Nosocomial Pneumonia in the Intensive Care Unit Acquired by Mechanically Ventilated versus Nonventilated Patients

Esperatti, Mariano; Ferrer, Miquel; Theessen, Anna; Liapikou, Adamantia; Valencia, Mauricio; Saucedo, Lina María; Zavala, Edward Y.; Welte, Tobias; Torres, Antoni

doi:10.1164/rccm.201001-0094oc

Cited by 166 publications

(158 citation statements)

References 40 publications

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“…34 Nosocomial pneumonia has been associated with increased mortality. 1,2,4,21 In previous studies, hospital mortality rates were similar or lower in subjects with nonventilator ICU-acquired pneumonia compared with those with VAP. 2,5,35 The mortality rate was low in our study and did not differ between subjects with and without confirmed non-ventilator ICU-acquired pneumonia.…”

Section: Discussionmentioning

confidence: 85%

“…Diagnostic strategies have been extensively studied in VAP and community-acquired pneumonia but not in non-ventilator ICU-acquired pneumonia. 2,4,5,21 The best method for collecting lower-respiratory-tract secretions remains unclear. The European Respiratory Society stated that "bronchoscopic sampling of the lower respiratory tract can be considered in selected non-intubated patients, where gas exchange status allows."…”

Section: Discussionmentioning

confidence: 99%

“…1 Risk factors for specific pathogens are particularly prevalent in ICU patients. 2 Postoperative pneumonia may be acquired in the ICU, in patients receiving mechanical ventilation 1,3 (ventilator-associated pneumonia [VAP]) or in non-ventilated patients 1,2 (non-ventilator ICU-acquired pneumonia). Because nearly 90% of episodes of hospital-acquired pneumonia occur during mechanical ventilation, 1 non-ventilator ICU-acquired pneumonia has received little research attention.…”

Section: Introductionmentioning

confidence: 99%

“…The diagnosis and treatment of non-ventilator ICU-acquired pneumonia remain challenging. 2,4,5 Few studies have assessed the accuracy of clinical diagnostic methods. In particular, the Clinical Pulmonary Infection Score (CPIS) 6 based on clinical variables has been suggested for the diagnosis and management of VAP 6,7 but has not been evaluated in non-ventilator ICU-acquired pneumonia.…”

Section: Introductionmentioning

confidence: 99%

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Non-Ventilator ICU-Acquired Pneumonia After Cardiothoracic Surgery: Accuracy of Diagnostic Tools and Outcomes

et al. 2015

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BACKGROUND: Non-ventilator ICU-acquired pneumonia after cardiothoracic surgery is challenging to diagnose, and little is known about its impact on patient outcomes. Here, our primary objective was to compare the sensitivity and specificity of cultures of 2 types of fiberoptic bronchoscopy (FOB) specimens: endotracheal aspirates (FOB-EA) and bronchoalveolar lavage fluid (FOB-BAL). The secondary objectives were to evaluate the sensitivity and specificity of spontaneous sputum cultures and of the modified Clinical Pulmonary Infection Score (CPIS) and to describe patient outcomes. METHODS: We conducted a prospective observational study of consecutive cardiothoracic surgery subjects with suspected non-ventilator ICU-acquired pneumonia. Using FOB-BAL cultures >10 4 cfu/mL as the reference standard, we evaluated the accuracy of FOB-EA >10 5 cfu/mL and spontaneous sputum >10 7 cfu/mL. On the day of FOB, we determined the modified CPIS. Mortality and antibiotic treatments were recorded. RESULTS: Of 105 subjects, 57 (54.3%) received a diagnosis of non-ventilator ICU-acquired pneumonia. FOB-EA cultures had 82% (95% CI 69 -91%) sensitivity and 100% (95% CI 89 -100%) specificity and were significantly less sensitive than FOB-BAL cultures (P < .004). Spontaneous sputum was obtained from one-third of subjects. Spontaneous sputum cultures had 82% (95% CI 56 -95%) sensitivity and 94% (95% CI 68 -100%) specificity and were non-significantly less sensitive than FOB-BAL (P ‫؍‬ .061). A modified CPIS >6 had 42% (95% CI 29 -56%) sensitivity and 87% (95% CI 74 -95%) specificity for non-ventilator ICU-acquired pneumonia. Antibiotic therapy was stopped in all subjects without non-ventilator ICU-acquired pneumonia, after 1.6 ؎ 1.2 d, without deleterious effects. CONCLUSIONS: The modified CPIS has low diagnostic accuracy for non-ventilator ICU-acquired pneumonia. FOB-EA cultures perform less well than do FOB-BAL cultures for diagnosing nonventilator ICU-acquired pneumonia. Spontaneous sputum is valuable when FOB cannot be performed but could be obtained in only a minority of subjects. When cultures are negative, antibiotic discontinuation is safe.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Non-Ventilator ICU-Acquired Pneumonia After Cardiothoracic Surgery: Accuracy of Diagnostic Tools and Outcomes

et al. 2015

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“…This goal can be achieved by hand washing strategies before and after nursing each patient or using gloves. Closed-suction of purulent discharge is another method to decrease the risk of infections in ICU patients (12,22).…”

Section: Discussionmentioning

confidence: 99%

Nosocomial Pneumonia in Patients Admitted to the Intensive Care Unit of a Tertiary Care Center in Mashhad, Northeast of Iran; an Etiologic Survey

Farid

Moghaddam

Bojdy

2018

Arch Clin Infect Dis

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Background: Hospital-acquired pneumonia (HAP) prevalence is related to patients' population and diagnostic methods. HAP incidence is reported in different studies from 9% to 46%. The current study aimed at evaluating the etiology of HAP in patients admitted to intensive care units (ICUs). Methods:The patients admitted to ICU of Imam Reza hospital (a tertiary care and teaching hospital in Mashhad, Northeast of Iran) were evaluated for HAP based on the following criteria: fever, leukocytosis, purulent discharge, new radiologic findings, changes in O2 saturation, and ventilator setting. Blood and endotracheal aspirates cultures were performed for all patients. Demographic characteristics were recorded in a checklist. Results: Among the 88 adult patients enrolled in the current study, the most frequent radiologic finding was patchy infiltration in

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Short-course versus prolonged-course antibiotic therapy for hospital-acquired pneumonia in critically ill adults

Pugh

Grant

Cooke

et al. 2015

Cochrane Database of Systematic Reviews

144

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Nosocomial Pneumonia in the Intensive Care Unit Acquired by Mechanically Ventilated versus Nonventilated Patients

Cited by 166 publications

References 40 publications

Non-Ventilator ICU-Acquired Pneumonia After Cardiothoracic Surgery: Accuracy of Diagnostic Tools and Outcomes

Non-Ventilator ICU-Acquired Pneumonia After Cardiothoracic Surgery: Accuracy of Diagnostic Tools and Outcomes

Nosocomial Pneumonia in Patients Admitted to the Intensive Care Unit of a Tertiary Care Center in Mashhad, Northeast of Iran; an Etiologic Survey

Short-course versus prolonged-course antibiotic therapy for hospital-acquired pneumonia in critically ill adults

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