Hospital-Acquired Pneumonia in a Multipurpose Intensive Care Unit: One-Year Prospective Study

Abstract

Introduction: Hospital-acquired pneumonia continues to be a frequent complication in the intensive care unit and an important cause of admission in the intensive care unit. The aim of our study was to evaluate the demography, incidence, risk factors, causative bacterial pathogens and outcome of all episodes of Hospital-acquired pneumonia in our unit.Material and Methods: Prospective observational study, at a tertiary university hospital during one year (2014) including all the cases of hospital-acquired pneumonia in the intensive care unit.Results: Sixty patients were identified with pneumonia. Thirty-five (58.3%) had an intensive care unit acquired pneumonia, corresponding to 6.9 cases/1000 intubation-days. Antibiotic treatment in the previous 30 days was present in 75% of the cases. The incidence of Staphylococcus aureus, Pseudomonas aeruginosa and Acinetobacter baumannii was 26.2%, 20.0% and 9.2%, respectively. Patients with late-onset hospital-acquired pneumonia (≥ 7 days) showed higher frequency of non-fermenting Gram-negative bacilli isolates, and methicillin-resistant S. aureus. Combination therapy was performed in 67.0%, and de-escalation in 18.3%. The mortality rate was 18.3%. The adjusted odds ratio for intensive care unit mortality in the group of patients with non-intensive care unit acquired pneumonia was 5.2 (95% CI of 1.02 – 22.10; p = 0.046).Discussion: The knowledge of local bacterial flora and resistance patterns is of crucial importance and strongly recommended. This evidence increases the probability of success of empiric antibiotic therapy.Conclusion: S. aureus was the predominant causative agent of nosocomial pneumonia. The most frequent risk factor identified for infection with multidrug-resistant organisms was previous treatment with antibiotics. Multidrug-resistant organisms were present in 45% of documented hospital-acquired pneumonias. In admitted patients with non-intensive care unit acquired pneumonia, the intensive care unit mortality rate was nearly five times higher compared to intensive care unit acquired pneumonia.

Spatial Patterns in Hospital-Acquired Infections in Portugal (2014–2017)

“…In addition, more prolonged hospitalizations due to HAIs can consequently increase antibiotic resistance and the presence of multidrug-resistant bacteria for all patients [ 69 ]. In addition to the specificity of the demographic, clinical, and physiological characterization (comorbidity index), in the case of hospital-acquired pneumonia, the literature warns of the importance of some risk factors that, in certain situations, could be present before hospitalization: prior antibiotic treatment (previous 30 days), structural lung disease, residence in assisted living facilities/nursing homes, long-term dialysis, diabetes mellitus and immunosuppression [ 26 , 70 ], gastrointestinal medication (suppression of gastric acid: use of antagonists H2), and proton pump inhibitors. In addition, the poor condition of the oral cavity is a risk factor to be taken into account.…”

“…According to data provided by the Portuguese Directorate-General of Health in the scope of the report of the 2nd European survey on the prevention program for infection control in 2017, the prevalence of HAIs in Portugal was around 7.8%, showing a decreasing trend since 2012 [ 24 , 25 ]. Nonetheless, the literature indicates, for the Portuguese case, an absence of epidemiological data on HAIs in individual Portuguese Intensive Care Units (ICUs), which makes it difficult to compare data and impairs the understanding of any spatial differences in prevalence, which may be associated with the area of influence of the ICUs, according to the national referral network [ 26 ].…”

Socioeconomic burden of pneumonia due to multidrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa in Korea

“…The prognoses of MRAB-P and MRPA-P in this study were similar to those of previous studies. The proportion of MRAB and MRPA among causative agents of nosocomial pneumonia and VAP has been reported to be approximately 30–34% and 35.6%, respectively 9 , 26 . The previously known mortality rate of A. baumannii pneumonia was 37.2–48.1% 27 , and A. baumannii infection caused an additional economic burden of $6,693–16,074.…”

The Socioeconomic Burden of Pneumonia Due to Multidrug-Resistant Acinetobacter Baumannii and Pseudomonas Aeruginosa in Korea: A Prospective Case-Control Study

“…In this study, the prognosis of MRAB-P and MRPA-P were similar to previous studies. The proportion of these two bacteria among the causative agents of nosocomial pneumonia and VAP was reported to be about 30-34% and 35.6%, respectively 9,14 . The known mortality rate of Acinetobacter pneumonia was 37.2-48.1% 15 , and Acinetobacter infection caused an additional economic burden of $6,693-$16,074.…”