Risk Of Hospital-acquired Pneumonia Research Articles

Prevalence of Hospital-Acquired Pneumonia Among Patients With Severe to Critical COVID-19 Pneumonia Given Tocilizumab.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has challenged healthcare systems worldwide since late 2019. The interleukin-6 inhibitor tocilizumab is one of the most studied agents with a proven benefit for patients with severe and critical coronavirus disease 2019 (COVID-19) pneumonia. Known adverse effects of this agent include upper respiratory tract infections, headache, hypertension, and transaminitis. The risk of secondary bacterial complications among patients who were given tocilizumab remains unclear. A descriptive study was done that included all laboratory-confirmed COVID-19 patients with a severe or critical severity for the year 2021 who received at least one dose of tocilizumab. Of the 1220 laboratory-confirmed COVID-19 patients admitted to Manila Doctors Hospital in the year 2021, a total of 139 patients fulfilled the inclusion criteria and were included in the study. Twenty-one patients, or 15% of the study population, were diagnosed with hospital-acquired pneumonia. This value was similar to previous studies showing the prevalence of secondary bacterial infections among patients who were given tocilizumab. These values could potentially aid clinicians when deciding whether or not to give one or two doses of tocilizumab to patients with severe or critical COVID-19 pneumonia. Given that many patients who are admitted with severe or critical COVID-19 pneumonia often have multiple decompensated comorbidities, the decision to give tocilizumab to manage severe COVID-19 should be weighed against the risk of hospital-acquired pneumonia.

THE RESEARCH OF THE STATUS OF HAND HYGIENE COMPLIANCE AMONG STAFF IN ACTIVE ANTIPOOXICICURATOR DEPARTMENT IN LAM DONG II HOSPITAL IN 2019

The research was carried out at Lam Dong II Hospital with a scale of 450 beds with the task of solving emergencies, providing medical examination and treatment for staff and people in 3 districts:Bao Loc, Da Huoai, and Di Linh. At the Intensive Care Unit - Anti-poison Department, Lam Dong II Hospital, patients have to undergo invasive procedures such as endotracheal intubation, mechanicalventilation, and the risk of hospital-acquired pneumonia is very high. To prevent people from risk, hand hygiene VST in patient care is a very important factor. The research analysis solves actual public health problems at Lam Dong II hospital with two main objectives: (1) Describe the current situation of routine hand hygiene of staff at the Intensive Care Unit - Anti-poison Department, Lam Dong II Hospital; (2) Proposing solutions to increase the hand hygiene rate among staff at the Intensive Care Unit - Anti-poison Department, Lam Dong II Hospital. Statistics show that the VST compliance rate of nurses at the Intensive Care Unit - Anti-poison Department is higher than that of doctors, nurses, the percentage of medical staff performing VSTwith quick hand sanitizer (71.8%) higher than the practice of washing hands with soap and water (28.2%), the survey results of 20 health workers showed that the knowledge about VST of the medicalstaff at the department meets the requirements of knowledge from 60% and above

Diagnosis and treatment of upper gastrointestinal bleeding in patients with acute cerebrovascular accident

Bleeding from the uppergastrointestinal tract is one of the most dangerous complications in patients with acute CVA (ischemic and/or hemorrhagic type). The combination of these conditions requires special attention in the diagnosis and choice of treatment methods. Central Nervous System pathology makes diagnosis, choosing methods oftreatment and the use of drug more complicated to surgeons in the postoperative period. With onset of hemorrhage, antithrombotic treatment should be canceled, that can negatively affect the results of treatment of patients with ischemic type of cerebral vascular accident. The use of anti-ulcer drugs, namely proton pump inhibitors, may increase the risk of hospital-acquired pneumonia,Clostridium difficileinfections, and cardiovascular diseases. These factors force us to consider issues related to diagnosis and treatment plans in this group of patients. The most promising direction in the treatment of patients with ischemic or hemorrhagic stroke in combination with gastroduodenal bleeding is the identification of risk factors for upper gastrointestinal bleeding, early endoscopic diagnosis and treatment, performing preventive treatment. The article presents a brief review of domestic and foreign literature, some issues of etiology and pathogenesis of gastroduodenal bleeding in patients with cancer, the results of our own research, capabilities of modern endoscopy in the diagnosis and treatment of gastrointestinal bleeding in this group of patients. The algorithm of management of patients with a combination of bleeding from the upper gastrointestinal tract and CNS pathologies.

Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA): a systematic review and meta-analysis

Supplemental oxygen is often administered liberally to acutely ill adults, but the credibility of the evidence for this practice is unclear. We systematically reviewed the efficacy and safety of liberal versus conservative oxygen therapy in acutely ill adults. In the Improving Oxygen Therapy in Acute-illness (IOTA) systematic review and meta-analysis, we searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, HealthSTAR, LILACS, PapersFirst, and the WHO International Clinical Trials Registry from inception to Oct 25, 2017, for randomised controlled trials comparing liberal and conservative oxygen therapy in acutely ill adults (aged ≥18 years). Studies limited to patients with chronic respiratory diseases or psychiatric disease, patients on extracorporeal life support, or patients treated with hyperbaric oxygen therapy or elective surgery were excluded. We screened studies and extracted summary estimates independently and in duplicate. We also extracted individual patient-level data from survival curves. The main outcomes were mortality (in-hospital, at 30 days, and at longest follow-up) and morbidity (disability at longest follow-up, risk of hospital-acquired pneumonia, any hospital-acquired infection, and length of hospital stay) assessed by random-effects meta-analyses. We assessed quality of evidence using the grading of recommendations assessment, development, and evaluation approach. This study is registered with PROSPERO, number CRD42017065697. 25 randomised controlled trials enrolled 16 037 patients with sepsis, critical illness, stroke, trauma, myocardial infarction, or cardiac arrest, and patients who had emergency surgery. Compared with a conservative oxygen strategy, a liberal oxygen strategy (median baseline saturation of peripheral oxygen [SpO2] across trials, 96% [range 94-99%, IQR 96-98]) increased mortality in-hospital (relative risk [RR] 1·21, 95% CI 1·03-1·43, I2=0%, high quality), at 30 days (RR 1·14, 95% CI 1·01-1·29, I2=0%, high quality), and at longest follow-up (RR 1·10, 95% CI 1·00-1·20, I2=0%, high quality). Morbidity outcomes were similar between groups. Findings were robust to trial sequential, subgroup, and sensitivity analyses. In acutely ill adults, high-quality evidence shows that liberal oxygen therapy increases mortality without improving other patient-important outcomes. Supplemental oxygen might become unfavourable above an SpO2 range of 94-96%. These results support the conservative administration of oxygen therapy. None.

Injury Region and Risk of Hospital-Acquired Pneumonia Among Pediatric Trauma Patients

To describe the relationship between injury region and risk of hospital-acquired pneumonia (HAP) in pediatric trauma patients. Analyses included patients <19 years of age from the National Trauma Data Bank, during 2009-2011. Multivariable logistic regression was used to examine the association between injury region and odds of developing HAP stratified by age group. A total of 71 377 patients were eligible for analysis, and 1818 patients developed pneumonia. In adjusted regression models both younger (11-15 years) and older (16-18 years) adolescents with multisite injuries including the head and neck had higher odds of developing HAP compared with adolescents with isolated head and neck injuries (odds ratio [OR] = 2.04, 95% confidence interval [CI] 1.34-3.10; OR = 1.47, 95% CI 1.14-1.89, respectively), and younger adolescents with multisite injuries not involving the head and neck also had higher odds of developing HAP (OR = 1.97, 95% CI 1.08-3.60). We found no significant association between injury region and risk of HAP in children <11 years of age. Younger and older adolescents with firearm (OR = 1.85, 95% CI 1.00-3.42; OR = 1.39, 95% CI 1.02-1.88, respectively) or pulmonary (OR = 3.78, 95% CI 1.26-11.3; OR = 2.56, 95% CI 1.01-6.51, respectively) injuries had higher odds of developing HAP compared with those with motor vehicle collision injuries. Adolescent trauma patients with multisite injuries including the head and neck have a higher risk of developing HAP compared with those with isolated head and neck injuries. We identified several risk factors that can be used to inform future research focused on identifying subgroups at high risk for the development of HAP.

Acanthamoeba containing endosymbiotic chlamydia isolated from hospital environments and its potential role in inflammatory exacerbation.

BackgroundEnvironmental chlamydiae belonging to the Parachlamydiaceae are obligate intracellular bacteria that infect Acanthamoeba, a free-living amoeba, and are a risk for hospital-acquired pneumonia. However, whether amoebae harboring environmental chlamydiae actually survive in hospital environments is unknown. We therefore isolated living amoebae with symbiotic chlamydiae from hospital environments.ResultsOne hundred smear samples were collected from Hokkaido University Hospital, Sapporo, Japan; 50 in winter (February to March, 2012) and 50 in summer (August, 2012), and used for the study. Acanthamoebae were isolated from the smear samples, and endosymbiotic chlamydial traits were assessed by infectivity, cytokine induction, and draft genomic analysis. From these, 23 amoebae were enriched on agar plates spread with heat-killed Escherichia coli. Amoeba prevalence was greater in the summer-collected samples (15/30, 50%) than those of the winter season (8/30, 26.7%), possibly indicating a seasonal variation (p = 0.096). Morphological assessment of cysts revealed 21 amoebae (21/23, 91%) to be Acanthamoeba, and cultures in PYG medium were established for 11 of these amoebae. Three amoebae contained environmental chlamydiae; however, only one amoeba (Acanthamoeba T4) with an environmental chlamydia (Protochlamydia W-9) was shown the infectious ability to Acanthamoeba C3 (reference amoebae). While Protochlamydia W-9 could infect C3 amoeba, it failed to replicate in immortal human epithelial, although exposure of HEp-2 cells to living bacteria induced the proinflammatory cytokine, IL-8. Comparative genome analysis with KEGG revealed similar genomic features compared with other Protochlamydia genomes (UWE25 and R18), except for a lack of genes encoding the type IV secretion system. Interestingly, resistance genes associated with several antibiotics and toxic compounds were identified.ConclusionThese findings are the first demonstration of the distribution in a hospital of a living Acanthamoeba carrying an endosymbiotic chlamydial pathogen.Electronic supplementary materialThe online version of this article (doi:10.1186/s12866-016-0906-1) contains supplementary material, which is available to authorized users.

Executive Summary: Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society.

It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.These guidelines are intended for use by healthcare professionals who care for patients at risk for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), including specialists in infectious diseases, pulmonary diseases, critical care, and surgeons, anesthesiologists, hospitalists, and any clinicians and healthcare providers caring for hospitalized patients with nosocomial pneumonia. The panel's recommendations for the diagnosis and treatment of HAP and VAP are based upon evidence derived from topic-specific systematic literature reviews.

Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society.

It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.These guidelines are intended for use by healthcare professionals who care for patients at risk for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), including specialists in infectious diseases, pulmonary diseases, critical care, and surgeons, anesthesiologists, hospitalists, and any clinicians and healthcare providers caring for hospitalized patients with nosocomial pneumonia. The panel's recommendations for the diagnosis and treatment of HAP and VAP are based upon evidence derived from topic-specific systematic literature reviews.

Abstract P246: Hospital Acquired Pneumonia and Dysphagia Screening in Patients With Acute Ischemic Stroke: Findings From Get With the Guidelines-Stroke

National guidelines recommend dysphagia screening (DS) before any oral intake in hospitalized stroke patients to reduce the risk of hospital-acquired pneumonia (HAP). We examined the relationship between DS and HAP in acute ischemic stroke patients in the Get With the Guidelines-Stroke (GWTG-S) program. Methods: Data from 1251 GWTG-S hospitals from 04/01/2003 to 03/01/2009 were analyzed. GWTG-S defines HAP as a clinical diagnosis of pneumonia requiring antibiotics. Use of a bedside, evidence-based swallow screen prior to any oral intake qualified as a DS. Univariate analyses (chi-square for categorical variables or Wilcoxon for continuous variables) and multivariate logistic regression analyses were performed to examine the relationship between DS and HAP, adjusting for patient and hospital characteristics Results: Among 365,726 ischemic stroke patients, 213097 (59.83%) underwent DS, and 25,166 (6.88%) developed HAP. When compared to patients without pneumonia ( Table 1 ), patients with HAP were older and more frequently had CAD/MI, diabetes, prior stroke/TIA, dyslipidemia, atrial fibrillation. They, underwent DS less often, and had increased length of stay, morbidity and in-hospital mortality. Among the subgroup who had NIHSS recorded (n=160,837, 44%), HAP patients had higher median NIHSS (13 vs. 5). Among patients with NIHSS&lt;2, 3.3% developed HAP. In multivariate analysis, factors independently associated with a lower risk of HAP were DS (OR 0.86 [0.83-0.90]), female (OR 0.83 [0.81-0.85]), dyslipidemia (OR 0.84 [0.82-0.86]), and hypertension (OR 0.96 [0.94-0.98]). Discussion: Our data suggests that dysphagia screening is associated with a lower likelihood of HAP, but screening rates remain low. Strategies that increase the rate of dysphagia screening among all stroke patients, even those with mild strokes, should be more broadly implemented. Prospective validation of these findings is warranted. Table 1. Unadjusted associations between patient and hospital characteristics and clinical outcomes Overall(% or value) HAP(% or value) No HAP(% or value) Study Population 365726 (100%) 25166(6.9%) 340560(93.1%) Age (years) Median (IQR) 73(61, 82) 77(66, 85) 73(61,82) Female 52.5 49.2 52.8 Dysphagia Screen Performed 59.8 54.8 60.2 In Hospital Death 5.7 18.1 4.8 P-values are &lt;.0001 for all comparisons and are based on Chi-square test (for dichotomous and nominal factors) or Wilcoxon test (for ordinal and continuous factors)

Acid-Suppressive Medication Use and the Risk for Hospital-Acquired Pneumonia

Acid-Suppressive Medication Use and the Risk for Hospital-Acquired Pneumonia

Acid-Suppressive Medication Use and the Risk for Hospital-Acquired Pneumonia

The use of acid-suppressive medication has been steadily increasing, particularly in the inpatient setting, despite lack of an accepted indication in the majority of these patients. To examine the association between acid-suppressive medication and hospital-acquired pneumonia. Prospective pharmacoepidemiologic cohort study. All patients who were admitted to a large, urban, academic medical center in Boston, Massachusetts, from January 2004 through December 2007; at least 18 years of age; and hospitalized for 3 or more days were eligible for inclusion. Admissions with time spent in the intensive care unit were excluded. Acid-suppressive medication use was defined as any order for a proton-pump inhibitor or histamine(2) receptor antagonist. Traditional and propensity-matched multivariable logistic regression were used to control for confounders. Incidence of hospital-acquired pneumonia, defined via codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), in patients exposed and unexposed to acid-suppressive medication. The final cohort comprised 63 878 admissions. Acid-suppressive medication was ordered in 52% of admissions and hospital-acquired pneumonia occurred in 2219 admissions (3.5%). The unadjusted incidence of hospital-acquired pneumonia was higher in the group exposed to acid-suppressive medication than in the unexposed group (4.9% vs 2.0%; odds ratio [OR], 2.6; 95% confidence interval [CI], 2.3-2.8). Using multivariable logistic regression, the adjusted OR of hospital-acquired pneumonia in the group exposed to acid-suppressive medication was 1.3 (95% CI, 1.1-1.4). The matched propensity-score analyses yielded identical results. The association was significant for proton-pump inhibitors (OR, 1.3; 95% CI, 1.1-1.4) but not for histamine(2) receptor antagonists (OR, 1.2; 95% CI, 0.98-1.4). In this large, hospital-based pharmacoepidemiologic cohort, acid-suppressive medication use was associated with 30% increased odds of hospital-acquired pneumonia. In subset analyses, statistically significant risk was demonstrated only for proton-pump inhibitor use.

Comment on: Guidelines for the management of hospital-acquired pneumonia in the UK: Report of the Working Party on Hospital-Acquired Pneumonia of the British Society for Antimicrobial Chemotherapy

Sir, I appreciated the recent and very comprehensive guidelines for managing hospital-acquired pneumonia by Masterton et al. Malnutrition can greatly increase pneumonia morbidity and mortality rates in both children and adults. Malnutrition is responsible for an estimated 52% of the 2 million impoverished children who die annually worldwide due to pneumonia. However, the relationship between malnutrition and pneumonia in adults in the developed world is often overlooked. Various studies have reported malnutrition for hospitalized elderly to range from 42% to 91% in the developed world. Several studies have reported that rates of both hospital-acquired pneumonia and nosocomial infections, in general, are significantly higher in malnourished versus well-nourished patients. A study of 578 nursing home elderly reported that rates of both pneumonia infection and antibiotic consumption were significantly higher in residents with low serum zinc levels. Many acutely ill patients require enteral tube feeding, which may present some aspiration risk. A study of 4049 mechanically ventilated patients reported that enteral feeding within 48 h of intubation was associated with a significant reduction in hospital mortality (27.8% versus 34.2%, P 1⁄4 0.0005), even though rates of aspiration pneumonia were increased (12.6% versus 9.5%, P 1⁄4 0.007) when compared with patients who received later enteral feeding. Use of ‘immunonutrition’ enteral formulas containing omega 3 fatty acids and extra levels of glutamine, zinc, copper, selenium and vitamins may reduce the risk of pneumonia among the acutely ill. Meta-analysis of 11 studies reported that the use of such ‘immunonutrition’ formulas was associated with a 46% reduced risk of hospital-acquired pneumonia when compared with standard formulas (P 1⁄4 0.007). A study of 165 mechanically ventilated patients with severe sepsis reported that use of an enteral formula with omega 3 fatty acids and extra vitamins was associated with significantly lower mortality and significantly fewer days on mechanical ventilation when compared with patients on standard formula. Good nutrition can play a major role in preventing and treating hospital-acquired pneumonia. Much more research on the relationship between nutrition and pneumonia should be published and the results incorporated into future pneumonia guidelines.

What is healthcare-associated pneumonia, and how should it be treated?

In contrast to patients at risk for hospital-acquired pneumonia or mechanically ventilated patients at risk for ventilator-associated pneumonia, healthcare-associated pneumonia is a relatively new clinical entity that includes a spectrum of adult patients who have close association with acute care hospitals or reside in chronic care settings that increase their risk for pneumonia caused by multi-drug-resistant bacteria. Multi-drug-resistant pathogens include methicillin-resistant Staphylococcus aureus and Gram-negative bacilli, such as Pseudomonas aeruginosa, extended-spectrum beta-lactamase-producing Klebsiella pneumoniae, and Acinetobacter species. New guidelines for the management and prevention of hospital-acquired pneumonia, ventilator-associated pneumonia and healthcare-associated pneumonia from the American Thoracic Society and the Infectious Diseases Society of America were published in 2005 and are highlighted in this article. Recent data indicate that types of multi-drug-resistant pathogens may vary in different healthcare settings, and that individuals infected with multi-drug-resistant pathogens are more likely to receive inappropriate initial antibiotic therapy, which may result in poorer outcomes in terms of patient morbidity, mortality and increased length of hospital stay. This review highlights key points in the new recommendations and principles for initiating, de-escalating and stopping antibiotic therapy in individuals with healthcare-associated pneumonia. Widespread implementation of these guidelines is needed in healthcare institutions in order to reduce patient morbidity, mortality, and healthcare costs.