Prognostic factors of nosocomial pneumonia in general wards: a prospective multivariate analysis in Japan

Takano, Yoshihisa; Sakamoto, Osamu; Suga, Moritaka; Muranaka, Hiroyuki; Ando, Masayuki

doi:10.1053/rmed.2001.1201

Cited by 22 publications

(16 citation statements)

References 24 publications

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“…Mortality rate of ventilator‐associated nosocomial pneumonia was significantly higher than that of nosocomial pneumonia not associated with ventilator However, in this study, multivariate analysis revealed that only inappropriate initial anti‐microbial therapy, high SAPS score and multiple organ failures are independent risk factors of mortality of nosocomial pneumonia. In the present study, there is only one case with rapidly fatal underlying disease (Table 1) and no significant difference of mortality rate is found between patients with nonfatal underlying diseases and patients with ultimately fatal underlying disease, different from other reports (3,29,30). Our findings that appropriate anti‐microbial therapy including appropriate dosage and duration are found to be significantly related to the outcome of nosocomial pneumonia (Table 3) is consistent with earlier findings (3,15,16).…”

Section: Discussioncontrasting

confidence: 99%

“…This finding indicated that with early, appropriate, effective anti‐microbial therapy, nosocomial pneumonia could be cured even in aged patients with chronic underlying diseases. Significant risk factors of mortality of nosocomial pneumonia in this study including acquisition of nosocomial pneumonia in ICU, shock, high SAPS index, low Glasgow coma scale score, acute renal failure, respiratory failure with mechanical ventilation, high serum creatinine, low serum albumin, high serum total bilirubin and multiple organ failures are in agreement with those identified in earlier reports (3,8,9,16,30). Mortality rate of ventilator‐associated nosocomial pneumonia was significantly higher than that of nosocomial pneumonia not associated with ventilator However, in this study, multivariate analysis revealed that only inappropriate initial anti‐microbial therapy, high SAPS score and multiple organ failures are independent risk factors of mortality of nosocomial pneumonia.…”

Section: Discussionsupporting

confidence: 91%

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Risk factors of mortality for nosocomial pneumonia: importance of initial anti-microbial therapy

et al. 2005

International Journal of Clinical Practice

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Nosocomial pneumonia is a common nosocomial infection and has high mortality rate. Risk factors of mortality of nosocomial pneumonia were studied in 132 hospitalised patients who developed nosocomial pneumonia. The overall mortality rate was 64/132, 48.5%. Of the 11 risk factors univariately associated with mortality due to nosocomial pneumonia, only the inappropriate initial anti-microbial therapy, high simplified acute physiology score and multiple organ failures remained significant after stepwise logistic regression. Gram-negative bacilli were still the most pre-dominant causative microbiologic agents of nosocomial pneumonia with Pseudomonas aeruginosa (20.3%), Acinetobacter baumannii (18.6%) and Escherichia coli (5.9%) being the three most predominant pathogens. A. baumannii were significantly more predominant among non-survivors than survivors (13.56 vs. 5.08%, p=0.0418). The incidence rate of methicillin-resistant Staphylococcus aureus was 19.5% higher than previous reports. We conclude that inappropriate initial anti-microbial therapy for nosocomial pneumonia is associated with the mortality rate of nosocomial pneumonia, and appropriate anti-microbial therapy improves outcome of nosocomial pneumonia.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 91%

Risk factors of mortality for nosocomial pneumonia: importance of initial anti-microbial therapy

et al. 2005

International Journal of Clinical Practice

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“…Other measures of disease severity also indicated that PSE9 was more virulent than PSE9ΔrhsT. LDH, a marker for tissue destruction during pneumonia (18), was present in higher amounts in BAL fluid from PSE9-infected mice compared with PSE9ΔrhsT-infected mice (Fig. S6B).…”

Section: Rhst Is Associated With Enhanced Virulence In a Mouse Model Ofmentioning

confidence: 86%

An rhs gene of Pseudomonas aeruginosa encodes a virulence protein that activates the inflammasome

Kung

Khare

Stehlik

et al. 2012

Proc. Natl. Acad. Sci. U.S.A.

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The rhs genes are a family of enigmatic composite genes, widespread among Gram-negative bacteria. In this study, we characterized rhsT, a Pseudomonas aeruginosa rhs gene that encodes a toxic protein. Expression of rhsT was induced upon contact with phagocytic cells. The RhsT protein was exposed on the bacterial surface and translocated into phagocytic cells; these cells subsequently underwent inflammasome-mediated death. Moreover, RhsT enhanced host secretion of the potent proinflammatory cytokines IL-1β and IL-18 in an inflammasome-dependent manner. In a mouse model of acute pneumonia, infection with a P. aeruginosa strain lacking rhsT was associated with less IL-18 production, fewer recruited leukocytes, reduced pulmonary bacterial load, and enhanced animal survival. Thus, rhsT encodes a virulence determinant that activates the inflammasome.rhs element | YD repeat | pathogenesis T he rhs genes are a widely distributed, enigmatic family of horizontally acquired genes. First described in Escherichia coli in the 1980s (1), rhs genes have subsequently been found in a broad range of Gram-negative bacteria, including other members of the Enterobacteriaceae, such as Salmonella, Yersinia, and Photorhabdus, as well as the Pseudomonadaceae, Flavobacteriaceae, Neisseriaceae, Myxoccaceae, and Vibrionaceae. An observed chromosomal rearrangement following recombination between distinct rhs genes in E. coli led to the name "rearrangement hot spot (rhs)" (1). However, recombination events are no longer thought to be a biologically relevant aspect of rhs genes (2). Despite their ubiquity and the many years since their discovery, rhs genes have not been assigned a definitive function, and even clear evidence of gene expression has been elusive (3).Interest in rhs genes has been fueled by their unique structure. These genes, which generally range from 2 to 12 kb in size, exhibit a bipartite structure consisting of two distinct sequences: a long core followed by a short tip (Fig. S1A). Core sequences are GC-rich and display a high degree of intra-and interspecies sequence conservation. In contrast, tip sequences are relatively GC-poor and are highly variable even between closely related rhs genes. Corresponding to the rhs gene core and tip sequences, the proteins predicted to be encoded by rhs genes also contain two regions: a large core domain and a short C-terminal tip domain. Rhs core domains are defined by a variable number of tyrosineaspartate (YD) repeats and are separated from their cognate tip domains by a 61-amino acid hyperconserved region ending in the consensus sequence PXXXXDPXGL (2). Some predicted Rhs proteins also contain a large N-terminal domain. Putative Rhs proteins are predicted to be hydrophilic, and the products of some rhs genes have features of bacteriocins or capsule transport proteins (4-6). Furthermore, Rhs protein YD-repeats and hyperconserved regions display sequence similarity with toxins produced by bacteria that infect insects (7). These observations suggest that some rhs genes encode surface expo...

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“…are among the most outstanding reasons for a bad prognosis. 34,36 Moreover, nosocomial pneumonia increases the lenght of stay and the rate of discharge to skilled centers. In the study of Thompson et al, 35 HAP had a 55% increase in hospital stay (average 11-day increase) and a 6-fold increase in risk for discharge to a skilled nursing facility.…”

Section: Prognosismentioning

confidence: 99%

“…21,36 The prevention of nosocomial legionellosis requires the establishment of a control system for potable hospital water and the active surveillance of pneumonia for Legionella which includes the use of antigenuria tests in the cases of nosocomial pneumonia observed in centers with water colonized by this microorganism. Potable water disinfection measures should be implemented to minimize the water colonization.…”

Section: Preventionmentioning

confidence: 99%

Nosocomial Pneumonia Outside the Intensive Care Unit

Sabrià

Sopena

2011

Clinical Pulmonary Medicine

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Nosocomial pneumonia is the second most frequent cause of nosocomial infection. Most studies have been carried out in intensive care units with patients requiring mechanical ventilation or at high risk for developing nosocomial pneumonia. However, about half of the cases of nosocomial pneumonia occur outside intensive care unit and differ from ventilator-associated pneumonia in several aspects. Patients admitted in conventional hospital wards are not exposed to such aggressive maneuvers as those receiving mechanical ventilation. Moreover, changes in the oropharyngeal flora are probably delayed and the community flora persists longer in them. In addition, these patients are more susceptible to the pathogens present in the air and water environment. These facts suggest that the etiology and therapeutic approach in these 2 groups are not totally comparable.

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Prognostic factors of nosocomial pneumonia in general wards: a prospective multivariate analysis in Japan

Cited by 22 publications

References 24 publications

Risk factors of mortality for nosocomial pneumonia: importance of initial anti-microbial therapy

Risk factors of mortality for nosocomial pneumonia: importance of initial anti-microbial therapy

An rhs gene of Pseudomonas aeruginosa encodes a virulence protein that activates the inflammasome

Nosocomial Pneumonia Outside the Intensive Care Unit

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