Pneumonia prevention

According to the CDC, almost 1.7 million hospital-acquired infections (HAIs) occur yearly, contributing to approximately 99,000 deaths. Such infections were long accepted by clinicians as an inevitable hazard. Recent efforts demonstrate that simple measures can prevent the majority of common infections. Hospitals and providers must work to reduce the burden of these infections. Four specific infections account for more than 80 percent of all hospital-related infections. They are surgical site infections, catheter-associated urinary tract infections, central venous catheter-related bloodstream infections, and ventilator-associated pneumonia. Preventing the transmission of antibiotic-resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) remains an important infection control priority. Effective measures exist to prevent the most common healthcare-related infections. 

Daschner F, Kappstein I, Engels I et al (1988) Stress ulcer prophylaxis and ventilation pneumonia prevention by antibacterial cytoprotective agents Infection Control and Hospital Epidemiol 9 59-65... 

Niederman MS, Craven DE. Devising strategies for nosocomial pneumonia prevention should we ignore the stomach Clin Infect Dis 1997 24 320-323. 

In Vivo Properties. The efficacy of dalbaheptides has been assessed ia various models of experimental septicemia ia mice. In general there was good correlation between the ED qS (effective doses which prevent death ia 50% of test animals) and the MICs on test strains. Teicoplanin was very effective, ED q values ranged from 0.11 to 0.72 mg/kg sc administration for septicemias caused by S. pyogenes S. pneumoniae and S. aureu whereas for vancomycin ED qS were from 0.58 to 7.2 mg/kg (33). Eremomycin (52) had therapeutic activity 2—3 times greater than vancomycin. Therapeutic indices... 

In 1956 selenium was identified (123) as an essential micronutrient iu nutrition. In conjunction with vitamin E, selenium is effective iu the prevention of muscular dystrophy iu animals. Sodium selenite is adrninistered to prevent exudative diathesis iu chicks, a condition iu which fluid leaks out of the tissues white muscle disease iu sheep and infertility iu ewes (see Eeed ADDITIVES). Selenium lessens the iacidence of pneumonia iu lambs and of premature, weak, and stillborn calves controls hepatosis dietetica iu pigs and decreases muscular inflammation iu horses. White muscle disease, widespread iu sheep and cattle of the selenium-deficient areas of New Zealand and the United States, is insignificant iu high selenium soil areas. The supplementation of animal feeds with selenium was approved by the U.S. EDA iu 1974 (see Eeed additives). Much of selenium s metaboHc activity results from its involvement iu the selenoproteia enzyme, glutathione peroxidase. 

Vaccines for special populations are Hsted in Table 2. Two vaccines that are in fairly widespread use in the adult population are vaccines that prevent viral influenza and pneumococcal pneumonia. 

This drug is used cautiously in patients with peripheral vascular disease, neuropathy, chronic pancreatitis, or impaired liver function. Didanosine is a Pregnancy Category B drug and is used cautiously during pregnancy and lactation. There may be a decrease in the effectiveness of dapsone in preventing Pneumocystis carinii pneumonia when didanosine is administered with dapsone Use of didanosine with zalcitabine may cause additive neuropathy. Absorption of didanosine is decreased when it is administered with food. 

Prevention of Hospital-Acquired and Ventilator-Associated Pneumonia... 

Vaccination against hepatitis A and B is recommended in patients with underlying cirrhosis to prevent additional liver damage from an acute viral infection.35 Pneumococcal and influenza vaccination may also be appropriate and can reduce hospitalizations due to influenza or pneumonia. 

Influenza and pneumonia are common preventable infectious diseases that increase mortality and morbidity in persons with chronic diseases including DM.5 Yearly influenza vaccinations, commonly called flu shots, are recommended for patients with DM. Pneumococcal vaccination also is recommended for patients with DM as a one-time vaccination for most patients. 

Prevention of pneumococcal disease by use of vaccination is a national goal Vaccination is used to prevent or minimize the severity of pneumonia caused by S. pneumoniae or the influenza virus. 

Kollef MH. Prevention of hospital-associated pneumonia and ventilator-associated pneumonia. Crit Care Med 2004 32 1396-1405. 

Niederman MS, Mandell LA, Anzueto A, et al. Guidelines for the management of adults with community-acquired pneumonia Diagnosis, assessment of severity, antimicrobial therapy, and prevention. Am J Respir Crit Care Med 2001 163 1730-1754. 

Streptococcus pneumoniae is the most common bacterial cause of community-acquired respiratory tract infections. S. pneumoniae causes approximately 3000 cases of meningitis, 50,000 cases of bacteremia, 500,000 cases of pneumonia, and over 1 million cases of otitis media each year. The increasing prevalence of drug-resistant S. pneumoniae has highlighted the need to prevent infection through vaccination. Both licensed pneumococcal vaccines are highly effective in preventing disease from the common S. pneumoniae serotypes that cause human disease. 

The 23-valent pneumococcal polysaccharide vaccine contains 23 serotypes that are responsible for causing more than 80% of invasive S. pneumoniae infections in adults. The vaccine includes those serotypes that are associated with drug resistance. Use of the vaccine will not prevent the development of antibiotic-resistant S. pneumoniae, but is likely to prevent infection from drug-resistant strains. The 23-valent pneumococcal polysaccharide vaccine has demonstrated good immunogenicity in adults, but an individual will not develop immunity to all 23 serotypes following vaccination.10... 

Trimethoprim-sulmethoxazole is started in all patients with acute leukemia for the prevention of Pneumocystis car-rinii pneumonia. Patients normally continue this therapy for 6 months after completion of treatment. The use of additional antibiotic prophylaxis is not encouraged in all patients with leukemia because of concerns for antibiotic resistance. 

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