Nosocomial pneumonia mortality

Prophylaxis of stress ulceration in intensive care units is the major interest to the anaesthetist. Here, it is given in a dose of 1 g every 6 hours via nasogastric tube. Several studies have shown sucralfate to be comparable in efficacy to H2 blockers. It has been claimed, but not proved, to result in a reduction in morbidity and mortality from nosocomial pneumonias in comparison to H2 antagonists. The latter, by raising gastric pH, eliminate the acid barrier to colonisation of the gut by pathogens, which sucralfate does not do. 

Craig CP, Connelly S. Effect of intensive care unit nosocomial pneumonia on duration of stay and mortality. Am J Infect Control 1984 12 233-238. 

Fagon JY, Chastre J, Hance AJ, Montravers P, Novara A, Gibert C. Nosocomial pneumonia in ventilated patients. A cohort study evaluating attributable mortality and hospital stay. Am J Med 1993 94 281-288. 

Fagon JY, Chastre J, Vuagnat A, et al. Nosocomial pneumonia and mortality among patients in intensive care units. JAMA 1996 275 866-869. 

VI. MORBIDITY AND MORTALITY ASSOCIATED WITH NOSOCOMIAL PNEUMONIA... 

Besides the role of pathogens, worsening of respiratory failure caused by nosocomial pneumonia, presence of shock, and an inappropriate antibiotic treatment were associated with higher fatality rate (22). The attributable mortality rate of nosocomial pneumonia is still not known from most of these studies, because of the well-known relationship between severity of illness and pneumonia. In addition, it is difficult to establish whether such critically ill patients would have survived if nosocomial pneumonia had not occurred (9,23). However, more recent studies have further clarified the influence of nosocomial pneumonia on death. Fagon et al. reported that the mortality rate attributable to nosocomial pneumonia exceeded 25%, corresponding to a relative risk of death equal to 2.0, (respectively 40% and 2.5 in cases of pneumonia caused by Pseudomonas or Acinetobacter species) (24). Bueno-Cavanillas supported these results by reporting that the risk of mortality was almost three times higher in patients with pneumonia than in noninfected patients (relative risk 2.95 Cl 95, 1.73-5.03) (25). 

Nosocomial pneumonia (NP) is defined as an infection of lung parenchyma that was neither present nor incubating at the time of hospital admission. As the second most frequent hospital-acquired infection in the United States, NP accounts for approximately 15% of aU hospital-associated infections (1,2). Despite improvements in diagnosis and treatment, the associated mortality and morbidity rates remain high and related costs have been estimated to be about 1.2 bilUon per year (3). 

Deppe SA, Kelly JW, Thoi LL, Chudy JH, Longfield RN, Ducey JP, et al. Incidence of colonization, nosocomial pneumonia, and mortality in critically ill patients using a Trach Care closed-suction system versus an open-suction system a prospective, randomized study. Crit Care Med 1990 18 1389-1394. 

Because S. pneumoniae and influenza viruses contribute to the morbidity and mortality associated with nosocomial pneumonia and vaccines against these infections are available and recommended for routine use in those at highest risk, this chapter focuses on use of vaccines against these diseases and... 

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 pneumonia continues to be a significant cause of morbidity and mortality among hospitalized patients. In recent years, nosocomial pneumonia has become the second most frequently occurring nosocomial infection (after that of the urinary tract) in U.S. hospitals. Factors contributing to the increased occurrence of nosocomial pneumonia include increased severity of illness in hospitalized patients and the rapidly increasing complexity of medical technology. 

Ps. aeruginosa is a frequent cause of nosocomial pneumonia as well as a Sequent pathogen isolated from sputa in patients with bronchiectasis or cystic fibrosis (105). Moreover, gram-negative nosocomial pneumonia has a 30-50% mortality... 

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... 

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). 

Gouin F, Bregeon F, Thirion X, Saux P, Denis JP, Papazian L. Ventilator-associated pneumonia and mortality (abstr). 35th Interscience Conference on Antimicrobial Agents and Chemotherapy, San Francisco 1995 1119 278. Johanson WGJ, Pierce AK, Sanford J, Thomas GD. Nosocomial respiratory infections with gram-negative bacilli the significance of colonization of the respiratory tract. Ann Intern Med 1972 77 701-706. 

Similar to cases with P. aeruginosa, nosocomial ventilator-associated pneumonia caused by Acinetobacter is associated with a high mortality rate. In a study of 48 patients (70), pneumonia caused by these two organisms have a mortality rate of 71.4% compared to other pathogens (40.7%), with the observation that this rate was in excess of that observed for the underlying disease however, the impact of antimicrobial therapy was not discussed. 

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). 

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