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Nosocomial pneumonia in the 1990s: update of epidemiology and risk factors
D E Craven1, T W Barber, K A Steger
1Department of Medicine, Boston University School of Medicine, Massachusetts 02118.
Abstract:
Hospital-acquired pneumonia is the second most common nosocomial infection in the United States. Aspiration appears to be the major route for the entry of microorganisms into the lower respiratory tract. Nosocomial pneumonia may be caused by bacteria, viruses and fungi. Aerobic gram-negative bacilli and Staphylococcus aureus are the most common etiologic agents, but infection is usually polymicrobial. Risk factors for nosocomial pneumonia include host variables, colonization with nosocomial pathogens, and impaired response of pulmonary defenses to the microbial challenge. Bacteria causing nosocomial pneumonia may be part of the patient's endogenous flora, originate from the hands of hospital personnel, or result from the use of invasive devices. The mechanically ventilated patient has multiple risk factors that contribute to the high rate of nosocomial pneumonia. An understanding of the epidemiology and risk factors for nosocomial pneumonia is fundamental for implementation of preventive strategies to reduce patient morbidity, mortality, and hospital costs.
Insights
Hospital-acquired pneumonia, a common nosocomial infection, is often caused by aspiration of microorganisms. Understanding its risk factors is key to reducing patient harm and healthcare costs.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Hospital Epidemiology
Background:
- Hospital-acquired pneumonia (HAP) is a significant nosocomial infection, frequently originating from lower respiratory tract microbial entry via aspiration.
- Common causative agents include aerobic gram-negative bacilli and Staphylococcus aureus, often leading to polymicrobial infections.
Purpose of the Study:
- To elucidate the epidemiology and risk factors associated with hospital-acquired pneumonia.
- To provide a foundation for developing effective preventive strategies against nosocomial pneumonia.
Main Methods:
- Review of existing literature on the etiology and transmission routes of hospital-acquired pneumonia.
- Analysis of host variables, microbial colonization, and pulmonary defense mechanisms contributing to HAP development.
Main Results:
- Aspiration is identified as the primary route for microbial invasion in HAP.
- Mechanical ventilation presents multiple risk factors, increasing the incidence of nosocomial pneumonia in affected patients.
Conclusions:
- Identifying epidemiological patterns and risk factors for HAP is crucial for implementing targeted preventive measures.
- Effective prevention strategies can decrease patient morbidity, mortality, and associated healthcare expenditures.