Epidemiology, Treatment, and Prevention of Nosocomial Bacterial Pneumonia

Abstract

Septicaemia likely results in high case-fatality rates in the present multidrug-resistant (MDR) era. Amongst them are hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), two frequent fatal septicaemic entities amongst hospitalised patients. We reviewed the PubMed database to identify the common organisms implicated in HAP/VAP, to explore the respective risk factors, and to find the appropriate antibiotic choice. Apart from methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa, extended-spectrum β-lactamase-producing Enterobacteriaceae spp., MDR or extensively drug-resistant (XDR)-Acinetobacter baumannii complex spp., followed by Stenotrophomonas maltophilia, Chryseobacterium indologenes, and Elizabethkingia meningoseptica are ranked as the top Gram-negative bacteria (GNB) implicated in HAP/VAP. Carbapenem-resistant Enterobacteriaceae notably emerged as an important concern in HAP/VAP. The above-mentioned pathogens have respective risk factors involved in their acquisition. In the present XDR era, tigecycline, colistin, and ceftazidime-avibactam are antibiotics effective against the Klebsiella pneumoniae carbapenemase and oxacillinase producers amongst the Enterobacteriaceae isolates implicated in HAP/VAP. Antibiotic combination regimens are recommended in the treatment of MDR/XDR-P. aeruginosa or A. baumannii complex isolates. Some special patient populations need prolonged courses (>7-day) and/or a combination regimen of antibiotic therapy. Implementation of an antibiotic stewardship policy and the measures recommended by the United States (US) Institute for Healthcare were shown to decrease the incidence rates of HAP/VAP substantially.

Incidence and impact of hospital-acquired pneumonia: a Portuguese nationwide four-year study

“…Hospital-acquired infections, especially pneumonia (HAP), remain one of the most important challenges clinicians face in everyday work [1]. Nevertheless, the epidemiology of HAP is uncertain.…”

Management of community-acquired pneumonia: essential tips for the physician on call

“…Hospital acquired pneumonia (HAP) is pneumonia acquired 48 hours after admission to hospital or within 14 days after discharge from hospital. Ventilator acquired pneumonia (VAP) is a subset of HAP affecting patients 48 hours after endotracheal intubation (Jean et al 2020). Pneumonia is one of the most commonly encountered respiratory infection accounting for approximately 230,000 deaths in Europe (29,000 in the UK) per year, and in the UK is responsible for more hospital admissions than any other lung disease (Chalmers et al 2017;Marshall et al 2018).…”

A New Anti-Estrogen Discovery Platform Identifies FDA-Approved Imidazole Anti-Fungal Drugs as Bioactive Compounds against ERα Expressing Breast Cancer Cells

“…By using this approach, we have identified 3 anti-fungal drugs (i.e., econazole, clotrimazole, and fenticonazole) and 1 antibiotic (i.e., tigecycline) and further characterized the effect of Clo and Fenti because these two drugs affect ERα signaling in cellular models of primary (i.e., MCF-7) and metastatic (i.e., Y537S) BC cells. It is interesting to note that tigecycline is the election therapy for multi-drug resistant (MDR) pathogens that arise in nosocomial infections [ 35 ]. Thus, although this molecule is particularly attractive for potential MBC treatment, its use could be limited as continuous and prolonged administration to BC patients would increase the possibility to select MDR bacterial strains also resistant to tigecycline.…”