Onset Nosocomial Pneumonia

Data from the National Nosocomial Infection Surveillance System (NNIS), Centers for Disease Control and Prevention (CDC) Ifom January 1986 through April 1997 report that S. aureus and P. aeruginosa each accounted for about 

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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 

Once cultures and sensitivity testing results become available, the antibiotic regimen is then modified to improve cost-benefits, enhance outcome, reduce toxicity from unnecessary drug exposure, and discourage the emergence of multidrug-resistant bacteria within a hospital environment. 

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Community-acquired pneumonia Health care-associated, ventilator-asociated, or nosocomial pneumonia (Early onset no risk factors for MDR pathogens) Third-generation cephalosporin plus a macrolide or doxycycline Third-generation cephalosporin OR Fluoroquinolone OR Ampicillin-sulbactam OR Ertapenem... 

Health care-associated, ventilator-associated, or nosocomial pneumonia (Late onset and/or MDR pathogen risk factors) Antipseudomonal penicillin OR Antipseudomonal cephalosporin OR Antipseudomonal carbapenem plus Aminoglycoside OR Antipseudomonal fluoroquinolone plus Vancomycin or linezolid... 

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

Once the diagnosis of nosocomial pneumonia has been established, several important factors must be considered before a rational empirical antimicrobial regimen can be chosen. These include severity of illness and comorbid conditions of the patient, prior antibiotic use, early versus late onset of infection, results of the sputum Gram s stain, and the resident flora profile of the institution, particularly in the intensive care unit (Table 1). Empirical antimicrobial therapy for nosocomial pneumonia in a ventilated patient with renal failure in whom multiple intra-abdominal abscesses develop following colon resection is very different from the patient who aspirates following an otherwise uncomplicated cholecystectomy. 

The use of antibiotics to prevent NP in susceptible patients is controversial. Clearly, some antibiotics have had a role in reducing colonization with early onset pathogens such as S. pneumoniae and H. influenzae (14,22,34,102). Thus, although broad-spectrum antibiotics, such as cephalosporins, may decrease the risk of early onset HAP, they may, in turn, increase the prevalence of colonization and infection resulting from nosocomial, MDR pathogens (10,22,34,102). 

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