day 28. An independent risk factor for nosocomial pneumonia was a greater SOFA score at admission. Furthermore, the patients with severe COVID-19 infection who developed HAP/VAP had a significantly longer duration of SARS-CoV-2 shedding (19.50 days vs. 15.00 days, p = 0.006). Patients with severe COVID-19 infection who developed nosocomial pneumonia had longer SARS-CoV-2 shedding days, more complications, and worse outcomes.

Impaired host response and the presence of Acinetobacter baumannii in the serum microbiome of type-II diabetic patients.

SummaryType II diabetes (T2D) affects over 10% of the US population and is a growing disease worldwide that manifests with numerous comorbidities and defects in inflammation. This dysbiotic host response allows for infection of the host by numerous microorganisms. In the course of T2D disease, individuals can develop chronic infections including foot ulcers and periodontitis, which lead to further complications and opportunistic infections in multiple body sites. In this study, we investigated the serum of healthy subjects and patients with T2D with (T2DP) or without periodontitis for both microbiome signatures in addition to cytokine profiles. Surprisingly, we detected the presence of Acinetobacter baumanii in the serum of 23% individuals with T2D/T2DP tested. In T2DP, IL-1β, TNF-α, MCP-1, IL-6, IL-8, and IFN-γ were significantly elevated in ABC-positive subjects. As an emerging pathogen, A. baumanii infection represents a risk for impaired inflammation and the development of comorbidities in subjects with T2D.

Some Risk Factors for Hospital Infections at the ICU in the Vietnam National Children’s Hospital

Purpose: To identify some risk factors for hospital infections in the ICU, Vietnam National Children’s Hospital in 2018-2019.
 Method: A prospective cohort study was conducted.
 Results: Malnutrition grade II or higher, PRISM > 10, ≥ 3 invasive intervention, use of H2-receptor antagonists and intravenous feeding were risk factors for nosocomial infections. Endotracheal intubation, intubation for > 5 days, re-intubation, and aspiration of vomit were risk factors for nosocomial pneumonia. Intravenous exposure, 3 or more IV lines, and central venous catheterization were risk factors for sepsis. Gastrointestinal surgery, surgery time > 2 hours, postoperative drainage, drainage time > 5 days and no prophylactic antibiotics were risk factors for wound infection. Urinary retention and urinary flow > 3 days were risk factors for urinary tract infections.
 Conclusion: Nosocomial infections with grade II or higher malnutrition and 3 invasive interventions, the use of H2-receptor resistance and intravenous nutrition associated with nosocomial infections. Pneumonia, urinary tract infections, and sepsis are high risk factors for nosocomial infections.

Deep odontogenic infections\u2014identifying risk factors for nosocomial pneumonia

ObjectivesTo evaluate occurrence and risk factors for pneumonia in patients with deep odontogenic infection (OI).Materials and methodsAll patients treated for deep OIs and requiring intensive care and mechanical ventilation were included. The outcome variable was diagnosis of nosocomial pneumonia. Primary predictor variables were re-intubation and duration of mechanical ventilation. The secondary predictor variable was length of hospital stay (LOHS). The explanatory variables were gender, age, current smoking, current heavy alcohol and/or drug use, diabetes, and chronic pulmonary disease.ResultsNinety-two patients were included in the analyses. Pneumonia was detected in 14 patients (15%). It was diagnosed on postoperative day 2 to 6 (median 3 days, mean 3 days) after primary infection care. Duration of mechanical ventilation (p = 0.028) and LOHS (p = 0.002) correlated significantly with occurrence of pneumonia. In addition, re-intubation (p = 0.004) was found to be significantly associated with pneumonia; however, pneumonia was detected in 75% of these patients prior to re-intubation. Two patients (2%) died during intensive care unit stay, and both had diagnosed nosocomial pneumonia. Smoking correlated significantly with pneumonia (p = 0.011).ConclusionSecondary pneumonia due to deep OI is associated with prolonged hospital care and can predict the risk of death. Duration of mechanical ventilation should be reduced with prompt and adequate OI treatment, whenever possible. Smokers with deep OI have a significantly higher risk than non-smokers of developing pneumonia.Clinical relevanceNosocomial pneumonia is a considerable problem in OI patients with lengthy mechanical ventilation. Prompt and comprehensive OI care is required to reduce these risk factors.

Characteristics and factors associated with nosocomial pneumonia among patients undergoing continuous renal replacement therapy (CRRT): A case–control study

ObjectivesContinuous renal replacement therapy (CRRT) is a specialized type of dialysis. However, the characteristics and factors associated with nosocomial pneumonia in patients undergoing CRRT have received little attention to date. Therefore, this study investigated the characteristics of and factors contributing to nosocomial pneumonia in patients receiving CRRT. MethodsThe clinical data of 1160 patients undergoing CRRT during the period January 2008 to December 2015 were analyzed retrospectively. Of these 1160 cases, 145 (12.5%) were included in the nosocomial pneumonia group, while 1015 were included in the control group. ResultsThe primary pathogen in the 145 cases of nosocomial pneumonia in the CRRT patients was Staphylococcus aureus (58.57%); the morbidity rate was 12.5%. Multivariate logistic regression analysis revealed that age (odds ratio (OR) 2.209), initial curative time (OR 1.960), underlying diseases (OR 1.820), consciousness disorder (OR 1.616), organ failure (OR 2.154), the Acute Physiology and Chronic Health Evaluation II score (APACHE II) (OR 1.186), and the Charlson Comorbidity Index score (CCI) (OR 1.278) were risk factors for nosocomial pneumonia (all p<0.05). Conversely, the serum white blood cell count (OR 0.585), albumin (OR 0.673), and hemoglobin (OR 0.712) levels were protective factors (all p<0.05). ConclusionsResults from this study indicate that by modifying risk factors, such as providing adequate nutrition, earlier treatment of underlying diseases, and controlling organ failure, the risks associated with nosocomial pneumonia may be reduced.

Reflujo gastroesofágico en pacientes con ventilación mecánica: hacia el manejo integral mediante la analogía del «pozo de petróleo»

Gastroesophageal reflux (GER) is one of the major risk factors for nosocomial pneumonia, mainly in patients on mechanical ventilation. In a “real life” setting, identifying the causes of GER involves an indisputable diagnostic complexity, which varies as the patient is under critical care. The “oil well” analogy is a comprehensive conceptualisation of the causes of GER, which is potentially modifiable in these patients, although therapeutic interventions require a comprehensive assessment of its causes. The analogy appears to be useful to improve and expedite the diagnostic and therapeutic process in critically ill patients. The simple usual prokinetic and/or antacid treatment appears to be insufficient. Patients may require and benefit from specific, differential, and additional strategies that change with the time according to each case and its progression. The oil well analogy is an aid to the multifactorial diagnosis, and highlights the dynamic nature of these causes of GER, thus allowing the clinicians to offer therapeutic target both individually and dynamically in each patient.

Overproduction of Outer Membrane Protein A by Acinetobacter baumannii as a Risk Factor for Nosocomial Pneumonia, Bacteremia, and Mortality Rate Increase.

Outer membrane protein A (OmpA) is a porin involved in Acinetobacter baumannii pathogenesis. However, OmpA clinical implication in hospital-acquired infections remains unknown. We aimed to determine whether OmpA overproduction was a risk factor associated with pneumonia, bacteremia, and mortality. We analyzed demographic, microbiological, and clinical data from 100 patients included in a unicenter cohort and 246 included in a unicenter cohort and a multicenter cohort. Representative isolates were classified into 2 groups: (1) isolates from patients colonized by A. baumannii (16 from the unicenter and 20 from the multicenter cohort) and (2) isolates from bacteremic or nonbacteremic patients with pneumonia (PP) caused by A. baumannii (13 from the unicenter and 23 from the multicenter cohort) Expression of ompA was determined with quantitative reverse-transcription polymerase chain reaction. Isolates from PP overexpressed more ompA than those from colonized patients from the unicenter (ratio, 1.76 vs 0.36; P < .001) and the multicenter (1.36 vs 0.91; P = .03) cohorts. Among isolates from PP, those from bacteremic patients overexpressed nonsignificantly more ompA than those from nonbacteremic patients in the unicenter (ratio, 2.37 vs 1.43; P = .06) and the multicenter (2.03 vs 0.91; P = .14) cohorts. Multivariate analysis in both cohorts together showed ompA overexpression as independent risk factor for pneumonia (P < .001), bacteremia (P = .005), and death (P = .049). These data suggest that ompA overexpression is an associated factor for pneumonia, bacteremia, and death due to A. baumannii.

Non-Intensive Care Unit Acquired Pneumonia: A New Clinical Entity?

Hospital-acquired pneumonia (HAP) is a frequent cause of nosocomial infections, responsible for great morbidity and mortality worldwide. The majority of studies on HAP have been conducted in patients hospitalized in the intensive care unit (ICU), as mechanical ventilation represents a major risk factor for nosocomial pneumonia and specifically for ventilator-associated pneumonia. However, epidemiological data seem to be different between patients acquiring HAP in the ICU vs. general wards, suggesting the importance of identifying non ICU-acquired pneumonia (NIAP) as a clinical distinct entity in terms of both etiology and management. Early detection of NIAP, along with an individualized management, is needed to reduce antibiotic use and side effects, bacterial resistance and mortality. The present article reviews the pathophysiology, diagnosis, treatment and prevention of NIAP.

Risk factors for nosocomial pneumonia in patients with abdominal surgery

Abstract Background The risk of post-operative pneumonia is a latent complication. A study was conducted to determine its risk factors in abdominal surgery. Material and methods A cross-sectional study was performed that included analysing the variables of age and gender, chronic obstructive pulmonary disease and smoking, serum albumin, type of surgery and anaesthesia, emergency or elective surgery, incision site, duration of surgery, length of hospital stay, length of stay in the intensive care unit, and time on mechanical ventilation. The adjusted odds ratio for risk factors was obtained using multivariate logistic regression. Results The study included 91 (9.6%) patients with pneumonia and 851 (90.4%) without pneumonia. Age 60 years or over (OR = 2.34), smoking (OR = 9.48), chronic obstructive pulmonary disease (OR = 3.52), emergency surgery (OR = 2.48), general anaesthesia (OR = 3.18), surgical time 120 min or over (OR = 5.79), time in intensive care unit 7 days or over (OR = 1.23), time on mechanical ventilation greater than or equal to 4 days (OR = 5.93) and length of post-operative hospital stay of 15 days or over (OR = 1.20), were observed as independent predictors for the development of postoperative pneumonia. Conclusions Identifying risk factors for post-operative pneumonia may prevent their occurrence. The length in the intensive care unit of greater than or equal to 7 days (OR = 1.23; 95% CI 1.07–1.42) and a length postoperative hospital stay of 15 days or more (OR = 1.20; 95% CI 1.07–1.34) were the predictive factors most strongly associated with lung infection in this study.

Administration of proton pump inhibitors in critically ill medical patients is associated with increased risk of developing Clostridium difficile–associated diarrhea

PurposeProton pump inhibitors (PPIs) effectively prevent gastrointestinal bleedings in critically ill patients at the intensive care unit (ICU). In non-ICU hospitalized patients, PPI administration increases the risk of infectious complications, especially Clostridium difficile–associated diarrhea (CDAD); but no such data are available for the ICU setting. Materials and methodsThis is a retrospective, observational, single-center analysis (1999-2010) including 3286 critically ill patients. ResultsA total of 91.3% of patients received stress ulcer prophylaxis by PPI (55.6%), histamine 2 receptor antagonists (5.8%), sucralfate (10.1%), or combinations (19.8%). Only 29 (0.9%) of 3286 patients developed gastrointestinal bleedings during the course of ICU treatment, independent from the type of prophylaxis. The PPIs were not an independent risk factor for nosocomial pneumonia. One hundred and ten (3.3%) patients developed CDAD during the course of ICU treatment, which was associated with prolonged ICU stay and increased ICU mortality (odds ratio, 1.59). Similar to fluoroquinolones and cephalosporins, PPI was identified as an independent risk factor (odds ratio, 3.11) for developing CDAD at the ICU by multivariate analysis. ConclusionsProton pump inhibitor therapy was an independent risk factor for CDAD in medical ICU patients. Instead of routine PPI use for bleeding prophylaxis, further trials should investigate risk-adjusted algorithms, balancing benefits, and threats of PPI medication.

Risk factors for nosocomial pneumonia in intensive care units of a University Hospital

Amac: Nozokomiyal pnomoni (NP) yogun bakim unitesi (YBU)’nde en sik karsilasilan nozokomiyal enfeksiyondur. NP gelisen hastalardaki risk faktorlerinin degerlendirilmesi YBU ihtiyaci olan hastalar icin yol gosterici olabilir. Bu calismanin amaci YBU’de gelisen NP risk faktorlerinin belirlenmesidir. Yontemler: Alti aylik sure icerisinde, bir universite hastanesinin YBU’lerinde 48 saatten uzun kalan hastalar calismaya alindi. Toplam olarak 304 hasta prospektif izlenirken, bu hastalarin NP gelisen 78’i NP grubunu olusturdu. Herhangi bir enfeksiyon gelismeyen hastalar ise kontrol grubu olarak tanimlandi. Tek degiskenli analiz ile NP risk faktoru olabilecegi dusunulen veya saptanan degiskenler cok degiskenli lojistik regresyon analizi ile incelendi. Bulgular: 304 hastanin 78’inde (% 25,6) NP gelisti. Cok degiskenli analiz ile ileri yas (odds ratio [OR] 1, %95 guven araligi [CI] 1,00-1,06), YBU’de yatis suresi (OR 1,3, % 95 CI 1,17-1,39), YBU oncesi enfeksiyon varligi (OR 6,7, %95 CI 1,52-29,94), kan urunu transfuzyonu (OR 4, %95 CI 1,43-11,46) ve YBU yatisindan onceki 2 hafta icerisinde antibiyotik kullanim oykusu (OR 3,3, %95 CI 1,28-8,48) NP icin bagimsiz risk faktorleri olarak tanimlandi. Ayrica, NP gelisen hastalarin ortalama APACHE II skoru (16,7±6,7) kontrol grubundan anlamli olarak yuksek bulundu (11,5±8,1; p<0.001).Sonuc: Nozokomiyal pnomoni ozellikle YBU’lerde hastanede yatis suresini, maliyeti ve mortaliteyi arttiran onemli bir enfeksiyon hastaligidir. Ileri yas, yatis oncesi enfeksiyon varligi, YBU’de yatis suresinin uzunlugu, kan urunu transfuzyonu ve onceden antibiyotik kullanimi gibi tanimlanmis risk faktorleri olan hastalarda erken tani acisindan uyanik olunmalidir

STANDARD EPIDEMIOLOGICAL CASE DEFINITION AND RISK FACTORS OF NOSOCOMIAL PNEUMONIA TERM AND PRETERM INFANTS

Based on the results of studying the frequency of clinical and laboratory symptoms single standard epidemiological estimate of pneumonia is designed to be possible to be used with respect to full term and preterm infants. Such estimate should include the presence of inflammatory reaction in the lung on chest radiograph and at least one of the symptoms such as apnea, wheezing, sputum. For term infants the leading risk factor for nosocomial pneumonia associated with neonatal departments at Children ’s Hospital, was established to be a long-term (over 5 days) mechanical ventilation. For preterm newborns the risk factor for pneumonia, in addition, may be a history of respiratory distress syndrome, pneumopathy, intrauterine growth retardation, amniotic fluid aspiration and asphyxia at birth.

Effect of metoclopramide on nosocomial pneumonia in patients with nasogastric feeding in the intensive care unit

This study in the Islamic Republic of Iran aimed to determine whether metoclopramide can prevent nosocomial pneumonia in the intensive care unit (ICU). Of 220 patients admitted to the surgical ICU who had a nasogastric tube for more than 24 hours, 68 case patients received oral metoclopramide (10 mg every 8 hours) and 152 control patients did not. Similar proportions of cases and controls developed nosocomial pneumonia (33.8% versus 33.6%). Endotracheal intubation was a risk factor for nosocomial pneumonia (odds ratio 7.70). There were no significant differences between groups in mortality rate or time of onset of nosocomial pneumonia. Metoclopramide appears to have no effect on the development of nosocomial pneumonia with nasogastric feeding.

Determinantes morfológicos de prognóstico em pneumonia nosocomial: um estudo em autópsias

To determine the prevalence of nosocomial pneumonia in autopsies at a public university hospital; to identify the risk factors for nosocomial pneumonia and the potential prognostic factors associated with fatal nosocomial pneumonia and with fatal aspiration pneumonia; and to determine whether anatomopathological findings correlate with nosocomial pneumonia or aspiration pneumonia. A retrospective study involving 199 autopsied patients, older than 1 year of age, who had been admitted to the São Paulo State University Botucatu School of Medicine Hospital das Clínicas and died of nosocomial pneumonia (underlying or contributing cause), between 1999 and 2006. Demographic, clinical and anatomopathological variables were tested regarding their association with the outcomes (fatal nosocomial pneumonia and fatal aspiration pneumonia). The significant variables were analyzed using multivariate analysis. The mean age was 59 +/- 19 years. The prevalence of nosocomial pneumonia in autopsies was 29%, and the disease was the cause of death in 22.6% of the autopsied patients. Fatal nosocomial pneumonia correlated with the following anatomopathological findings: tobacco-associated structural lesions (OR = 3.23; 95% CI: 1.26-2.95; p = 0.02) and bilateral pneumonia (OR = 3.23; 95% CI: 1.26-8.30; p = 0.01). None of the variables were found to be significantly associated with fatal aspiration pneumonia. In our sample, there was a high prevalence of nosocomial pneumonia, which was responsible for almost 25% of all of the deaths. Smoking-related structural lesions and bilateral pneumonia all favored mortality. These findings corroborate the results of various clinical studies on nosocomial pneumonia.

Nosocomial Pneumonia Risk and Stress Ulcer Prophylaxis: A Comparison of Pantoprazole vs Ranitidine in Cardiothoracic Surgery Patients

Stress ulcer prophylaxis (SUP) using ranitidine, a histamine H2 receptor antagonist, has been associated with an increased risk of ventilator-associated pneumonia. The proton pump inhibitor (PPI) pantoprazole is also commonly used for SUP. PPI use has been linked to an increased risk of community-acquired pneumonia. The objective of this study was to determine whether SUP with pantoprazole increases pneumonia risk compared with ranitidine in critically ill patients. The cardiothoracic surgery database at our institution was used to identify retrospectively all patients who had received SUP with pantoprazole or ranitidine, without crossover between agents. From January 1, 2004, to March 31, 2007, 887 patients were identified, with 53 patients excluded (pantoprazole, 30 patients; ranitidine, 23 patients). Our analysis compared the incidence of nosocomial pneumonia in 377 patients who received pantoprazole with 457 patients who received ranitidine. Nosocomial pneumonia developed in 35 of the 377 patients (9.3%) who received pantoprazole, compared with 7 of the 457 patients (1.5%) who received ranitidine (odds ratio [OR], 6.6; 95% confidence interval [CI], 2.9 to 14.9). Twenty-three covariates were used to estimate the probability of receiving pantoprazole as measured by propensity score (C-index, 0.77). Using this score, pantoprazole and ranitidine patients were stratified according to their probability of receiving pantoprazole. After propensity adjusted, multivariable logistic regression, pantoprazole treatment was found to be an independent risk factor for nosocomial pneumonia (OR, 2.7; 95% CI, 1.1 to 6.7; p = 0.034). The use of pantoprazole for SUP was associated with a higher risk of nosocomial pneumonia compared with ranitidine. This relationship warrants further study in a randomized controlled trial.

Risk factors for the development of nosocomial pneumonia and mortality on intensive care units: application of competing risks models

IntroductionPneumonia is a very common nosocomial infection in intensive care units (ICUs). Many studies have investigated risk factors for the development of infection and its consequences. However, the evaluation in most of theses studies disregards the fact that there are additional competing events, such as discharge or death.MethodsA prospective cohort study was conducted over 18 months in five intensive care units at one university hospital. All patients that were admitted for at least 2 days were included, and surveillance of nosocomial pneumonia was conducted. Various potential risk factors (baseline- and time-dependent) were evaluated in two competing risks models: the acquisition of nosocomial pneumonia and discharge (dead or alive; model 1) and for the risk of death in the ICU and discharge alive (model 2).ResultsPatients from 1,876 admissions were included. A total of 158 patients developed nosocomial pneumonia. The main risk factors for nosocomial pneumonia in the multivariate analysis in model 1 were: elective surgery (cause-specific hazard ratio = 1.95; 95% CI 1.33 to 2.85) or emergency surgery (1.59; 95% CI 1.10 to 2.28) prior to ICU admission, usage of a nasogastric tube (3.04; 95% CI 1.25 to 7.37) and mechanical ventilation (5.90; 95% CI 2.47 to 14.09). Nosocomial pneumonia prolonged the length of ICU stay but was not directly associated with a fatal outcome (p = 0.55).ConclusionMore studies using competing risk models, which provide more accurate data compared to naive survival curves or logistic models, should be carried out to verify the impact of risk factors and patient characteristics for the acquisition of nosocomial infections and infection-associated mortality.

Diabetes mellitus as a risk factor for nosocomial pneumonia and associated mortality

Patients with diabetes mellitus (DM) are considered to be more susceptible to several types of infections, including community-acquired pneumonia. However, it is not clear whether DM is a risk factor for development of hospital-acquired pneumonia (HAP), an infection with considerable morbidity and mortality worldwide. We searched PubMed for relevant publications that included data on the possible association between DM and HAP. Cohort studies, case-control studies and observational studies were included in this analysis. Two of the authors performed the literature search independently. We identified 84 studies designed to identify risk factors and predictors of mortality as a result of HAP. Of these, 13 studied patients in the ward or intensive care unit (ICU), 28 studied patients treated in the ICU only, and 44 studied patients with ventilator-associated pneumonia. Only 14 considered the role of DM for this nosocomial complication. The reviewed data suggest that DM is not a risk factor for development of HAP in patients who require ICU treatment. In addition, patients with DM are not at increased risk for development of ventilator-associated pneumonia. Moreover, DM is not a prognostic factor for mortality in patients with HAP based on data from two out of 84 identified studies that provided relevant information. There is a relative scarcity of studies examining DM as a potential risk factor for HAP. Our analysis of the available data supports the conclusion that DM is not a risk factor for development of HAP and mortality associated with this nosocomial infection.

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.