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Nosocomial pneumonia in medical intensive care unit
T H Trivedi1, S B Shejale, M E Yeolekar
1Department of Medicine and Intensive Care Unit, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai 22.
Objectives:
This study was undertaken to determine incidence, clinical features, microbiological flora and prognosis of patients with nosocomial pneumonia (NP) in medical intensive care unit (ICU). Also to study impact of comorbid illnesses, intubation and mechanical ventilation on outcome.
Methods:
In this prospective study over a period of one year 89 patients were detected to have nosocomial pneumonia amongst 948 total admissions in ICU. All these 89 patients were investigated radiologically, microbiologically and biochemically. Mortality in these patients was correlated with various factors using chi-square test.
Results:
Incidence of NP was 9.38%. Enteric gram-negative organisms were commonest isolates (61.9%), followed by Staph aureus (29.8%). Sixty five (73%) patients had severe pneumonia, 47 (52.8%) required intubation and 42 (47.2%) mechanical ventilation. Total mortality was 19 out of 89 (21.3%). High mortality was associated with habits like smoking (33.3%), age group over 60 years (27.3%), presence of comorbid illness like DM and COAD (38.5%), complications like ARDS (61.3%, p < 0.001) or sepsis with end organ failure (73.7%, p < 0.001) and need of intubation (36.2%) or mechanical ventilation (40.5%, p < 0.005).
Conclusion:
Nosocomial pneumonias constitute important problem in medical ICU and are associated with high mortality. Patients with advanced age, co-morbid illness, ARDS and end organ failure are at high risk for mortality. However with intensive supportive care and appropriate antibiotics many such lives can be saved.
Insights
Nosocomial pneumonia (NP) in the medical intensive care unit (ICU) affects 9.38% of admissions, with high mortality linked to age, comorbidities, and ventilation. Early intervention and antibiotics can improve outcomes for these critical patients.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Pulmonology
Background:
- Nosocomial pneumonia (NP) is a significant concern in medical intensive care units (ICUs).
- Understanding the incidence, clinical characteristics, and prognostic factors of NP is crucial for patient management.
- The impact of comorbidities and mechanical ventilation on NP outcomes requires further investigation.
Purpose of the Study:
- To determine the incidence, clinical features, microbiological flora, and prognosis of nosocomial pneumonia (NP) in a medical intensive care unit (ICU).
- To evaluate the influence of comorbid illnesses, intubation, and mechanical ventilation on patient outcomes in the ICU.
Main Methods:
- A prospective study was conducted over one year, analyzing 89 patients diagnosed with nosocomial pneumonia among 948 ICU admissions.
- Patients underwent radiological, microbiological, and biochemical investigations.
- Mortality rates were correlated with various factors using the chi-square test.
Main Results:
- The incidence of NP was 9.38%, with enteric gram-negative organisms and Staph aureus being the most common pathogens.
- Severe pneumonia, intubation, and mechanical ventilation were required in 73%, 52.8%, and 47.2% of patients, respectively.
- Overall mortality was 21.3%, with significantly higher mortality observed in patients with smoking habits, advanced age, comorbid conditions (DM, COAD), ARDS, sepsis with end-organ failure, and those requiring intubation or mechanical ventilation.
Conclusions:
- Nosocomial pneumonia presents a substantial challenge in medical ICUs, associated with considerable mortality.
- Advanced age, comorbid illnesses, ARDS, and end-organ failure are identified as high-risk factors for mortality.
- Intensive supportive care and appropriate antibiotic therapy are vital for improving survival rates in patients with nosocomial pneumonia.