Management of nosocomial pneumonia on a medical ward: a comparative study of outcomes and costs of invasive procedures

Abstract

The goal of this study was to compare outcomes and costs of two management strategies for non-ventilator-associated nosocomial pneumonia (NP) in a medical ward. In this single-centre study, NP patients (n = 68) were randomized to receive non-invasive management (NIM) with immediate empirical antibiotic treatment (n = 34), or invasive management (IM) based on protected brush sampling of specimens (n = 34). The economic analysis adopted the hospital's perspective and took into account only direct costs. Baseline characteristics did not differ significantly between the two patient groups. The most frequently isolated organisms were Staphylococcus (25.4%), Streptococcus (23.7%) and Pseudomonas (18.6%) species. The 28-day clinical cure rate did not differ notably between the two groups (NIM, 79.4%; IM, 73.5%). Mortality at 28 days tended to be lower in the NIM group (10.0% vs. 21.8%). Mean antibiotic costs were lower in the IM group (euro194 +/- 355 vs. euro300 +/- 335, p <0.001) but overall management costs were similar (respectively, euro367 +/- 355 and euro346 +/- 363 in the IM and NIM groups, p = 0.08). With respect to both outcome and cost, this study does not support routine management of NP in medical wards using invasive procedures.

Non-Intensive Care Unit Acquired Pneumonia: A New Clinical Entity?

“…Most of the available data come for studies enrolling a mixed population of patients who developed a nosocomial pneumonia either in the ICU or general wards (incidence ratio of 0.5–2 per 100 patients) or those who underwent thoracic or abdominal surgery (incidence ratio of 3.8–17.5 per 100 patients), immunosuppressed patients (incidence ratio of 19.5–20 per 100 patients) or the elderly (incidence ratio of 0.7–1.7 per 100 patients) [ 16 ]. The incidence of NIAP reported from the few studies conducted only in patients admitted to the general wards ranges from 1.6 to 3.67 cases per 1000 admissions [ 10 , 11 , 12 , 13 , 14 , 15 ].…”

“…Nevertheless, the absence of intubation and invasive mechanical ventilation could differentiate the etiology and physiopathology of NV-ICUAP/VAP vs. NIAP, suggesting that the microbiology and therapeutic approaches in these two diseases might be different. Thus, there is a clear need of reviewing the available data on NIAP, in order to better identify, treat and eventually prevent the development of this specific disease [ 10 , 11 , 12 , 13 , 14 , 15 ], see Table 1 . We included studies specifically enrolling adult patients with HAP hospitalized in general wards.…”

Economic burden of nosocomial pneumonia in non-intensive care clinics

“…Another study investigating the costs of NP patients in medical clinics calculated the cost-effectiveness of invasive procedures for isolation of pathogens and had a different design than this study (13).…”

“…The studies on NP in non-intensive care clinics are very limited and only include specific groups of patients (11)(12)(13). This study aims to determine the economic burden of NP on developed clinics of the hospital.…”

Nosocomial Pneumonia Outside the Intensive Care Unit

“…However, invasive management of nosocomial pneumonia in nonventilated patients led to less antibiotic consumption. 31 Ultrafine needle transthoracic pulmonary aspiration puncture allows the collection of a sample from the infectious source, avoiding the risk of oropharyngeal contamination produced with sputum, endotracheal aspirate, or fibrobronchoscopy. This is a simple technique in the hands of experienced physicians, it is less traumatic for the patient than fibrobronchoscopy and may be carried out in the room of the patient.…”