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A Study of the Etiologies and Treatment of Nosocomial Pneumonia in a Community-Based Teaching Hospital

  • Charles J. Schleupner (a1) and David K Cobb (a2)

Abstract

Objective:

To compare the frequency of the pathogens of nosocomial pneumonia in a community-based teaching hospital to the frequencies previously published, and to evaluate recommendations for the therapy of nosocomial pneumonia in this setting.

Design:

Retrospective review of prospectively acquired data accrued during 9 randomized single-blinded and 4 single-agent investigational antibiotic studies for the therapy of pneumonia in hospitalized patients between 1981 and 1989.

Setting:

The study was performed at a university affiliated, community-based teaching Department of Veterans Affairs Medical Center.

Patients:

Patients were hospitalized on the acute medical/surgical and intermediate medicine wards. Informed consent was obtained prior to enrolling patients into the respective antimicrobial studies. Pneumonia was documented radiographicahy and clinically for each patient.

Results:

Two hundred thirty-one episodes of nosocomial pneumonia were treated. Overall, 51% of pneumonias were caused by Streptococcus pneumoniae or Hemophilus influenzae with or without other organisms that were not gram-negative bacilli. Gram-negative bacilli, with or without other organisms, accounted for only 26% of all nosocomial pneumonias. Overall, monotherapy with a cephalosporin (usually a broad-spectrum agent) was equally efficacious compared with combination therapy (87% versus 81%, respectively). Cure rates for nosocomial pneumonias from gram-negative bacilli treated with these 2 therapies also were similar (70% versus 60%, respectively).

Conclusions:

In nontertiary care settings, gram-negative bacilli may cause fewer episodes of nosocomial pneumonia (26% in this study) than noted by previously published reports, which indicated that these organisms account for 50% of nosocomial pneumonias. Further, S pneumoniae and H influenzae may account etiologicahy for many of these nosocomial pneumonias. Monotherapy with an extended-spectrum cephalosporin may be more appropriate than combined treatment with a b-lactam and an aminoglycoside in a nontertiary care setting, thereby reducing potential toxicity in an older, hospitalized patient population.

Copyright

Corresponding author

Infectious Diseases Section (111L), VA Medical Center, Salem, VA 24153

References

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1.Horan, TC, White, JW, Jarvis, WR,, et al. Nosocomial infection surveillance, 1984. Surveillance Summaries. 1984;35(1SS):17SS–29SS.
2.Stamm, WE, Martin, SM, Bennett, JV. Epidemiology of nosocomial infections from gram-negative bacilli: aspectsrelevant todevelopment and use of vaccines. J Infect Dis. 1977;136:S151S160.
3.Craybill, JR, Marshall, LW, Charache, R, Wallace, CK, Melvin, VB. Nosocomial pneumonia: a continuing major problem. Am Rev Respir Dis. 1973;108:11301140.
4.Verghese, A, Berk, SL. Bacterial pneumonia in the elderly. Medicine. 1983;62:271285.
5.Bartlett, JG, O'Keefe, P, Tally, FP, Gorbach, SL. Bacteriology of hospital-acquired pneumonia. Arch Intern Med. 1986;146:868871.
6.Hessen, MTKaye, D. Nosocomial pneumonia. Crit Care Clin. 1988;4:245257.
7.Septimus, EJ. Nosocomial bacterial pneumonias. Sem Respir Infect 1989;4:245252.
8.Ruiz-Santana, S, Jimenez, AG, Esteban, S, et al. ICU pneumonias: a multi-institutional study. Crit Care Med. 1987;15:930932.
9.Potgieter, PD, Linton, DM, Oliver, S, et al. Nosocomial infections in arespiratory intensive care unit. Crit Care Med. 1987;15:495498.
10.Berk, SL, Gallemore, GM, Smith, JK. Nosocomial pneumococcal pneumonia in the elderly. J Am Ger Society. 1981;29:319321.
11.Simon, HB, Southwick, FS, Moellering, RC Jr, Sherman, E. Hemophilus influenzae in hospitalized adults: current perspectives. Am J Med. 1980;69:219226.
12.Alvarez, S, Guarderas, J, Shell, CG, Holtsclaw-Berk, S, Berk, SL. Nosocomial pneumococcal bacteremia. Arch Intern Med. 1986;146:15091512.
13.Tbwes, GB. Southwestern internal medicine conference: nosocomial pneumonia. Am J Med Sci. 1986;291:355367.
14.Stratton, CW. Bacterial pneumonias-an overview with emphasis on pathogenesis, diagnosis, and treatment. Heart Lung. 1986;15:226244.
15.Pennington, JE. Hospital-acquired pneumonia In: Wenzel, RP, ed. Prevention and Control of Nosocomial Infections. Baltimore, Md: Williams and Wilkins; 1987:321334.
16.Moore, RD, Smith, CR, Lietman, PS. Association of aminoglyco-side plasma levels with therapeutic outcome in gram-negative pneumonia. Am J Med. 1984:77:657662.
17.Schleupner, CJ, Engle, JC. Clinical evaluation of cefotaxime for therapy of lower respiratory tract infection. Antimicrob Agents Chemother. 1982;21:327333.
18.Engle, JC, Liiand, PW, Schleupner, CJ. Comparison of ceftazidime to cefamandole for the therapy of community-acquired pneumonias. Antimicrob Agents Chemother. 1985;28:146148.
19.Schleupner, CJ, Anthony, WC, Tan, J, et al. Multicenter single-blinded comparison of cefuroxime to cefaclor in the therapy of lower respiratory tract infections in adults. Arch Intern Med. 1988;148.343348.
20.Murray, PR, Washington, JA II. Microscopic and bacteriologic analysis of expectorated sputum. Mayo Clinic Proc. 1975;50:339344.
21.Geckler, RW, Gremillion, DH, McAllister, CK, Ellenbogen, C. Microscopic and bacteriological comparison of paired sputa and transtracheal aspirates. J Clin Microbial. 1977;6:396399.
22.Louria, DB, Kaminski, TThe effects of four antimicrobial drug regimens on sputum super-infection in hospitalized patients. Am Rev Resp Dis. 1962;85:649665.
23.Gherman, CR, Simon, HJ. Pneumonia complicating severe underlying disease. Disease of the Chest. 1965:48:297304.
24.Pierce, AK, Edmonson, EB, McGee, G, Ketchersid, J, London, RG, Sanford, JP, An analysis of factors predisposing to gram-negative bacillary necrofizing pneumonia. Am Rev Resp Dis. 1966;94:309315.
25.Tilloston, JR, Finland, M. Secondary pulmonary infections following antibiotic therapy for primary bacterial pneumonia. Antimicrob Agents Chemother. 1968;8:326330.
26.Johanson, WG, Pierce, AK, Sanford, JF! Changing pharyngeal bacterial flora of hospitalized patients. N Engl J Med. 1969;281:11371140.
27.Tillotson, JR, Finland, M. Bacterial colonization and clinical superinfection of the respiratory tract complicating antibiotic treatment of Qneumonia. I Infect Dis. 1969;119:597624.
28.Johanson, WG, Pierce, AK, Sanford, JP, Thomas, GD. Nosocomial respiratory infection with gram-negative bacilli. The significance of colonization of the respiratory tract. Ann Intern Med. 1972;77:701706.
29.Pierce, AK, Sanford, JRAerobic gram-negative bacillary pneumonias. Am Rev Resp Dis. 1974;110:647658.
30.Valenti, WM, Tiudell, RG, Bentley, DW. Factors predisposing to oropharyngeal colonization with gram-negative bacilli in the aged. N Engl J Med 1978;298:11081111.
31.LaForce, FM. Hospital acquired-n-am-nggative rod nneumonias: an overview. Am J Med. 1981;70:664669.
32.Craven, DE, Driks, MR. Nosocomial pneumonia in the intubated patient. Semin Resp Infect. 1987;2:2033.
33.Mylotte, JM, Beam, TR Jr. Comparison of community-acquired and nosocomial pneumonia bacteremia. Am Rev Resp Dis. 1981;123:265268.
34.Levison, ME, Kaye, D. Pneumonia caused by gram-negative bacilli: an overview. Rev Infect Dis. 1985;7(S4):S656S665.
35.Garb, JL, Brown, RB, Garb, JR, Tuthill, RW. Differences in etiology of pneumonias in nursing home and community patients. JAMA. 1978;240:21692172.
36.Elbright, JR, Rytel, NWBacterial pneumonia in the elderly. J Am Ger Soc. 1980:36:220223.
37.Norman, DC, Castle, SC, Cantrell, M. Infections in the nursing home. Am Ger Soc. 1987;35:796805.
38.Barrett-Connor, E. The nonvalue of sputum culture in the diagnosis of pneumococcal pneumonia. Am Rev Resp Dis. 1971;103:845848.
39.Rein, MEGwaltney, JM, O'Brien, WM, Jennings, RH, Mandell, GL. Accuracy of gram's stain in identifying pneumococci in sputum. JAMA. 1978;239:26712673.
40.Gardner, WG. Multicentered clinical evaluation of cefoperazone for the treatment of lower respiratory tract infections. Rev Infect Dis. 1983:5:S137S144.
41.Perkins, RL. Clinical trials of cefotaxime for the treatment of bacterial infections of the lower respiratory tract. Rev Infect Dis. 1982;4:S421S431.
42.Mangi, RJ, Greco, T, Ryan, J, Thornton, G, Andriole, VTCefopera-zone versus combinaton antibiotic therapy of hospital-acquired pneumonia. Am J Med. 1988;84:6874.
43.Warren, JW, Miller, EH, Fitzpatrick, Bet al. A randomized, controlled trial of cefoperazone vs. cefamandole-tobramyacin in the treatment of putative, severe infections with gram-negative bacilli. Rev Infect Dis. 1983;5(suppl):S173S180.
44.Trenholme, GM, Pottage, JC, Karakusis, PH. Use of ceftazidime in the treatment of nosocomial lower respiratory infections. Am J Med. 1985;79(S2A):3236.
45.Mangi, RJ, Ryan, J, Berenson, C, et al. Cefoperazone versus ceftazidiie monotherapy of nosocomial pneumonia. Am J Med. 1988;95(S1A):4448.
46.LaForce, FM. Systemic antimicrobial therapy of nosocomial pneumonia: monotherapy versus combination therapy. Eur J Clin Microbiol Infect Dis. 1989;8:6168.

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