Hostname: page-component-8448b6f56d-c47g7 Total loading time: 0 Render date: 2024-04-24T02:22:30.605Z Has data issue: false hasContentIssue false
  • English
  • Français

Microbiology of Ventilator–Associated Pneumonia Compared With That of Hospital-Acquired Pneumonia

Published online by Cambridge University Press:  02 January 2015

David J. Weber ,
William A. Rutala ,
Emily E. Sickbert-Bennett ,
Gregory P. Samsa ,
Vickie Brown  and
Michael S. Niederman
David J. Weber*
Affiliation:
Department of Hospital Epidemiology, University of North Carolina Health Care System, Chapel Hill, North Carolina Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina
William A. Rutala
Affiliation:
Department of Hospital Epidemiology, University of North Carolina Health Care System, Chapel Hill, North Carolina Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina
Emily E. Sickbert-Bennett
Affiliation:
Department of Hospital Epidemiology, University of North Carolina Health Care System, Chapel Hill, North Carolina
Gregory P. Samsa
Affiliation:
Department of Biostatistics and Bioinformatics, Duke University Medical School, Durham, North Carolina
Vickie Brown
Affiliation:
Department of Hospital Epidemiology, University of North Carolina Health Care System, Chapel Hill, North Carolina
Michael S. Niederman
Affiliation:
Winthrop University Hospital and State University of New York, Stony Brook, New York, New York
*
CB #7030, 130 Mason Farm Road, UNC at Chapel Hill, Chapel Hill, NC 27599-7030 (dweber@unch.unc.edu)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

Nosocomial pneumonia is the leading cause of mortality attributed to nosocomial infection. Appropriate empirical therapy has been associated with improved survival, but data are limited regarding the etiologic agents of hospital-acquired pneumonia in non-ventilated patients (HAP). This evaluation assessed whether the currently recommended empirical therapy is appropriate for both ventilator-associated pneumonia (VAP) and HAP by evaluating the infecting flora.

Design.

Prospectively collected hospitalwide surveillance data was obtained by infection control professionals using standard Centers for Disease Control and Prevention definitions.

Setting.

A tertiary care academic hospital.

Patients.

All patients admitted from 2000 through 2003.

Results.

A total of 588 episodes of pneumonia were reported in 556 patients: 327 episodes of VAP in 309 patients, and 261 episodes of HAP in 247 Patients. The infecting flora in ventilated patients included gram-positive cocci (32.0% [oxacillin-susceptible Staphylococcus aureus {OSSA}, 9.25%; oxacillin-resistant Staphylococcus aureus {ORSA}, 17.75%]), gram-negative bacilli (59.0% {Pseudomonas aeruginosa, 17.50%; Stenotrophomonas maltophilia, 6.75%; Acinetobacter species, 7.75%), and miscellaneous pathogens (9.0%). The infecting flora in nonventilated patients included gram-positive cocci (42.59% [OSSA, 13.33%; ORSA, 20.37%]), gram-negative bacilli (39.63% [P. aeruginosa, 9.26%; S. maltophilia, 1.11%; Acinetobacter species, 3.33%), and miscellaneous pathogens (17.78%).

Conclusions.

Our data demonstrated that patients with HAP, compared with those with VAP, had a similar frequency of infection with ORSA but less commonly had infections due to P. aeruginosa, Acinetobacter species, and S. maltophilia. However, the overall frequency of infection with these pathogens was sufficiently high to warrant the use of empirical therapy likely to be active against them. Our data supports using the currently recommended empirical therapy for both HAP and VAP.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 7 , July 2007 , pp. 825 - 831
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Smolinski, MS, Hamburg, MA, Lederberg, J. Microbial Threats to Health. Institute of Medicine. Washington, DC: National Academies Press; 2003.Google Scholar
2.Richards, MJ, Edwards, JR, Culver, DH, Gaynes, RP. Nosocomial infections in medical intensive care units in the United States. Crir Care Med 1999;27:887–892.CrossRefGoogle ScholarPubMed
3.Vincent, JL, Bihari, DJ, Suter, PM, et al.The prevalence of nosocomial infection in intensive care units in Europe: results of the European Prevalence of Infection in Intensive Care (EPIC) study. JAMA 1995;274:639–644.CrossRefGoogle ScholarPubMed
4.Alvarez-Lerma, F. Modification of empiric antibiotic treatment in patients with pneumonia acquired in the intensive care unit. Intensive Care Med 1996;22:387–394.CrossRefGoogle ScholarPubMed
5.Relio, I, Gallego, M, Mariscal, D, Sonora, R, Valles, I. The value of routine microbial investigation in ventilator-associated pneumonia. Am J Resp Crit Care Med 1997;156:196–200.CrossRefGoogle Scholar
6.Luna, CM, Vujacich, P, Niederman, MS, et al.Impact of BAL on the therapy and outcome of ventilator-associated pneumonia. Chest 1997;111:676–685.CrossRefGoogle Scholar
7.Kollef, MH, Ward, S. The influence of mini-BAL cultures on patient outcomes: implications for the antibiotic management of ventilator-associated pneumonia. Chest 1998;113:412–420.Google ScholarPubMed
8.American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Resp Crit Care Med 2005;171:388–416.CrossRefGoogle Scholar
9.Chastre, J, Fagon, J-Y. Ventilator-associated pneumonia. Am J Resp Crit Care Med 2002;165:867–903.CrossRefGoogle ScholarPubMed
10.Sopena, N, Sabria, M. Multicenter study of hospital-acquired pneumonia in non-ICU Patients. Chest 2005;127:213–219.CrossRefGoogle ScholarPubMed
11.Kollef, MH, Shorr, A, Tabak, YP, Gupta, V, Liu, LZ, Johannas, RS. Epidemiology and outcome of health-care-associated pneumonia: results from a large US database of culture-positive bacteremia. Chest 2005;128:3854–3862.CrossRefGoogle Scholar
12.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infection, 1988. Am J Infect Control 1988;16:128–140.CrossRefGoogle ScholarPubMed
13.Centers for Disease Control and Prevention. Criteria for defining pneumonia. Available at: http://www.cdc.gov/ncidod/dhqp/pdf/nnis/NosInfDefinitions.pdf. Accessed May 2, 2007.Google Scholar
14.Bouza, E, Brun-Buisson, C, Chastre, J, et al.Ventilator-associated pneumonia. European Task Force on ventilator-associated pneumonia. Eur Respir J 2001;17:1034–1045.Google Scholar
15.Craven, DE, De Rosa, FG, Thornton, D. Nosocomial pneumonia: emerging concepts in diagnosis, management, and prophylaxis. Curr Opin Crit Care 2002;8:421–429.CrossRefGoogle ScholarPubMed
16.Relio, J, Diaz, E. Pneumonia in the intensive care unit. Crit Care Med 2003;31:2544–2551.CrossRefGoogle Scholar
17.Tablan, OC, Anderson, LJ, Besser, R, Bridges, C, Hajjeh, R. Guideline for preventing health-care-associated pneumonia, 2003. Available at: http://www.cdc.gov/ncidod/dhqp/gl_hcpneumonia.html. Accessed May 2,2007.Google Scholar
18.Trouillet, J-L, Chastre, J, Vuagnat, A, et al.Ventilator-associatedpneumonia caused by potentially drug-resistant bacteria. Am J Respir Crit Care Med 1998;157:531–539.CrossRefGoogle Scholar
19.Prod'hom, G, Leuenberger, P, Koerfer, J, et al.Nosocomial pneumonia in mechanically ventilated patients receiving antacid, ranitidine, or sucralfate as prophylaxis for stress ulcers. Ann Intern Med 1994;120:653–662.CrossRefGoogle ScholarPubMed
20.Relio, J, Sa-Borges, M, Correa, H, Leal, S-R, Baraibar, J. Variations in etiology of ventilator-associated pneumonia across four treatment sites. Am J Respir Crit Care Med 1999;160:608–613.CrossRefGoogle Scholar
21.George, DL, Falk, PS, Wunderink, RG, et al.Epidemiology of ventilator-associated pneumonia based on protected bronchoscopic sampling. Am J Respir Crit Care Med 1998;158:1839–1847.CrossRefGoogle ScholarPubMed
22.Ibrahim, EH, Ward, S, Sherman, G, Kollef, MH. A comparative analysis of patients with early-onset vs late-onset nosocomial pneumonia in the ICU Setting. Chest 2000;117:1434–1442.CrossRefGoogle ScholarPubMed
23.Bochicchio, GV, loshi, M, Bochicchio, K, Tracy, K, Scalea, TM. A time-dependent analysis of intensive care unit pneumonia in trauma Patients. J Trauma 2004;56:296–303.CrossRefGoogle ScholarPubMed
24.Giantsou, E, Liratzopoulos, N, Efraimidou, E, et al.Both early-onset and late-onset ventilator-associated pneumonia are caused mainly by potentially multiresistant bacteria. Intensive Care Med 2005;31:1488–1494.CrossRefGoogle ScholarPubMed
25.Relio, J, Ausina, V, Ricart, M, Castella, J, Prats, G. Impact of previous antimicrobial therapy on the etiology and outcome of ventilator associated pneumonia. Chest 1993;104:1230–1235.CrossRefGoogle Scholar
26.Fridkin, SK. Increasing prevalence of antimicrobial resistance in intensive care units. Crit Care Med 2001;29(4-suppl):N64–68.CrossRefGoogle ScholarPubMed