Hospital-acquired pneumonia incidence and diagnosis in older patients

Burton, Louise A.; Price, Rosemary J. G.; Barr, Karen E.; McAuley, Sean M.; Allen, J. B.; Clinton, Aoibhinn; Phillips, G.; Marwick, Charis; McMurdo, Marion E. T.; Witham, Miles D.

doi:10.1093/ageing/afv168

Cited by 45 publications

(47 citation statements)

References 15 publications

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“…In dieser lag die histologisch überprüfte Sensitivität bei 69 % und die Spezifität bei 75 % [113]. Fagon et al (1993) [114] [115] und im klinischen Alltag etwa 1/3 der Patienten, die als V. a. HAP diagnostiziert werden, die oben beschriebenen Röntgenkriterien objektiv nicht erfüllen [116,117]. Der Einsatz mikrobiologischer Kriterien zur Diagnose einer HAP verbessert die Sensitivität und Spezifität nicht [113].…”

Section: Diagnostikunclassified

Epidemiologie, Diagnostik und Therapie erwachsener Patienten mit nosokomialer Pneumonie – Update 2017

Dalhoff

Abele‐Horn

Andreas³

et al. 2018

Pneumologie

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Nosocomial pneumonia (HAP) is a frequent complication of hospital care. Most data are available on ventilator-associated pneumonia. However, infections on general wards are increasing. A central issue are infections with multidrug resistant (MDR) pathogens which are difficult to treat in the empirical setting potentially leading to inappropriate use of antimicrobial therapy.This guideline update was compiled by an interdisciplinary group on the basis of a systematic literature review. Recommendations are made according to GRADE giving guidance for the diagnosis and treatment of HAP on the basis of quality of evidence and benefit/risk ratio.This guideline has two parts. First an update on epidemiology, spectrum of pathogens and antimicrobials is provided. In the second part recommendations for the management of diagnosis and treatment are given. New recommendations with respect to imaging, diagnosis of nosocomial viral pneumonia and prolonged infusion of antibacterial drugs have been added. The statements to risk factors for infections with MDR pathogens and recommendations for monotherapy vs combination therapy have been actualised. The importance of structured deescalation concepts and limitation of treatment duration is emphasized.

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Section: Diagnostikunclassified

Epidemiologie, Diagnostik und Therapie erwachsener Patienten mit nosokomialer Pneumonie – Update 2017

Dalhoff

Abele‐Horn

Andreas³

et al. 2018

Pneumologie

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“…The limited evidence available suggests that HAP complicates approximately 1·5% (95% CI 1·4-1·6) of UK hospital admissions , 2 has a major impact on length of stay , 3 and because its management invariably involves broad-spectrum antibiotics, has potential to be an important driver for the emergence of antibiotic resistance . 4 HAP is associated with higher mortality (29% with HAP versus 8% without), 5 but the attributable mortality is unknown.…”

Section: Commentmentioning

confidence: 99%

“…weak cough). However without criterion-based diagnosis which includes microbiological evidence, over-diagnosis is common, 5,8 and in the UK there is little financial incentive for accurate coding at discharge, making HAP difficult to detect using electronic records alone.…”

Section: Commentmentioning

confidence: 99%

Hospital-acquired pneumonia surveillance—an unmet need

Ewan

Witham

Kiernan

et al. 2017

The Lancet Respiratory Medicine

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“…Over a quarter of all hospital-acquired infections in Europe affect the respiratory tract (European Centre for Disease Prevention and Control, 2013 ). Nosocomial respiratory tract infections increase the average cost of hospital care by up to 75% (Thompson et al, 2006 ), increase length of hospital stay by up to 12 days (Thompson et al, 2006 ; Redelmeier et al, 2010 ), require the prescription of broad-spectrum antibiotics which may act as a driver for antimicrobial resistance, increase mortality (Thompson et al, 2006 ; Burton et al, 2016 ), and are associated with loss of independence (Thompson et al, 2006 ). Approximately two thirds of these infections occur in patients who have not been intubated and mechanically ventilated in critical care (Health Protection Agency, 2012 ).…”

Section: Introductionmentioning

confidence: 99%

“…Approximately two thirds of these infections occur in patients who have not been intubated and mechanically ventilated in critical care (Health Protection Agency, 2012 ). The non-ventilated hospital population at risk is predominantly older, frail and characterized by multimorbidity (European Centre for Disease Prevention and Control, 2013 ; Burton et al, 2016 ).…”

Section: Introductionmentioning

confidence: 99%

Oropharyngeal Microbiota in Frail Older Patients Unaffected by Time in Hospital

Ewan

Reid

Shirley

et al. 2018

Front. Cell. Infect. Microbiol.

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Respiratory tract infections are the commonest nosocomial infections, and occur predominantly in frailer, older patients with multiple comorbidities. The oropharyngeal microbiota is the major reservoir of infection. This study explored the relative contributions of time in hospital and patient demographics to the community structure of the oropharyngeal microbiota in older patients with lower limb fracture. We collected 167 throat swabs from 53 patients (mean age 83) over 14 days after hospitalization, and analyzed these using 16S rRNA gene sequencing. We calculated frailty/comorbidity indices, undertook dental examinations and collected data on respiratory tract infections. We analyzed microbial community composition using correspondence (CA) and canonical correspondence analysis. Ten patients were treated for respiratory tract infection. Microbial community structure was related to frailty, number of teeth and comorbidity on admission, with comorbidity exerting the largest effect. Time in hospital neither significantly changed alpha (t = −0.910, p = 0.365) nor beta diversity (CA1 t = 0.022, p = 0.982; CA2 t = −0.513, p = 0.609) of microbial communities in patient samples. Incidence of respiratory pathogens were not associated with time in hospital (t = −0.207, p = 0.837), nor with alpha diversity of the oral microbiota (t = −1.599, p = 0.113). Patient characteristics at admission, rather than time in hospital, influenced the community structure of the oral microbiota.

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Hospital-acquired pneumonia incidence and diagnosis in older patients

Abstract: HAP is common but over-diagnosed in older hospitalised patients.

Cited by 45 publications

References 15 publications

Epidemiologie, Diagnostik und Therapie erwachsener Patienten mit nosokomialer Pneumonie – Update 2017

Epidemiologie, Diagnostik und Therapie erwachsener Patienten mit nosokomialer Pneumonie – Update 2017

Hospital-acquired pneumonia surveillance—an unmet need

Oropharyngeal Microbiota in Frail Older Patients Unaffected by Time in Hospital

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