Nosocomial pneumonia: Epidemiology and infection control

Craven, Donald E.; Steger, Kathleen A.; Barat, Lawrence M.; Duncan, Robert A.

doi:10.1007/bf01752970

Cited by 59 publications

(21 citation statements)

References 61 publications

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“…In a series of international surveillance studies, pneumonia accounted for 14-20% of all nosocomial infections and was repeatedly found to be the second most frequent type of hospital-acquired infection after urinary tract infection. The US National Nosocomial Infections Surveillance System (NISS) identified six to ten episodes of nosocomial pneumonia (NP) for every 1,000 patients admitted to hospital [1][2][3][4][5][6]. The highest rates of NP occur in intensive care units (ICU).…”

Section: Introductionmentioning

confidence: 99%

Nosocomial Pneumonia: A Cost-of-Illness Analysis

et al. 2002

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The study gives insight into the structure of incremental cost caused by NP and shows that based on a conservative cost calculation the incremental cost per NP patient is higher for the hospital than for health insurance funds which indicates a significant financial deficit for the hospital. Antibiotics and microbiology together only contribute 6.8% to incremental cost. Therefore in a cost saving initiative their close relationship to length of hospitalization must be considered.

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Section: Introductionmentioning

confidence: 99%

Nosocomial Pneumonia: A Cost-of-Illness Analysis

et al. 2002

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“…VAP is defined as having either an early- or a late-onset according to whether it begins before or after the first 5 to 7 days of hospitalization [4]. During early-onset ventilator-associated pneumonia (EOVAP), the normal bacterial flora consists of Haemophilus influenzae , Streptococcus pneumoniae , methicillin-sensitive Staphylococcus aureus , Moraxella catarrhalis and non multiresistant Escherichia coli [5], [6]. The bacteria isolated may vary due to antibiotic treatment, recent hospitalization and ICU ecology [7], [8], [9], [10].…”

Section: Introductionmentioning

confidence: 99%

Early-Onset Ventilator-Associated Pneumonia in Adults Randomized Clinical Trial: Comparison of 8 versus 15 Days of Antibiotic Treatment

Capellier¹,

Mockly²,

Charpentier³

et al. 2012

PLoS ONE

108

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PurposeThe optimal treatment duration for ventilator-associated pneumonia is based on one study dealing with late-onset of the condition. Shortening the length of antibiotic treatment remains a major prevention factor for the emergence of multiresistant bacteria.ObjectiveTo demonstrate that 2 different antibiotic treatment durations (8 versus 15 days) are equivalent in terms of clinical cure for early-onset ventilator-associated pneumonia.MethodsRandomized, prospective, open, multicenter trial carried out from 1998 to 2002.MeasurementsThe primary endpoint was the clinical cure rate at day 21. The mortality rate was evaluated on days 21 and 90.Results225 patients were included in 13 centers. 191 (84.9%) patients were cured: 92 out of 109 (84.4%) in the 15 day cohort and 99 out of 116 (85.3%) in the 8 day cohort (difference = 0.9%, odds ratio = 0.929). 95% two-sided confidence intervals for difference and odds ratio were [−8.4% to 10.3%] and [0.448 to 1.928] respectively. Taking into account the limits of equivalence (10% for difference and 2.25 for odds ratio), the objective of demonstrative equivalence between the 2 treatment durations was fulfilled. Although the rate of secondary infection was greater in the 8 day than the 15 day cohort, the number of days of antibiotic treatment remained lower in the 8 day cohort. There was no difference in mortality rate between the 2 groups on days 21 and 90.ConclusionOur results suggest that an 8-day course of antibiotic therapy is safe for early-onset ventilator-associated pneumonia in intubated patients.Trial RegistrationClinicalTrials.gov NCT01559753

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“…GNB, such as Pseudomonas aeruginosa, Klebsiella pneumoniae and Enterobacter spp. are putative pathogens and can cause infections such as pneumonia [2]. It has been shown that the incidence of infection with GNB rises in institutionalised patients and frail elderly subjects [3].…”

Section: Introductionmentioning

confidence: 99%

Oral Flora of Elderly Patients following Acute Medical Admission

Preston

Gosney²,

Noon³

et al. 1998

Gerontology

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The human oral microflora is diverse and is usually predominately composed of Gram-positive bacteria. It is uncommon to find Gram-negative bacilli (GNB) in healthy mouths. The incidence of infection with GNB rises in institutionalised, frail elderly subjects. There is also evidence of an association between intra-oral GNB presence and denture wearing. There have been few studies which have investigated intra-oral GNB carriage in acutely ill elderly patients. The aim of this study was to evaluate the oral flora of a group of elderly patients during an acute medical admission and to investigate any associations between the oral microflora and existing medical or oral factors. A total of 28 patients (17 females and 11 males; age: 74–93 years) on a care for the elderly ward were studied. Epidemiological data, detailed medical histories and oral examinations were undertaken. In addition, oral swabs of the palate area were taken to determine their oral flora. Twelve (43%) of the patients had GNB in their oral cavities. These patients were suffering from a variety of medical conditions and were on various drug regimes. There was a correlation between oral GNB presence and denture use. There was no association between GNB presence and denture hygiene. As oropharyngeal GNB colonisation can be associated with infections such as aspiration pneumonia, it is important in patients at risk that intra-oral organisms are identified and managed.

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Nosocomial pneumonia: Epidemiology and infection control

Cited by 59 publications

References 61 publications

Nosocomial Pneumonia: A Cost-of-Illness Analysis

Nosocomial Pneumonia: A Cost-of-Illness Analysis

Early-Onset Ventilator-Associated Pneumonia in Adults Randomized Clinical Trial: Comparison of 8 versus 15 Days of Antibiotic Treatment

Oral Flora of Elderly Patients following Acute Medical Admission

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