Article metrics

  • citations in SCindeks: 0
  • citations in CrossRef:0
  • citations in Google Scholar:[=>]
  • visits in previous 30 days:1
  • full-text downloads in 30 days:1
article: 2 from 3  
Back back to result list
Srpski arhiv za celokupno lekarstvo
2011, vol. 139, iss. 7-8, pp. 476-480
article language: Serbian
document type: Original Paper
doi:10.2298/SARH1108476G


Incidence, risk factors and outcome of nosocomial pneumonia in patients with central nervous system infections
aMedicinski fakultet, Kragujevac + Klinika za infektivne bolesti, Klinički centar, Kragujevac
bMedicinski fakultet, Kragujevac + Centralna biohemijska laboratorija, Klinički centar, Kragujevac
cMedicinski fakultet, Kragujevac + Centar za plućne bolesti, Klinički centar, Kragujevac

e-mail: gaja.kg@open.telekom.rs

Abstract

Introduction. Pneumonia is the most frequent nosocomial infection in intensive care units. The reported frequency varies with definition, the type of hospital or intensive care units and the population of patients. The incidence ranges from 6.8-27%. Objective. The objective of this study was to determine the frequency, risk factors and mortality of nosocomial pneumonia in intensive care patients. Methods. We analyzed retrospectively and prospectively the collected data of 180 patients with central nervous system infections who needed to stay in the intensive care unit for more than 48 hours. This study was conducted from 2003 to 2009 at the Clinical Centre of Kragujevac. Results. During the study period, 54 (30%) patients developed nosocomial pneumonia. The time to develop pneumonia was 10±6 days. We found that the following risk factors for the development of nosocomial pneumonia were statistically significant: age, Glasgow Coma Scale (GCS) score <9, mechanical ventilation, duration of mechanical ventilation, tracheostomy, presence of nasogastric tube and enteral feeding. The most commonly isolated pathogens were Klebsiella-Enterobacter spp. (33.3%), Pseudomonas aeruginosa (24.1%), Acinetobacter spp. (16.6%) and Staphylococcus aureus (25.9%). Conclusion. Nosocomial pneumonia is the major cause of morbidity and mortality of patients with central nervous system infections. Patients on mechanical ventilation are particularly at a high risk. The mortality rate of patients with nosocomial pneumonia was 54.4% and it was five times higher than in patients without pneumonia.

Keywords

References

American Thoracic Society, Infectious Diseases Society of America (2005) Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med, 171(4): 388-416
Augustyn, B. (2007) Ventilator-associated pneumonia: risk factors and prevention. Critical care nurse, 27(4): 32-6, 38-9; quiz 40
Chastre, J., Fagon, J. (2002) Ventilator-associated pneumonia. Am J Respir Crit Care Med, 165(7): 867-903
Cook, D.J., Walter, S.D., Cook, R.J., Griffith, L.E., Guyatt, G.H., Leasa, D., Jaeschke, R.Z., Brun-Buisson, C. (1998) Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Intern Med, 129(6): 433-40
Daubin, C., Vincent, S., Vabret, A., Cheyron, D., Parienti, J., Ramakers, M., Freymuth, F., Charbonneau, P. (2005) Nosocomial viral ventilator-associated pneumonia in the intensive care unit: a prospective cohort study. Intensive care medicine, 31(8): 1116-22
Fartoukh, M., Maitre, B., Honoré, S., Cerf, C., Zahar, J., Brun-Buisson, C. (2003) Diagnosing pneumonia during mechanical ventilation: The clinical pulmonary infection score revisited. American journal of respiratory and critical care medicine, 168(2): 173-9
Gastmeier, P., Sohr, D., Geffers, C., Behnke, M., Rüden, H. (2007) Risk factors for death due to nosocomial infection in intensive care unit patients: findings from the Krankenhaus Infektions Surveillance System. Infection control and hospital epidemiology, 28(4): 466-72
George, D.L., Falk, P.S., Wunderink, R.G., Leeper, K.V., Meduri, G.U., Steere, E.L., Corbett, C.E., Mayhall, C.G. (1998) Epidemiology of ventilator-acquired pneumonia based on protected bronchoscopic sampling. Am J Respir Crit Care Med, 158(6): 1839-47
Georges, H., Leroy, O., Guery, B., Alfandari, S., Beaucaire, G. (2000) Predisposing factors for nosocomial pneumonia in patients receiving mechanical ventilation and requiring tracheotomy. Chest, 118(3): 767-74
Girou, E., Schortgen, F., Delclaux, C., Brun-Buisson, C., Blot, F., Lefort, Y., Lemaire, F., Brochard, L. (2000) Association of noninvasive ventilation with nosocomial infections and survival in critically ill patients. JAMA, 284(18): 2361-7
Heyland, D.K., Cook, D.J., Griffith, L., Keenan, S.P., Brun-Buisson, C. (1999) The attributable morbidity and mortality of ventilator-associated pneumonia in the critically ill patient. The Canadian Critical Trials Group. Am J Respir Crit Care Med, 159(4 Pt 1): 1249-56
Mandell, L.A., Wunderink, R.G., Anzueto, A., Bartlett, J.G., Campbell, G.D., Dean, N.A., i dr. (2007) Infectious diseases society of America/American thoracic society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis, 44(Suppl 2):S27-72
Meric, M., Willke, A., Caglayan, C., Toker, K. (2005) Intensive care unit-acquired infections: incidence, risk factors and associated mortality in a Turkish university hospital. Japanese journal of infectious diseases, 58(5): 297-302
Pennington, J.E. (2000) Nosocomial respiratory infections. in: Mandell G.L., Bennett J.E., Dolin R. [ed.] Principles and practices of infectious diseases, Edinburgh, itd: Churchill-Livingstone, p.3020-8
Rello, J., Paiva, J.A., Baraibar, J., Barcenilla, F., Bodi, M., Castander, D., Correa, H., Diaz, E., Garnacho, J., Llorio, M., Rios, M., Rodriguez, A., Sole-Violan, J. (2001) International Conference for the Development of Consensus on the Diagnosis and Treatment of Ventilator-associated Pneumonia. Chest, 120(3): 955-70
Rello, J., Diaz, E. (2003) Pneumonia in the intensive care unit. Critical care medicine, 31(10): 2544-51
Richards, M.J., Edwards, J.R., Culver, D.H., Gaynes, R.P. (1999) Nosocomial infections in medical intensive care units in the United States. National Nosocomial Infections Surveillance System. Crit Care Med, 27(5): 887-92
Richards, M.J., Edwards, J.R., Culver, D.H., Gaynes, R.P. (2000) Nosocomial infections in combined medical-surgical intensive care units in the United States. Infect Control Hosp Epidemiol, 21(8): 510-5
Safdar, N., Dezfulian, C., Collard, H.R., Saint, S. (2005) Clinical and economic consequences of ventilator-associated pneumonia: A systematic review. Critical care medicine, 33(10): 2184-93
Vanhems, P., Lepape, A., Savey, A., Jambou, P., Fabry, J. (2000) Nosocomial pulmonary infection by antimicrobial-resistant bacteria of patients hospitalized in intensive care units: Risk factors and survival. Journal of hospital infection, 45(2): 98-106
Vincent, J.L., Bihari, D.J., Suter, P.M., Bruining, H.A., White, J., Nicolas-Chanoin, M.H., Wolff, M., Spencer, R.C., Hemmer, M. (1995) The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA, 274(8): 639-44