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Hospital acquired pneumonia in the medical intensive care unit--a prospective study
A E Stebbings1, T Y Ti, W C Tan
1Division of Respiratory Medicine, National University Hospital, Singapore.
Aim Of Study:
The aim of the study was to define the prevalence, risk factors, spectrum of organisms and sensitivity patterns, and the outcome in patients with severe hospital acquired pneumonia (HAP) in the Medical Intensive Care Unit (SCU) in a hospital in Singapore.
Method:
Consecutive patients admitted to the MICU over a 6-month period were studied and assessed daily to determine whether patients had developed HAP based on defined clinical criteria. Sputum or endotracheal aspirate was obtained and results recorded from each patient on admission and every subsequent three days throughout the stay in the MICU. Mortality during hospital stay was the main outcome measure recorded.
Results:
A total of 136 patients (150 admissions) were studied; 24 patients were identified as having HAP. The prevalence of HAP was 17% [both ventilator-associated pneumonia (VAP) and pneumonia acquired from the ward (WAP)]. Cerebral disease was the main risk factor for VAP (OR 4.94, 95% CI 1.33-18.4). The spectrum of organisms which caused HAP were polymicrobial, Klebsiella pneumoniae, Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus and coagulase negative Staphylococcus. The mortality of patients with VAP and WAP were 72.7% and 76.9% respectively.
Conclusion:
This study concludes that HAP in the MICU is common with a high mortality. The spectrum of organisms was comparable to previous studies.
Insights
Hospital-acquired pneumonia (HAP) is common in Singapore
Area of Science:
- Medical Research
- Infectious Diseases
- Critical Care Medicine
Background:
- Hospital-acquired pneumonia (HAP) poses a significant threat in intensive care settings.
- Understanding HAP's prevalence, risk factors, and causative agents is crucial for effective management.
Purpose of the Study:
- To determine the prevalence, risk factors, microbial spectrum, and outcomes of severe HAP in a Singaporean Medical Intensive Care Unit (MICU).
Main Methods:
- A 6-month prospective study of consecutive MICU admissions.
- Daily assessment for HAP development using defined clinical criteria.
- Microbiological analysis of respiratory samples and recording of in-hospital mortality.
Main Results:
- HAP prevalence was 17% (including ventilator-associated pneumonia [VAP] and ward-acquired pneumonia [WAP]).
- Cerebral disease was a key risk factor for VAP.
- Common pathogens included Klebsiella pneumoniae, Pseudomonas aeruginosa, and resistant Staphylococcus strains; mortality rates for VAP and WAP were high (72.7% and 76.9%).
Conclusions:
- HAP is a frequent and highly fatal condition in the MICU.
- The identified microbial spectrum aligns with previous research, emphasizing the need for targeted interventions.