Hospital-acquired pneumonia overview: Difference between revisions
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Most nosocomial respiratory infections are caused by so-called skorvatch microaspiration of upper airway secretions, through inapparent [[aspiration]], into the lower respiratory tract. Also, "macroaspirations" of esophageal or gastric material is known to result in HAP. Since it results from aspiration either type is called [[aspiration pneumonia]]. | Most nosocomial respiratory infections are caused by so-called skorvatch microaspiration of upper airway secretions, through inapparent [[aspiration]], into the lower respiratory tract. Also, "macroaspirations" of esophageal or gastric material is known to result in HAP. Since it results from aspiration either type is called [[aspiration pneumonia]]. | ||
Although [[gram-negative bacilli]] are a common cause they are rarely found in the respiratory tract of people without pneumonia, which has led to speculation of the mouth and throat as origin of the infection. | Although [[gram-negative bacilli]] are a common cause they are rarely found in the respiratory tract of people without pneumonia, which has led to speculation of the mouth and throat as origin of the infection. | ||
==Causes== | |||
The majority of cases related to various gram-negative bacilli (52%) and [[S. aureus]] (19%). Others are [[Haemophilus]]spp. (5%). In the ICU results were S. aureus(17.4%), [[P. aeruginosa]] (17.4%), [[Klebsiella pneumoniae]] and[[Enterobacter]] spp. (18.1%), and [[Haemophilus influenzae]] (4.9%). Viruses -[[influenza]] and [[respiratory syncytial virus]] and, in the immunocompromised host, [[cytomegalovirus]]- cause 10-20% of infections. | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 16:30, 5 March 2013
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
American Thoracic Society (ATS) and the Infectious Disease Society of America (IDSA) definitions of Hospital acquired pneumonia, ventilator-associated pneumonia, and health care associated pneumonia [1]
Hospital-acquired pneumonia (HAP)
HAP is defined as pneumonia that occurs 48 hours or more after admission, which was not incubating at the time of admission
Ventilator-associated pneumonia (VAP)
VAP refers to pneumonia that arises more than 48–72 hours after endotracheal intubation. Some patients may require intubation after developing severe HAP and should be managed similar to patients with VAP.
Healthcare-associated pneumonia (HCAP)
HCAP includes any patient who was hospitalized in an acute care hospital for two or more days within 90 days of the infection; resided in a nursing home or long-term care facility; received recent intravenous antibiotic therapy, chemotherapy, or wound care within the past 30 days of the current infection; or attended a hospital or hemodialysis clinic. }}
Pathophysiology
Most nosocomial respiratory infections are caused by so-called skorvatch microaspiration of upper airway secretions, through inapparent aspiration, into the lower respiratory tract. Also, "macroaspirations" of esophageal or gastric material is known to result in HAP. Since it results from aspiration either type is called aspiration pneumonia. Although gram-negative bacilli are a common cause they are rarely found in the respiratory tract of people without pneumonia, which has led to speculation of the mouth and throat as origin of the infection.
Causes
The majority of cases related to various gram-negative bacilli (52%) and S. aureus (19%). Others are Haemophilusspp. (5%). In the ICU results were S. aureus(17.4%), P. aeruginosa (17.4%), Klebsiella pneumoniae andEnterobacter spp. (18.1%), and Haemophilus influenzae (4.9%). Viruses -influenza and respiratory syncytial virus and, in the immunocompromised host, cytomegalovirus- cause 10-20% of infections.
References
- ↑ "Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia". American Journal of Respiratory and Critical Care Medicine. 171 (4): 388–416. 2005. doi:10.1164/rccm.200405-644ST. PMID 15699079. Retrieved 2012-09-12. Unknown parameter
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