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Nosocomial Pneumonia

Hospital-acquired Pneumonia


Presentation

  • RESULTS: Individuals with periodontitis were three times as likely to present with NP (unadjusted odds ratio [OR unadjusted] 3.06, 95% confidence interval [95% CI]: 1.82 to 5.15) as those without periodontal disease.[ncbi.nlm.nih.gov]
  • From 2,436 eligible ICU patients, 827 cases presented NP, with 18.3 episodes of VAP per 1000 ventilator-days. Most common findings were worsening oxygenation, purulent respiratory secretions and temperature increase.[ncbi.nlm.nih.gov]
  • The results demonstrated the difference in clinical presentation, microbial characteristics and outcomes between A. baumannii and A. nosocomialis nosocomial pneumonia, and supported that they are two distinct clinical entities. 2012 The Authors.[ncbi.nlm.nih.gov]
  • Here, we present a case of hospital-acquired pneumonia caused by R. planticola that likely originated in the gastrointestinal tract.[ncbi.nlm.nih.gov]
  • In this new work, leading international authorities present anupdate on current best practice for the diagnosis, treatment, andprevention of nosocomial pneumonia.[amazon.com]

Workup

  • The diagnostic workup may offer additional data that should be interpreted in the context of the patient's condition. 5.[frca.co.uk]
  • If the patient receives appropriate antimicrobial therapy for 2 weeks and does not respond (ie, improved infiltrates findings on chest radiograph), initiate a diagnostic workup to detect nonbacterial infections (eg, herpesvirus type 1 [HSV-1] pneumonitis[emedicine.medscape.com]
Pulmonary Infiltrate
  • The diagnosis of nosocomial pneumonia should be suspected in any patient with a new or worsened pulmonary infiltrate who meets any two of the following three criteria: leucocyte count above 10,000 or below 4000/µL, temperature above 38.3 C, and/or the[ncbi.nlm.nih.gov]
  • Nosocomial pneumonia is generally defined as a new pulmonary infiltrate on chest radiography, combined with evidence of infection expressed as fever, purulent respiratory secretions and/or leucocytosis, with onset at least 72 h after admission.[oxfordmedicine.com]
  • Obtain other tests that are related to the possible underlying causes of the pulmonary infiltrates; for example, if lupus pneumonitis is suspected, ask the patient about a history of SLE pneumonitis.[emedicine.medscape.com]
  • Minimally Invasive Diagnostic Strategy in Immunocompromized Patients with Pulmonary Infiltrates (Dra. Sandra. De Miranda and Dra. Élie Azoulay, Paris, France). 12. Pneumonia in trauma patients (Dra. Helene A. Haeberle and Dr. Wolfgang A.[wiley.com]
  • Patients eligible for inclusion were necessarily hospitalized with the presence of new radiological pulmonary infiltrate, purulent sputum, and signs of sepsis, thus requiring a parenteral antibiotic.[scielo.br]

Treatment

  • PURPOSE: Results from studies comparing health care resource use (HCRU), costs of treatment, and cost-effectiveness of linezolid compared with vancomycin therapy in the treatment of hospitalized patients with methicillin-resistant Staphylococcus aureus[ncbi.nlm.nih.gov]
  • The cure rate was higher in the telavancin than the vancomycin treatment group in microbiologically evaluable patients with only Gram-positive pathogens isolated at baseline [85.0% (130/153) versus 75.2% (109/145), respectively; treatment difference ([ncbi.nlm.nih.gov]
  • The base case first-line treatment duration for patients with MRSA-confirmed nosocomial pneumonia was 10 days.[ncbi.nlm.nih.gov]
  • Limitations of the study included unbalanced treatment groups at baseline and number of patients excluded to reach the per-protocol group. Results of the ZEPHyR trial do not support routine use of linezolid for the treatment of MRSA pneumonia.[ncbi.nlm.nih.gov]
  • The model is a decision-analytic analysis in which a MRSA-confirmed patient is simulated to utilize one of the treatments, using data from a clinical trial. Within each treatment arm, the patient can or cannot achieve clinical cure.[ncbi.nlm.nih.gov]

Prognosis

  • Cheng (Shanghai, China) Annual Congress 2012 - Respiratory infections: prognosis and outcome [ ] Health care associated pneumonia versus community acquired pneumonia: Comparison of etiology, treatment and prognosis C. Araujo, N. Andre, P.[ers-education.org]
  • Early and precise identification of this pathogen can lead to better prognosis of the associated infections and an improved approach to controlling the spread of carbapenemase-resistant gram-negative bacteria.[ncbi.nlm.nih.gov]
  • Treatment and prognosis The early onset type has a better prognosis. High morbidity and mortality are seen patients with Hospital acquired pneumonia as they are already hospitalised for another condition. Promoted articles (advertising)[radiopaedia.org]

Etiology

  • The etiology of 50% of the nosocomial infection cases was polymicrobial.[ncbi.nlm.nih.gov]
  • Two hundred seventy-five consecutive patients treated with bone marrow transplantation (BMT) during a 9-year interval were analyzed for the incidence and etiology of nosocomial pneumonia.[jco.ascopubs.org]
  • [ ] Risk factors, etiology and prognosis of adult patients with hospital -acquired pneumonia in Shanghai N. Li, Q.[ers-education.org]
  • Often caused by gram-negative or staphylococcal organisms. nosocomial pneumonia An infection of lungs–bronchoalveolar unit–in a Pt who has been hospitalized 48 hrs, and directly attributable to pathogens acquired during the hospital visit Etiology Pseudomonas[medical-dictionary.thefreedictionary.com]
  • P. aeruginosa was the etiological agent in 3 cases (27.3%), though the susceptibility was tested in only 1 isolate. S. aureus was the etiological agent in 2 cases (18.2%), 1 case susceptible to meropenem.[scielo.br]

Epidemiology

  • The incidence and microbiologic epidemiology of NIP and VAP were studied. RESULTS: There were 873 patients enrolled.[ncbi.nlm.nih.gov]
  • At the time of the original survey, the epidemiology of MRSA varied significantly across Europe and there were differing views on best practice.[ncbi.nlm.nih.gov]
  • Author information 1 Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.[ncbi.nlm.nih.gov]
  • METHODS: A retrospective, non-interventional epidemiological multicenter cohort study involving 143 patients with confirmed nosocomial pneumonia caused by P. aeruginosa.[ncbi.nlm.nih.gov]
  • Author information 1 Institute for Epidemiology and Prevention Research, Achterstrasse 30, D-28359 Bremen, Germany. joachim.roehmel@gmx.de Abstract This paper addresses statistical issues in non-inferiority trials where the primary outcome is a fatal[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • In critically ill patients, pathophysiological changes alter the pharmacokinetics of antibiotics. Imipenem exhibits primarily time-dependent killing.[ncbi.nlm.nih.gov]
  • Reviews " Nosocomial Pneumonia achieves its stated goal of seeking to present current knowledge on the pathophysiology, clinical presentation, diagnosis, and treatment of nosocomial pneumonia.[wiley.com]
  • Pathophysiology Extrinsic factors  Exposure to causative agent  Exposure to pulomary irritant Intrinsic factors (host related)  Pulmonary injury – COPD, bronchiectasis, CF, Ca  Loss of protective airway reflexes – CVA, intoxication, altered mental[slideshare.net]
  • Because aerobic gram-negative bacilli (eg, Pseudomonas aeruginosa ) are the major pathogens associated with HAP, the pathophysiology of nosocomial pneumonia relates to the destructive effect on lung tissue.[emedicine.medscape.com]
  • Hospital-acquired pneumonia: pathophysiology, diagnosis, and treatment. Surgical Clinics of North America, 89(2), 439-461. Stolbrink, M., McGowan, L., Saman, H., Nguyen, T., Knightly, R., Sharpe, J., ... & Turner, A. M. (2014).[physio-pedia.com]

Prevention

  • Various preventive strategies have been increasingly used to prevent the development of pneumonia.[ncbi.nlm.nih.gov]
  • Most articles included a study group with chlorhexidine users and a control group with placebo users for oral hygiene in the prevention of pneumonia.[ncbi.nlm.nih.gov]
  • Author information 1 Institute for Epidemiology and Prevention Research, Achterstrasse 30, D-28359 Bremen, Germany. joachim.roehmel@gmx.de Abstract This paper addresses statistical issues in non-inferiority trials where the primary outcome is a fatal[ncbi.nlm.nih.gov]
  • Author information 1 Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.[ncbi.nlm.nih.gov]

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