Hospital-acquired pneumonia overview: Difference between revisions
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==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
Pneumonia is a common illness in all parts of the world. It is a major cause of death among all age groups. Mortality from pneumonia generally decreases with age until late adulthood. Elderly individuals, however, are at particular risk for pneumonia and associated mortality. More cases of pneumonia occur during the winter months than during other times of the year. Pneumonia occurs more commonly in males than females, and more often in Blacks than Caucasians. Individuals with underlying illnesses such as [[Alzheimer's disease]], [[cystic fibrosis]], [[emphysema]], [[tobacco smoking]],[[alcoholism]], or [[immunosuppression|immune system problems]] are at increased risk for pneumonia.<ref name=Almirall>Almirall J, Bolibar I, Balanzo X, Gonzalez CA. Risk factors for community-acquired pneumonia in adults: A population-based case-control study.'' Eur Respir J.'' 1999;13:349. PMID 10065680</ref> These individuals are also more likely to have repeated episodes of pneumonia. People who are hospitalized for any reason are also at high risk for pneumonia. Following [[urinary tract infection]]s, this is the second common cause of [[nosocomial infection]]s, and its prevalence is 15-20% of the total number | Pneumonia is a common illness in all parts of the world. It is a major cause of death among all age groups. Mortality from pneumonia generally decreases with age until late adulthood. Elderly individuals, however, are at particular risk for pneumonia and associated mortality. More cases of pneumonia occur during the winter months than during other times of the year. Pneumonia occurs more commonly in males than females, and more often in Blacks than Caucasians. Individuals with underlying illnesses such as [[Alzheimer's disease]], [[cystic fibrosis]], [[emphysema]], [[tobacco smoking]],[[alcoholism]], or [[immunosuppression|immune system problems]] are at increased risk for pneumonia.<ref name=Almirall>Almirall J, Bolibar I, Balanzo X, Gonzalez CA. Risk factors for community-acquired pneumonia in adults: A population-based case-control study.'' Eur Respir J.'' 1999;13:349. PMID 10065680</ref> These individuals are also more likely to have repeated episodes of pneumonia. People who are hospitalized for any reason are also at high risk for pneumonia. Following [[urinary tract infection]]s, this is the second common cause of [[nosocomial infection]]s, and its prevalence is 15-20% of the total number | ||
==Diagnosis== | |||
===Diagnostic Criteria=== | |||
In hospitalised patient who develop respiratory symptoms and fever one should consider the diagnosis. The likelyhood increases when upon investigation symptoms are found of [[respiratory insufficiency]], purulent secretions, newly developed infiltrate on the [[chest X-Ray]], and increasing [[leucocytosis|leucocyte count]]. If pneumonia is suspected material from sputum or tracheal aspirates are sent to the [[microbiology department]] for cultures. In case of[[pleural effusion]] [[thoracentesis]] is performed for examination of [[pleural fluid]]. In suspected ventilator-associated pneumonia it has been suggested that [[bronchoscopy]]([[BAL]]) is necessary because of the known risks surrounding clinical diagnoses. | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 16:52, 5 March 2013
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Hospital-acquired pneumonia Microchapters |
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Differentiating Hospital-Acquired Pneumonia from other Diseases |
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Diagnosis |
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Treatment |
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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.
Differentiating Hospital-acquired pneumonia from other diseases
Epidemiology and Demographics
Pneumonia is a common illness in all parts of the world. It is a major cause of death among all age groups. Mortality from pneumonia generally decreases with age until late adulthood. Elderly individuals, however, are at particular risk for pneumonia and associated mortality. More cases of pneumonia occur during the winter months than during other times of the year. Pneumonia occurs more commonly in males than females, and more often in Blacks than Caucasians. Individuals with underlying illnesses such as Alzheimer's disease, cystic fibrosis, emphysema, tobacco smoking,alcoholism, or immune system problems are at increased risk for pneumonia.[2] These individuals are also more likely to have repeated episodes of pneumonia. People who are hospitalized for any reason are also at high risk for pneumonia. Following urinary tract infections, this is the second common cause of nosocomial infections, and its prevalence is 15-20% of the total number
Diagnosis
Diagnostic Criteria
In hospitalised patient who develop respiratory symptoms and fever one should consider the diagnosis. The likelyhood increases when upon investigation symptoms are found of respiratory insufficiency, purulent secretions, newly developed infiltrate on the chest X-Ray, and increasing leucocyte count. If pneumonia is suspected material from sputum or tracheal aspirates are sent to the microbiology department for cultures. In case ofpleural effusion thoracentesis is performed for examination of pleural fluid. In suspected ventilator-associated pneumonia it has been suggested that bronchoscopy(BAL) is necessary because of the known risks surrounding clinical diagnoses.
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
|month=ignored (help) - ↑ Almirall J, Bolibar I, Balanzo X, Gonzalez CA. Risk factors for community-acquired pneumonia in adults: A population-based case-control study. Eur Respir J. 1999;13:349. PMID 10065680