Nosocomial pneumonia


Nosocomial pneumonia

Description, Causes and Risk Factors:

Abbreviation: NP.

Nosocomial pneumonia is the second most frequent hospital acquired infection and the most common acquired infection in the ICU (intensive care unit). The incidence is age dependent. There is no race or sex predilection. Death from nosocomial pneumonia in ventilated patients reaches 30-50% with an estimated attributable mortality of 10- 50%.

Nosocomial pneumonia can be characterized by its onset: early or late. Early onset pneumonia occurs during the first four days of hospitalization and is often caused by Moraxella catarrhalis, Haemophilus influenzae, and Streptococcus pneumoniae. Causative agents of late onset pneumonia are frequently gram negative bacilli or S. aureus, including Methicillin-resistant Staphylococcus aureus. Viruses (e.g. Influenza A and B or respiratory syncytial virus) can cause early and late onset nosocomial pneumonia, whereas yeasts, fungi, Legionella, and Pneumocystis carinii are usually pathogens of late onset pneumonia.

Multiple episodes of nosocomial pneumonia may occur in critically ill patients with lengthy hospital stays. When determining whether to report multiple episodes of nosocomial pneumonia in a single patient, look for evidence of resolution of the initial infection. The addition of or change in pathogen alone is not indicative of a new episode of pneumonia. The combination of new signs and symptoms and radiographic evidence or other diagnostic testing is required.

The risk factors can be grouped into 5 general categories:

    Host factors such as extremes of age, immunosuppression.

  • Factors that enhance colonization of the oropharynx and/or stomach by microorganisms e.g. antibiotics, admission to ICU, underlying chronic lung disease or coma.

  • Conditions favoring aspiration or reflux e.g. intubation, insertion of nasogastric tube or supine position.

  • Conditions requiring prolonged use of mechanical ventilatory support with potential exposure to contaminated respiratory equipment and/or contact with colonized and contaminated hands of nursing and medical staff.

  • Factors that impede adequate pulmonary toilet e.g. surgery to head and neck or immobilization due to trauma.

The implementation of protocolized treatment guidelines and antibiotic rotation policies are emerging as useful tools for reducing the frequency of antibiotic resistance and the impact of nosocomial pneumonia.

Symptoms:

In an elderly person, the first sign of nosocomial pneumoniamay be mental changes or confusion. Other symptoms are:

    A cough that may produce mucus-like, greenish, or pus-like phlegm (sputum).

  • Fever and chills.

  • General discomfort, uneasiness, or ill feeling (malaise).

  • Loss of appetite.

  • Nausea and vomiting.

  • Sharp chest pain that gets worse with deep breathing or coughing.

  • Shortness of breath.

Diagnosis:

Tests to check for nosocomial pneumoniamay include:

    Arterial blood gases (ABG), to measure oxygen levels in the blood.

  • Blood cultures, to see if the infection has spread to the blood.

  • Chest x-ray or CT scan, to check the lungs.

  • Complete blood count (CBC).

  • Pulse oximetry, to measure oxygen levels in the blood.

  • Sputum culture or sputum gram stain, to check for what germs are causing the pneumonia.

Treatment:

You will receive IV antibiotics to treat your lung infection. The antibiotic you are given will fight the germs that are in your sputum culture. You may also receive oxygen to help you breathe better and lung treatments to loosen and remove thick mucus from your lungs. You may need a ventilator (breathing machine) to support your breathing.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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