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Therapy of nosocomial infections: past, present and future trends
Abstract:
There has been a significant increase in the number of bacteremias sustained by hospitalized patients over the past 45 years. Responsible bacterial flora has shifted from streptococcal to staphylococcal to gram-negative. Simultaneously, the patient population has become significantly older. Two types of nosocomial infection are reviewed in this clinical setting. Pneumococcal disease still accounts for 10% of nosocomial pneumonias and 5-10% of nosocomial bacteremias. Antimicrobial therapy, although effective, has not eliminated mortality, particularly among older patients with one or more underlying diseases. Vaccination with pneumonococcal polysaccharide vaccine may reduce the morbidity and mortality associated with this infectious process. Several Pseudomonas vaccines have been evaluated, but none has proven both efficacious and non-toxic. Further development of a gram-negative vaccine, preferably one which protects against several types of bacteria, is required.
Insights
Hospitalized patients face rising bacteremia rates, with a shift towards gram-negative bacteria. Vaccines for pneumococcal disease and gram-negative infections are crucial for reducing mortality in aging populations.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Vaccinology
Background:
- Hospital-acquired infections (bacteremias) have increased significantly over 45 years.
- The predominant bacteria causing bacteremia have shifted from streptococcal to staphylococcal and now to gram-negative organisms.
- The patient population in hospitals has aged considerably during this period.
Purpose of the Study:
- To review nosocomial infections in a clinical setting.
- To discuss the impact of changing bacterial flora and patient demographics on infection rates and outcomes.
- To evaluate current and potential vaccination strategies for preventing key nosocomial infections.
Main Methods:
- Review of clinical data on nosocomial infections.
- Analysis of trends in bacterial pathogens and patient populations.
- Evaluation of existing and experimental vaccine efficacy.
Main Results:
- Pneumococcal disease remains a significant cause of nosocomial pneumonia and bacteremia.
- Antimicrobial therapy has not eradicated mortality, especially in older patients with comorbidities.
- Current Pseudomonas vaccines have not been both effective and safe; a broad-spectrum gram-negative vaccine is needed.
Conclusions:
- Pneumococcal polysaccharide vaccine may decrease morbidity and mortality from pneumococcal disease.
- Development of an effective, non-toxic gram-negative vaccine is a priority.
- Addressing the evolving landscape of hospital-acquired bacteremias requires continued research and improved preventative measures, including vaccination.