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]

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]

Remote Access Favorites Save figures into PowerPoint Download tables as PDFs Go to My Dashboard Close Hospital-acquired pneumonia (HAP) occurs more than 48 hours after admission to the hospital or other health care facility and excludes any infection present [accessmedicine.mhmedical.com]

• Sepsis

  Clarithromycin Leads to Long-Term Survival and Cost Benefit in Ventilator-Associated Pneumonia and Sepsis. [eu-jr.eu]

  Wrong organism Wrong diagnosis Complications: Lung abscess, C. difficile colitis, Sepsis, Drug fever [quizlet.com]

  Masuda (Kurashiki City, Japan) Annual Congress 2013 –Pneumonia and sepsis [+] Bugs of the new era: More questions than answers Shyam Krishnan (Jamshedpur, India), Shyam Krishnan, Bhaskar Narayan Chaudhuri, Manasi Ghosh, Santu Samanta, Raja Dhar International [ers-education.org]

  Garnacho-Montero et al. [12] have shown the importance of de-escalation of empirical therapy in lowering the mortality in patients with severe sepsis and septic shock. [ncbi.nlm.nih.gov]

  The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996;22:707–710. [atsjournals.org]

• Congestive Heart Failure

  In suspected ventilator-associated pneumonia it has been suggested that bronchoscopy(BAL) is necessary because of the known risks surrounding clinical diagnoses.[1][3] Differential diagnosis[edit] Atelectasis Congestive heart failure Pulmonary embolism [en.wikipedia.org]

  These conditions include congestive heart failure and emphysema. For certain people, pneumonia increases their risk for having a heart attack. Bacteremia Bacteria from the pneumonia infection may spread to your bloodstream. [healthline.com]

  Non-invasive ventilation has been most successful in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) and pulmonary edema secondary to congestive heart failure (CHF) and should be considered in appropriately selected patients [the-hospitalist.org]

  Clinicians should understand that many of these findings are often shared with mimics of nosocomial pneumonia, such as congestive heart failure (CHF), pulmonary emboli, pulmonary hemorrhage, primary or metastatic lung carcinomas, leukemias/lymphomas, [emedicine.medscape.com]

• Collapse

  Pneumothorax presence of air between parietal and visceral pleurae with partial or collapse of the lung Pneumocystis jiroveci lungebetaendelse PcP - ssi Invasiva svampinfektioner, d v s infektioner i blod eller djupare liggande organ, är generellt sett [vembat-john.icu]

• Purulent Sputum

  […] justify a diagnosis of HAP Most postoperative patients with shadowing on chest X-ray do not have pneumonia, they have atelectasis ASSESSMENT Clinical focal chest signs purulent sputum fever Laboratory inflammatory marker elevation positive cultures [lifeinthefastlane.com]

  […] facility and excludes any infection present at the time of admission Ventilator-associated pneumonia (VAP) develops more than 48 hours following endotracheal intubation and mechanical ventilation At least two of the following are present Fever Leukocytosis Purulent [accessmedicine.mhmedical.com]

  Clinical criteria include new onset fever, leukocytosis, hypoxia and purulent sputum. [pulmonologyadvisor.com]

• Respiratory Insufficiency

  The clinical course of the disease in these patients suggests that nosocomial pneumonia caused by this agent can lead to profound respiratory insufficiency and acute respiratory distress syndrome, particularly in patients with significant comorbidities [ncbi.nlm.nih.gov]

  Our data on the inhaled tobramycin (Bramitob, Chiesi Farmaceutici, Italy) use in septic patients with NP proved its efficacy and safety: decrease of systemic inflammation and acute respiratory insufficiency signs 2.3 ± 1.2 after the treatment onset. [omicsonline.org]

  The likelihood increases when upon investigation symptoms are found of respiratory insufficiency, purulent secretions, newly developed infiltrate on the chest X-Ray, and increasing leucocyte count. [en.wikipedia.org]

• Heart Failure

  Multidrug-resistance, heart failure, increasing age, mechanical ventilation, and bacteremia were independently associated with in-hospital mortality in the Cox Proportional Hazards Model analysis. [ncbi.nlm.nih.gov]

  failure Atelectasis Aspiration Acute respiratory distress syndrome (ARDS) Pulmonary thromboembolism Pulmonary hemorrhage Drug reactions Blood cultures identify the pathogen in up to 20% of cases Arterial blood gases help define illness severity and the [accessmedicine.mhmedical.com]

  ECGs, cardiac enzymes, and Swan-Ganz readings may rule out left ventricular failure caused by exacerbation of heart failure or new myocardial infarction. [emedicine.medscape.com]

  In suspected ventilator-associated pneumonia it has been suggested that bronchoscopy(BAL) is necessary because of the known risks surrounding clinical diagnoses.[1][3] Differential diagnosis[edit] Atelectasis Congestive heart failure Pulmonary embolism [en.wikipedia.org]

• Hypertension

  Other potential risk factors such as alcohol consumption, history of smoking, hypersensitivity, hypertension, diabetes mellitus and so on were not showed such significance in this study. [ncbi.nlm.nih.gov]

  Huntington병 hypertensive vascular d. 고혈압혈관질환 iatrogenic d. 의인병, 의원병 idiopathic Parkinson’s d. 특발파킨슨병 infantile Refsum d. 영아레프숨병 inflammatory muscle d. 염증근(육)질환 ischemic cerebrovascular d. 허혈뇌혈관질환 Kennedy’s d. Kennedy병 Krabbe d. [neuro.or.kr]

• Ulcer

  We conclude that in patients receiving mechanical ventilation, the use of a prophylactic agent against stress-ulcer bleeding that preserves the natural gastric acid barrier against bacterial overgrowth may be preferable to antacids and H2 blockers. [nejm.org]

  Stress-ulcer prophylaxis for general medical patients: a review of the evidence. J Hosp Med. 2007;2(2):86-9217427249 PubMed Google Scholar Crossref 7. Grube RR, May DB. Stress ulcer prophylaxis in hospitalized patients not in intensive care units. [jamanetwork.com]

  The most significant preventive measures include routine hand washing and avoidance of (1) the supine position, (2) inappropriate antibiotics, and (3) overuse of H2-antagonists for stress ulcer prophylaxis. [journals.lww.com]

  However, despite the potential increased risk of pneumonia, when an anti-ulcer prophylactic strategy is necessary H 2 -blockers are preferable to sucralfate for their superior anti-ulcer efficacy. [thorax.bmj.com]

• Sweating

  Fever, chills, and sweating, which may be less common in older adults. Fast, often shallow, breathing and the feeling of being short of breath. Chest wall pain that is often made worse by coughing or breathing in. Fast heartbeat. [uofmhealth.org]

• Headache

  They may consist of headache, malaise, diarrhea, confusion, falling, and decreased appetite. Diagnosis is confirmed by chest x-ray. [academickids.com]

  Patients with HAP are likely to have a poor appetite, diaphoresis, and headache. Expect a high temperature, usually greater than 100[degrees] F (37.8[degrees] C), and a heart rate of more than 100 beats/minute. [nursingcenter.com]

  […] or sputum, coughed up from lungs fever fast breathing and shortness of breath shaking chills chest pain that usually worsens when taking a deep breath, known as pleuritic pain fast heartbeat fatigue and weakness nausea and vomiting diarrhea sweating headache [medicalnewstoday.com]

  The most common adverse reactions (occurring in more than 1% of patients) reported in the summary of product characteristics are fungal infection, insomnia, dysgeusia, headache, dizziness, nausea, constipation, diarrhoea, vomiting, increased alanine aminotransferase [nice.org.uk]

Laboratory Evaluation Lab studies are useful, and workup includes: 1. CBC and differential. 2. Liver function tests. 3. Sputum Gram’s stain and culture. 4. Blood cultures. 5. [intjinfection.com]

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]

Diagnostic Tests in the Workup of Pulmonary Infiltrates in the ICU 1. Respiratory Cultures Sputum Endotracheal or Tracheobronchial aspirate** [Toni: should this be transbronchial?] [antimicrobe.org]

• 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]

  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]

  […] radiography No infiltrate = 0 point Diffuse or patchy infiltrate = 1 point Localized infiltrate= 2 points Pulmonary radiography No infiltrate = 0 point Diffuse or patchy infiltrate = 1 point Localized infiltrate= 2 points Microbiological Data Pathogenic [antimicrobe.org]

  The most common causes of infiltrates in ventilated patients with fever and/or leukocytosis include the following conditions: Pulmonary embolus or infarction Pulmonary drug reactions Collagen vascular diseases Lung hemorrhage Bronchiolitis obliterans-organizing [emedicine.medscape.com]

• Atelectasis

  […] presence of bacteria in expectorated sputum or endotracheal aspirate cultures usually represents colonisation only, and does not itself justify a diagnosis of HAP Most postoperative patients with shadowing on chest X-ray do not have pneumonia, they have atelectasis [lifeinthefastlane.com]

  […] sensitive and 75% specific for the diagnosis of VAP in one study Colonization of the pharynx and possibly the stomach with bacteria is the most important step in the pathogenesis of nosocomial pneumonia See also Pneumonia, Community-Acquired Heart failure Atelectasis [accessmedicine.mhmedical.com]

  However, no symptom, sign, or x-ray finding is sensitive or specific for the diagnosis, because all can be caused by atelectasis, pulmonary embolism, or pulmonary edema. [msdmanuals.com]

• Pseudomonas

  A 28-day course of IT is proved to be effective in eradication of Pseudomonas aeruginosa in cystic fibrosis (300 mg/day within 28 days, then 28-days break). [omicsonline.org]

   Pseudomonas Aeruginosa Hospital Erhvervet Infektion 2020 :: congco.ipv6.barcelona Treating Pseudomonas aeruginosa lung infections. [congco.ipv6.barcelona]

  […] associated with HAP differs from that of community-acquired pneumonia (CAP) — reflects organisms that colonise the oropharynx of hospitalised patients aerobic Gram negative bacilli – ESCAPPM, Klebsiella Legionella MDR organism – MRSA, Enterobacteriaceae, Pseudomonas [lifeinthefastlane.com]

  Abstract Gram-negative bacilli including multidrug-resistant (MDR) Pseudomonas aeruginosa are responsible for a significant proportion of episodes of nosocomial pneumonia. [ncbi.nlm.nih.gov]

• Gram-Positive Bacteria

  Abstract Telavancin (Vibativ(®)), a lipoglycopeptide antibacterial agent, exhibits potent in vitro activity against Gram-positive bacteria associated with nosocomial pneumonia infections, including meticillin/oxacillin-resistant Staphylococcus aureus [ncbi.nlm.nih.gov]

  Key Exclusion Criteria: History of moderate or severe hypersensitivity reactions to beta-lactam antibiotics; Prior non-study antibiotics for > 24 hours; Gram stain of lower respiratory tract specimen showing only gram positive bacteria; Active immunosuppression [clinicaltrials.gov]

  Infection with antibiotic-resistant gram-negative or gram-positive bacteria worsens prognosis. [msdmanuals.com]

  Telavancin is active against Gram‑positive bacteria only. [nice.org.uk]

• Colitis

  Abstract Klebsiella oxytoca acts as a pathobiont in the dysbiotic human intestinal microbiota, causing antibiotic-associated hemorrhagic colitis (AAHC), but it also infects other organs, resulting in pneumonia and urinary tract and skin infections. [ncbi.nlm.nih.gov]

  Wrong organism Wrong diagnosis Complications: Lung abscess, C. difficile colitis, Sepsis, Drug fever [quizlet.com]

  There are accumulating data implicating an association between acid-suppressive medication and various disease states, including Clostridium difficile colitis, 17 - 20 ventilator-associated pneumonia, 21 - 26 and community-acquired pneumonia. 8 - 10 Only [jamanetwork.com]

  […] can have unknown immunodeficiency (acquired immunodeficiency syndrome) and pathogens like Pneumocystis jirovecii.Other Infections Other simultaneous causes of non-pneumonic fever include sinusitis, infection of the vascular catheter, pseudomembranous colitis [archbronconeumol.org]

• Leukocytosis

  […] care facility and excludes any infection present at the time of admission Ventilator-associated pneumonia (VAP) develops more than 48 hours following endotracheal intubation and mechanical ventilation At least two of the following are present Fever Leukocytosis [accessmedicine.mhmedical.com]

  Clinical criteria include new onset fever, leukocytosis, hypoxia and purulent sputum. [pulmonologyadvisor.com]

  Patients with hospital-acquired pneumonia usually present with a combination of fever (or hypothermia), leukocytosis (or leukopenia), increased tracheal secretions, and poor oxygenation. Alveolar shadowing on CXR or CT scan supports the diagnosis. [bestpractice.bmj.com]

  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 [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]

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]

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]

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]

ETIOLOGIC DIAGNOSIS OF PNEUMONIA All Patients Patients with Etiologic Diagnosis Only VAP (n = 164) NV-ICUAP (n = 151) P Value VAP (n = 117) NV-ICUAP (n = 64) P Value Etiologic diagnosis, n (%) 117 (71) 64 (42) <0.001 — — — Polymicrobial pneumonia, n [atsjournals.org]

The etiology of 50% of the nosocomial infection cases was polymicrobial. [ncbi.nlm.nih.gov]

Keywords: hospital-acquired pneumonia, ventilator-associated pneumonia, epidemiology, microbial etiology This work is published and licensed by Dove Medical Press Limited. [dovepress.com]

We always want to obtain the etiology of the pneumonia. As the MS-DRG assignment will vary based on etiology, this may require a query. The physician’s clinical opinion is sufficient to diagnose the type of infection. [hcpro.com]

The incidence and microbiologic epidemiology of NIP and VAP were studied. RESULTS: There were 873 patients enrolled. [ncbi.nlm.nih.gov]

Keywords: hospital-acquired pneumonia, ventilator-associated pneumonia, epidemiology, microbial etiology This work is published and licensed by Dove Medical Press Limited. [dovepress.com]

Keywords Costs and Cost Analysis — Cross Infection/epidemiology — Humans — Intensive Care — Intubation, Intratracheal/ adverse effects — Length of Stay — Pneumonia/economics/ epidemiology/mortality — Respiration, Artificial/ adverse effects — Risk Factors [archive-ouverte.unige.ch]

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]

In critically ill patients, pathophysiological changes alter the pharmacokinetics of antibiotics. Imipenem exhibits primarily time-dependent killing. [ncbi.nlm.nih.gov]

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]

Various preventive strategies have been increasingly used to prevent the development of pneumonia. [ncbi.nlm.nih.gov]

Other preventive interventions Besides the above mentioned interventions, other preventive measures have been considered for the prevention of HAP. [aricjournal.biomedcentral.com]

[…] for the prevention of ventilator-associated pneumonia in adults in Ireland (Health Protection Surveillance Centre - SARI Working Group, 2011) SLOVENIA Guidelines for the prevention of nosocomial pneumonia (Ministry of Health, 2009) Smernice za preprečevanje [ecdc.europa.eu]

[…] the body’s ability to carry oxygen in the blood Oxygen may be provided in order to maintain good oxygen levels HAP Prevention Bundle Craig Hospital has adopted a group of prevention strategies to reduce the chance of getting HAP. [craighospital.org]