Respiratory infections nosocomial

Pennington JE. Nosocomial respiratory infection. In Mandell GL, Douglas RG Jr, Bennett JE, eds. Principles and Practice of Infectious Diseases. 3rd ed. Churchill Livingstone, 1990 2199-2205. 

Johanson WG Jr, Pierce AK, Sanford JP, et al. Nosocomial respiratory infections with gram-negative bacilli. The significance of colonization of the respiratory tract. Ann Intern Med 1972 77 701-706. 

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. 

Pennington JE. Nosocomial respiratory infections. In Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas and Bennett s Principles and Practice of Infectious Disease. 4th ed. New York Churchill Livingstone, 1995 2599-2616. Schleupner CJ, Cobb DK. A study of the etiologies and treatment of nosocomial pneumonia in a community-based teaching hospital. Infect Control Hosp Epidemiol 1992 13 515-525. 

Table 1 Additional Factors that Place Infants and Children at Risk for Nosocomial Respiratory Infections...

Candida species and other yeasts are becoming increasingly important as causes of nosocomial infections in both PICUs and NICUs (2,26). Isolation of these fungi usually occurs in association with other bacteria and in a setting of broad-spectrum antibiotic use. Establishing causation for a nosocomial respiratory infection for an identified yeast is usually difficult. However, it is clear that yeasts are responsible for nosocomial pneumonia in some critically ill children. Endogenous spread of the yeasts from other sites on the child accounts for most of these infections. However, exogenous acquisition from health care provider hands or the environment is likely and may be responsible for initial colonization. 

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. 

Imipenem-cilastatin is effective for a wide variety of infections, including urinary tract and lower respiratory infections intra-abdominal and gynecological infections and skin, soft tissue, bone, and joint infections. The drug combination appears to be especially useful for the treatment of infections caused by cephalosporin-resistant nosocomial bacteria, such as Citrobacter freundii and Enterobacter spp. It would be prudent to use imipenem for empirical treatment of serious infections in hospitalized patients who have recently received other P-lactam antibiotics because of the increased risk of infection with cephalosporin- and/or penicillin-resistant bacteria. Imipenem should not be used as monotherapy for infections owing to P. aeruginosa because of the risk of resistance developing during therapy. 

Eile TJ, Tan J, Thomson RJ, Stephens C, Thompson P. An outbreak of Pseudomonas aeruginosa ventilator-associated respiratory infections due to contaminated food coloring dye—further evidence of the significance of gastric colonization preceding nosocomial pneumonia. Infect Control Hosp Epidemiol 1995 16 417-418. 

Hall CB, Douglas G, Geiman JM, et al. Nosocomial respiratory syncytial virus infections. N Engl J Med 1975 293 1343-1346. 

Valenti WM, Betts RE, Hall CB, Hruska JF, Douglas RGJ. Nosocomial viral infections II. Guidelines for prevention and control of respiratory viruses, herpes viruses, and hepatitis viruses. Infect Control 1981 1 165-178. 

Stoutenbeek CP, van Saene HKF, Miranda DR, Zandstra DF, Langrehr D. The effect of oropharyngeal decontamination using topical nonabsorbable antibiotics on the incidence of nosocomial respiratory tract infections in multiple trauma patients. J Trauma 1987 27 357-364. 

Viruses, also, can be an important and often unappreciated cause of nosocomial pneumonia, causing as many as 20% of endemic nosocomial pneumonia infections (1). Nosocomial respiratory viral infections have exogenous sources and usually follow community outbreaks occurring during particular times of the year (8-15). A number of viruses—adenoviruses, influenza virus. 

In general, the rate of nosocomial infections, including nosocomial respiratory tract infections, varies inversely with age. Hospital-wide nosocomial infection rates (of all types) have been reported as 11.5% for children 23 months of age and younger, 3.6% for children 2 to 4 years of age, and 2.6% for children at least 5 years old (26). Within a pediatric intensive care unit (PICU), nosocomial infection rates were two to three times higher for children 1 month of age or younger compared with children who were at least 2 years old at the time of hospitalization (3). 

The structural configuration of the nasal and oral passageways markedly restrict the access of large particles to the lower respiratory tract. Under normal circumstances, the filtration system of the upper airway and the mucociliary clearance system of the larger airways protect the lower respiratory infection from bacteria that may be present in the patient s environment or that reside in the upper respiratory tract. Nosocomial pneumonia and tracheitis may occur when the mucociliary and cellular defense mechanisms of the lower respiratory tract are evaded. 

Gala CL, Hall CB, Schnabel KC, Pincus PH, Blossom P, Hildreth SW, Betts RE, Douglas RG Jr. The use of eye-nose goggles to control nosocomial respiratory syncytial virus infection. JAMA 1986 256 2706-2708. 

The spectrum of respiratory tract infections (RTI) can vary from the common cold to acute or chronic bronchitis to community-acquired pneumonia to nosocomial pneumonia and aspiration pneumonia to ventilator-associated pneumonia to chronic pneumonia (in cystic fibrosis, histoplasmosis, tuberculosis, etc.). Important complications are lung abscess and pleural empyema that will often need drainage and prolonged antimicrobial treatment (>6 weeks). 

Lower respiratory tract infections IV 400 mg ql2h for 7-14 days. PO 500mgql2hfor 7-14 days (750 mgql2h for 7-14 days for severe or complicated infections). Nosocomial pneumonia IV 400 mg q8h for 10-14 days. 

Serious respiratory tract, skin and skin-structure, gynecologic, hone, joint, intra-abdominal, nosocomial, and polymicrobic Infections UTIs endocarditis septicemia IV... 

Joshi M, Bernstein J, Solomkin J, Wester BA, Kuye O. Piperacillin/tazobactam plus tobramycin versus ceftazidime plus tobramycin for the treatment of patients with nosocomial lower respiratory tract infection. Piperacillin/ Tazobactam Nosocomial Pneumonia Study Group. J Antimicrob Chemother 1999 43(3) 389-97. 

Peloquin CA, Cumbo TJ, Nix DE, et al. Evaluation of intravenous ciprofloxacin in patients with nosocomial lower respiratory tract infections. Arch Intern Med 1989 149 2269-2273. 

---