Nosocomial pneumonia bacterial

Risk factors for bacterial nosocomial pneumonia have been identified by several large studies (10,11,14-17,22,36,39,54-56) (see Table 1). The presence of advanced age, underlying diseases, inunune suppression, and malnutrition... 

Table 2 Selected Pathogens Commonly Associated with Bacterial Nosocomial Pneumonia Classified by Time of Onset...

A recent study performed in a Canadian pediatric intensive care unit identified specific risk factors or markers associated with bacterial nosocomial pneumonia and bacterial nosocomial tracheitis (38). By multivariate analysis, the following risk factors or markers (with odds ratio) were significantly associated with nosocomial infection ... 

Nosocomial LRI can have a significant impact on survival. Death and multiple organ failure have been reported in as many as 8% of children with bacterial nosocomial pneumonia (38). In this same group of children, no deaths were attributed directly to nosocomial tracheitis (38). However, reintubation was required in 24% of these patients in whom nosocomial tracheitis developed. 

Berger R, Arango L. Etiologic diagnosis of bacterial nosocomial pneumonia in seriously ill patients. Crit Care Med 1985 13 833-836. 

Gastric acid is an important barrier to colonization and infection of the stomach and intestine from ingested bacteria. Increases in gastric bacterial concentrations are detected in patients taking proton pump inhibitors, which is of unknown clinical significance. Some studies have reported an increased risk of both community-acquired respiratory infections and nosocomial pneumonia among patients taking proton pump inhibitors. 

Ciprofloxacin is a fluoroquinolone antibiotic that interferes with microbial DNA synthesis. It is indicated in the treatment of infections of the lower respiratory tract, skin and skin structure, bones and joints, urinary tract gonorrhea, chancroid, and infectious diarrhea caused by susceptible strains of specific organisms typhoid fever uncomplicated cervical and urethral gonorrhea women with acute uncomplicated cystitis acute sinusitis nosocomial pneumonia chronic bacterial prostatitis complicated intra-abdominal infections reduction of incidence or progression of inhalational anthrax following exposure to aerosolized Bacillus anthracis. Cipro IV Used for empirical therapy for febrile neutropenic patients. 

Levofloxacin is a fluoroquinolone/ophthalmic/antibiotic that interferes with microbial DNA synthesis. It is indicated in the treatment of acute maxillary sinusitis, acute bacterial exacerbation of chronic bronchitis, nosocomial pneumonia, community-acquired pneumonia, skin and skin structure infections, chronic bacterial prostatitis, urinary tract infection (UTI), inhalational anthrax (postexposure), and acute pyelonephritis caused by susceptible strains of specific microorganisms. Ophthalmic use is for the treatment of conjunctivitis caused by susceptible strains of aerobic Gram-positive and aerobic Gram-negative microorganisms. 

Bacterial overgrowth frequently occurs as consequence of acid inhibition in humans but is of little clinical consequence. Neither gastrointestinal infections nor nosocomial pneumonia in intensive care medicine are significantly increased. Increased formation of iV-nitroso compounds in the stomach after omeprazole treatment has not been found. 

Expectorated sputum and tracheal aspirate specimens obtained by direct suctioning through the endotracheal tube in mechanically ventilated patients are easily obtained but notoriously nonspecific in the diagnosis of nosocomial pneumonia. Bartlett et al. prospectively evaluated cultures of expectorated sputum in 67 patients with nosocomial pneumonia whose final diagnosis was based on bacterial studies from uncontamined specimens (blood, transtracheal... 

Ventilator-associated nosocomial pneumonia presents a particularly difficult therapeutic challenge because of the heavy bacterial burden, exemplified by a patient with closed head trauma and increased intracranial hypertension who is unable to clear secretions because of therapeutic paralysis or heavy... 

Table 7 Selected Antimicrobial Agents in the Therapy of Bacterial Pathogens of Nosocomial Pneumonia with Acquisition Costs ...

Rarely, a percutaneous or open lung biopsy is required to establish the presence of a bacterial pathogen in nosocomial pneumonia. However, these invasive procedures are more helpful for establishing nonbacterial agents such... 

Isolation of a bacterial pathogen from the blood of a child who has a nosocomial pneumonia when it is identical to the bacteria isolated from the lower respiratory tract usually confirms this organism to be the agent responsible for the nosocomial pneumonia. However, only approximately 2% to 5% of patients with nosocomial bacterial pneumonia have positive blood cultures (67). 

The mechanisms responsible for postoperative pneumonia are similar to the etiologies of other types of nosocomial pneumonia. The most frequent mechanism for bacteria to enter the lower respiratory tract is via aspiration of contaminated oropharyngeal or gastric fluids. Less commonly, organisms can be transmitted via contaminated anesthesia or respiratory therapy equipment or may spread hematogenously from a distant site of infection. As described later, both general anesthesia and postoperative alterations in pulmonary mechanics may increase the likelihood of infection after bacterial contamination of the lower respiratory tract. 

Nosocomial bacterial pneumonia developing in patients on mechanical ventilation... 

Levofloxacin (1), the levo-isomer or the (5)-enantiomer of ofloxacin, received FDA approval in 1996 (Fish, 2003 Hurst et al., 2002 Mascaretti, 2003 Norrby, 1999 North et al., 1998). The initial approval covered community-acquired pneumonia, acute bacterial exacerbation of chronic bronchitis, acute maxillary sinusitis, uncomplicated skin and skin structure infections, acute pyelonephritis, and complicated urinary tract infections (North et al., 1998). Four years later, the levofloxacin indication list grew to include community-acquired pneumonia caused by penicillin-resistant Streptococcus pneumoniae. In addition, in 2002, nosocomial (hospital-acquired) pneumonia caused by methicillin-susceptible Staphylococcus aureus, Pseudomonas aeruginosa, Serratia marcescens, Haemophilus influenzae, Kliebsella pneumoniae, and Escherichia coli was added (Hurst et al., 2002). Finally in 2004, LVX was approved as a post-exposure treatment for individuals exposed to Bacillus anthracis, the microbe that causes anthrax, via inhalation (FDA, 2004). 

The majority of sepsis cases, especially the more severe forms, have bacterial etiologies. Common bacterial species include Staphylococcus aureus. Streptococcus pneumoniae, Escherichia coli. Salmonella typhi (and other enterobacterial species). Pseudomonas species and haemolytic streptococci in children Haemophilus influenzae and Neisseria meningitidis are important whereas nosocomial episodes of sepsis are frequently caused by Staphylococcus epidermidis. Streptococcus faecalis (syn. enterococci), yeasts and anaerobes. 

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