Nosocomial infections pneumonia

Cefuroxime (35) is effective against community-acquired pneumonia in which ampicillin-resistant Haemophilus influence is the probable etiologic agent. Cefoxitin (23) is used to treat mixed aerobic—anaerobic infections including pelvic infections, intra-abdorninal infections, and nosocomial aspiration pneumonia. Cefonicid (31), because of its long half-life has been used in a once-a-day regimen to treat a variety of mild to moderate infections including community-acquired pneumonias, urinary tract infections, and infections of the skin and soft tissue (132,215). 

Freeman, R. Gould, F. K. Sisson, P. R. Lightfoot, N. F. Strain differentiation of capsule type 23 penicillin-resistant Streptcoccus pneumoniae from nosocomial infections by pyrolysis mass spectrometry. Lett. Appl. Microbiol. 1991, 13, 28-31. 

The urinary pathogens in complicated or nosocomial infections may include E. coli, which accounts for less than 50% of these infections, Proteus spp., Klebsiella pneumoniae, Enterobacter spp., Pseudomonas aeruginosa, staphylococci, and enterococci. Candida spp. have become common causes of urinary infection in the critically ill and chronically catheterized patient. 

Doripenem Carbepenem 2007 2008 Launched Nosocomial infections caused by S. aureus, P. aeruginosa, S. pneumoniae... 

Selective decontamination of the gastrointestinal tract was conceptualised with a view to preventing nosocomial infection (mainly due to enterobacteriaciae), specifically ventilator-associated pneumonia, in intensive care units. Protocols typically included the prescription of an intravenous cephalosporin with good activity against such Gram-negative pathogens (e.g. cefotaxime) with co-prescribed, poorly... 

Jarvis, V.R., Munn, V.P., Highsmith, A.K., Culver, D.H., Hughes, J.M. The epidemiology of nosocomial infection caused by Klebsiella pneumoniae. Infect Control 6 (1985) 68-74. 

Cefepime Maxipime IV, IM Nosocomial infections, septicemia, urinary tract infections, pneumonia... 

S. aureus causes a variety of suppurative (pusforming) infections and toxinoses in humans. It may cause superficial skin lesions (boils and styes) infections such as pneumonia, mastitis, phlebitis, meningitis, and urinary tract infections and deep-seated infections such as osteomyelitis and endocarditis. S. aureus is associated with nosocomial infections of surgical wounds and infections with indwelling medical devices. S. aureus can cause toxic... 

Klebsiella pneumoniae +++ Nosocomial infections, opportunistic pathogen chronic pulmonary disease, enteric pathogenicity, nasal mucosa atrophy and rhinoscleroma. 

Staphylococcus aureus has long been recognized as a major human pathogen and remains a frequent cause of morbidity and mortality (I). According to the National Nosocomial Surveillance System (NNIS), S. aureus is the most common cause of nosocomial infections (2). These infections include pneumonia, surgical site, and bloodstream infections, which can be complicated by endocarditis, osteomyelitis, or septic shock (1). The versatile tissue tropism... 

There are no vaccines against bacteria such as Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Clostridium difficile and Acine-tobacter baumannii, which together are responsible for the majority of nosocomial infections, ranging from septicemia to pneumonia and... 

Nosocomial pneumonia is the second most common nosocomial infection (1) and the most common nosocomial infection in intensive care units (ICUs). It affects more than 250,000 acute care patients annually in the United States (2). The Centers for Disease Control and Prevention (CDC) recently estimated that nosocomial pneumonia is a primary or contributing cause for more than 30,000 deaths annually in the United States (3). To decrease the incidence of nosocomial pneumonia, hospitals must focus their considerable prevention efforts. However, these efforts begin by appropriate monitoring of this costly complication of hospital care. This task is even more involved because nosocomial pneumonia is probably more than one syndrome with multiple pathogeneses. 

For the numerator of a nosocomial pneumonia rate, accurate and consistent case finding of nosocomial pneumonia in the population under study is needed. Consistent definitions for case finding are essential. Therefore, it is imperative that there be available a uniform set of criteria that define nosocomial pneumonia. The most widely used definitions currently in use are the definitions used by National Nosocomial Infection Surveillance (NNIS) system hospitals, the complete version of which was published in Hospital Epidemiology and Infection Control in 1996. The current definition for nosocomial pneumonia is shown on Table 1. 

Prevalence is the total number of active (existing and new) cases of the disease in a defined population, either during a specified period (period prevalence) or at a specified point in time (point prevalence). The prevalence nosocomial infection rate is calculated simply by dividing the number of active nosocomial infections in patients surveyed by the number of patients surveyed. Because nosocomial pneumonias occur relatively infrequently, the period chosen for surveillance must be large enough for an adequate estimation of a hospital s prevalence rate and usually varies depending on the number of occupied beds in a hospital. In addition, these rates require risk adjustment, which is currently not available for interhospital comparison of prevalence rates. 

Epidemiological studies evaluating adverse effects of nosocomial infections indicate that pneumonia is the leading cause of death from infections acquired during the hospital stay. Table 3 summarizes six studies that have reported crude mortality rates of ventilator-associated pneumonia ranging from 33% to 71% (20). 

Mechanieally ventilated patients are exposed to multiple devices and are at particular risk of development of ventilator-associated pneumonia (VAP), the risk of which is proportional to the duration of assisted ventilation (see Table 4). The rates of nosocomial infections may be influenced by the type of intensive care unit in which the patient undergoes treatment, with higher rates observed in surgical intensive care than in medical ICU patients (22,129,130). We examine specific devices that have been associated with NP... 

In intensive care units (ICUs), pneumonia is the most frequent nosocomial infection (1-3) and occurs most often as ventilator-associated pneumonia (VAP) in patients on mechanical ventilation. The overall incidence of VAP in different studies varies between 10% and 85%, depending on the patient population and the criteria used to establish the diagnosis. Ventilator-associated pneumonia has been associated with an attributable mortality rate ranging from 13% to 47% (4-7), although this is not a consistent finding (8-10). 

Nosocomial pneumonias are the second most frequently reported hospital-acquired infection, accounting for 16% to 19% of all nosocomial infections and affecting approximately 300,000 patients in the United States each year (1). The overall or crude mortality rate is 30% (90,000 deaths), and the direct or attributable mortality rate is 10% (30,000 deaths). Therefore, one-third of the deaths are directly due to the pneumonia and two-thirds to the underlying diseases (2). Furthermore, the extra length of hospital stay directly attributable to the pneumonias is estimated to be 9 days (2.7 million patient-days per year in the United States). Thus, morbidity rates, mortality rates, and direct costs are great. For these reasons, prevention of nosocomial pneumonias is clearly of great importance. 

Nosocomial lower respiratory tract infections (LRI) represent a significant concern to those caring for hospitalized infants and children because of both their frequency and their potential severity. Pneumonia is the second most common nosocomial infections in all patients hospitalized in the United States regardless of age (1,2). Data from the National Nosocomial Infections Surveillance (NNIS) System documents that nosocomial pneumonia is the second most frequent hospital-acquired infection in critically ill infants and children as well (2,3). Many of the significant risk factors for the development of nosocomial pneumonia previously identified in adult patients, such as severe underlying cardiopulmonary disease, immunosuppression, depressed sensorium, and prior thoracoabdominal surgery, are present in pediatric patients and place them similarly at risk for nosocomial lower respiratory tract infections. In addition, there are specific clinical situations that are unique for neonatal and pediatric patients that provide additional risks for severe nosocomial lower respiratory tract infections (Table 1). 

Lower respiratory tract infections comprise 6% to 27% of all nosocomial infections detected in a pediatric intensive care setting (3,4,26). The actual frequency of nosocomial pneumonia and tracheitis occurring in hospitalized children varies considerably because of marked differences in patient populations... 

Table 2 Criteria Used by the National Nosocomial Infections Surveillance System to Define Nosocomial Pneumonia...

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 ... 

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