Risk factors for Hospital-Acquired Pneumonia in nonventilated adults

Abstract

Although most recent publications focus on Ventilator-associated Pneumonia, Non-Ventilator-associated Hospitalacquired pneumonia (NVHAP) is still worrisome. We studied risk factors for NVHAP among patients admitted to a small teaching hospital. Sixty-six NVHAP case patients and 66 controls admitted to the hospital from

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“…This is similar to rates reported in other studies: in the HAPPI-1 study, 3 the rate of unreported NV-HAP was 1.25 cases per 1,000 patient days before intervention, and in 1 study on non-ICU HAP, 3 ± 1.4 cases per 1,000 hospital admissions were reported. 30 Although previous studies indicate that most NV-HAP cases occur in older patients, 31 we found that over half of NV-HAP cases (50.9%) were in patients <66 years of age. Although increased age is a known independent risk factor for NV-HAP, 31 our findings support that younger patients are also at some risk and do acquire pneumonia while hospitalized.…”

“…30 Although previous studies indicate that most NV-HAP cases occur in older patients, 31 we found that over half of NV-HAP cases (50.9%) were in patients <66 years of age. Although increased age is a known independent risk factor for NV-HAP, 31 our findings support that younger patients are also at some risk and do acquire pneumonia while hospitalized.…”

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“…16,24 In contrast, several studies observed a lower proportion of other intrinsic RFs ( Supplementary Table S1). 31,32 There were fewer intrinsic RFs found in the 12 case-control studies: age, 33 male sex, 34 nervous system diseases, 33 chronic renal failure, 35 acute respiratory distress syndrome, 36 chronic obstructive pulmonary disease, 37,38 previous episode of pneumonia, 39 DM, 37 urinary incontinence, 34 obesity, 34 nonsurgical wounds 40 and local-ized head and neck burns, 41 serum albumin <3.0 g/dL, 39 white blood cells count >12,000/mm 3 . 39 In the 5 included SRs, DM [42][43][44][45] was the most prevalent intrinsic RF, followed by acute renal failure 43,45 and potential renal failure currently on dialysis.…”

“…14,55 Other less frequent extrinsic RFs were found ( Supplementary Table S1). 65,68 It was observed that in the case-control studies, the most prevalent extrinsic RF was IMV, 40,69,70 followed by previous hospitalization, 35,39 hospitalization time, 71 low McCabe score at admission, 34 gastrostomy or central line-associated bloodstream infection at admission, 34 recent surgery, 34 acute graft rejection, 38 urologic surgery, 35 antacid use, 33 recent exposure to piperacillin-tazobactam, 72 antibiotic use within the last 3 months, 35 prolonged steroid use, 36,39 orotracheal intubation, 70 catheter use ≥7 days, 73 aspiration of secretions, 70 and high Abbreviated Burn Severity Index score. 41 In the SRs, the most commonly mentioned extrinsic RFs were corticosteroid use, [42][43][44] IMV, 42,43,74 blood transfusion, 42,45,74 elective surgery, 43,45 CVC, 43,44 total parenteral nutrition 43,45 and abdominal surgery, 44,45 among others.…”

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“…This study should be analyzed in conjunction with the study by Fortaleza et al ,67 who described age, central nervous diseases, and the use of antacids as risk factors for hospital-acquired pneumonia in non-ventilated adults. Serefhanoglu et al 68 described a prospective case-control study (October 2003 to June 2007) that evaluated risk factors for multidrug resistance among extended-spectrum-b-lactamase-producing Escherichia coli and Klebsiella spp.…”