Current Infectious Disease Reports

, Volume 11, Issue 5, pp 349–356 | Cite as

Severe hospital-acquired pneumonia: A review for clinicians

Article
First Online:

Abstract

Hospital-acquired pneumonia (HAP) is one of the most commonly encountered nosocomial infections. Patients who develop severe HAP experience considerable morbidity and mortality, and the condition results in a substantial expenditure of health care resources. A large body of scientific literature about HAP now exists. This article summarizes the current state of knowledge concerning severe HAP with an emphasis on recent advances in its diagnosis, treatment, and prevention.

Keywords

Selective Digestive Decontamination Infect Control Hosp National Healthcare Safety Network Subglottic Secretion Curr Opin Infect 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    American Thoracic Society and Infectious Diseases Society of America: Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005, 171:388–416.CrossRefGoogle Scholar
  2. 2.
    Anand N, Kollef MH: The alphabet soup of pneumonia: CAP, HAP, HCAP, NHAP, and VAP. Semin Respir Crit Care Med 2009, 30:3–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Gastmeier P, Sohr D, Geffers C, et al.: Risk factors for death due to nosocomial infection in intensive care unit patients: findings from the Krankenhaus Infektions Surveillance System. Infect Control Hosp Epidemiol 2007, 28:466–472.PubMedCrossRefGoogle Scholar
  4. 4.
    Venditti M, Falcone M, Corrao S, et al.: Outcomes of patients hospitalized with community-acquired, health care-associated, and hospital-acquired pneumonia. Ann Intern Med 2009, 150:19–26.PubMedGoogle Scholar
  5. 5.
    Ramirez P, Ferrer M, Torres A: Prevention measures for ventilator-associated pneumonia: a new focus on the endotracheal tube. Curr Opin Infect Dis 2007, 20:190–197.PubMedCrossRefGoogle Scholar
  6. 6.
    Pneumatikos IA, Dragoumanis CK, Bouros DE: Ventilator-associated pneumonia or endotracheal tube-associated pneumonia? An approach to the pathogenesis and preventive strategies emphasizing the importance of endotracheal tube. Anesthesiology 2009, 110:673–680.PubMedCrossRefGoogle Scholar
  7. 7.
    Stewart PS, Costerton JW: Antibiotic resistance of bacteria in biofilms. Lancet 2001, 358:135–138.PubMedCrossRefGoogle Scholar
  8. 8.
    Safdar N, Dezfulian C, Collard HR, et al.: Clinical and economic consequences of ventilator-associated pneumonia: a systematic review. Crit Care Med 2005, 33:2184–2193.PubMedCrossRefGoogle Scholar
  9. 9.
    Weber DJ, Rutala WA, Sickbert-Bennett EE, et al.: Microbiology of ventilator-associated pneumonia compared with that of hospital-acquired pneumonia. Infect Control Hosp Epidemiol 2007, 28:825–831.PubMedCrossRefGoogle Scholar
  10. 10.
    Chastre J, Fagon JY: Ventilator-associated pneumonia. Am J Respir Crit Care Med 2002, 165:867–903.PubMedGoogle Scholar
  11. 11.
    Centers for Disease Control and Prevention National Healthcare Safety Network (NHSN): Antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the NHSN at CDC, 2006–2007. Available at http://www.cdc.gov/nhsn/dataStat.html. Accessed June 2009.
  12. 12.
    Walkey AJ, Reardon CC, Sulis CA, et al.: Epidemiology of ventilator-associated pneumonia in a long-term acute care hospital. Infect Control Hosp Epidemiol 2009, 30:319–324.PubMedCrossRefGoogle Scholar
  13. 13.
    Luyt CE, Combes A, Nieszkowska A, et al.: Viral infections in the ICU. Curr Opin Crit Care 2008, 14:605–608.PubMedCrossRefGoogle Scholar
  14. 14.
    Vincent A, La Scola B, Forel JM, et al.: Clinical significance of a positive serology for mimivirus in patients presenting a suspicion of ventilator-associated pneumonia. Crit Care Med 2009, 37:111–118.PubMedCrossRefGoogle Scholar
  15. 15.
    Delisle MS, Williamson DR, Perreault MM, et al.: The clinical significance of Candida colonization of respiratory tract secretions in critically ill patients. J Crit Care 2008, 23:11–17.PubMedCrossRefGoogle Scholar
  16. 16.
    Roux D, Gaudry S, Dreyfuss D, et al.: Candida albicans impairs macrophage function and facilitates Pseudomonas aeruginosa pneumonia in rat. Crit Care Med 2009, 37:1062–1067.PubMedCrossRefGoogle Scholar
  17. 17.
    Nseir S, Jozefowicz E, Cavestri B, et al.: Impact of antifungal treatment on Candida-Pseudomonas interaction: a preliminary retrospective case-control study. Intensive Care Med 2007, 33:137–142.PubMedCrossRefGoogle Scholar
  18. 18.
    Morris AC, Kefala K, Simpson AJ, et al.: Evaluation of diagnostic methodology on the reported incidence of ventilator-associated pneumonia. Thorax 2009, 64:516–522.PubMedCrossRefGoogle Scholar
  19. 19.
    Kollef MH, Kollef KE: Antibiotic utilization and outcomes for patients with clinically suspected ventilator-associated pneumonia and negative quantitative BAL culture results. Chest 2005, 128:2706–2713.PubMedCrossRefGoogle Scholar
  20. 20.
    Rosbolt MB, Sterling ES, Fahy BG: The utility of the clinical pulmonary infection score. J Intensive Care Med 2009, 24:26–34.PubMedCrossRefGoogle Scholar
  21. 21.
    Rea-Neto A, Youssef NC, Tuche F, et al.: Diagnosis of ventilator-associated pneumonia: a systematic review of the literature. Crit Care 2008, 12:R56.PubMedCrossRefGoogle Scholar
  22. 22.
    Christ-Crain M, Stolz D, Bingisser R, et al.: Procalcitonin guidance of antibiotic therapy in community-acquired pneumonia: a randomized trial. Am J Respir Crit Care Med 2006, 174:84–93.PubMedCrossRefGoogle Scholar
  23. 23.
    Nachtigall I, Tamarkin A, Tafelski S, et al.: Impact of adherence to standard operating procedures for pneumonia on outcome of intensive care unit patients. Crit Care Med 2009, 37:159–166.PubMedCrossRefGoogle Scholar
  24. 24.
    Torres A, Ewig S, Lode H, et al.: Defining, treating and preventing hospital acquired pneumonia: European perspective. Intensive Care Med 2009, 35:9–29.PubMedCrossRefGoogle Scholar
  25. 25.
    Song JH; Asian Hospital Acquired Pneumonia Working Group: Treatment recommendations of hospital-acquired pneumonia in Asian countries: first consensus report by the Asian HAP Working Group. Am J Infect Control 2008, 36(4 Suppl):S83–S92.PubMedCrossRefGoogle Scholar
  26. 26.
    Masterton RG, Galloway A, French G, et al.: Guidelines for the management of hospital-acquired pneumonia in the UK: report of the working party on hospital-acquired pneumonia of the British Society for Antimicrobial Chemotherapy. J Antimicrob Chemother 2008, 62:5–34.PubMedCrossRefGoogle Scholar
  27. 27.
    Muscedere J, Dodek P, Keenan S, et al.: Comprehensive evidence-based clinical practice guidelines for ventilator-associated pneumonia: diagnosis and treatment. J Crit Care 2008, 23:138–147.PubMedCrossRefGoogle Scholar
  28. 28.
    Beardsley JR, Williamson JC, Johnson JW, et al.: Using local microbiologic data to develop institution-specific guidelines for the treatment of hospital-acquired pneumonia. Chest 2006, 130:787–793.PubMedCrossRefGoogle Scholar
  29. 29.
    Kollef KE, Schramm GE, Wills AR, et al.: Predictors of 30-day mortality and hospital costs in patients with ventilator-associated pneumonia attributed to potentially antibiotic-resistant gram-negative bacteria. Chest 2008, 134:281–287.PubMedCrossRefGoogle Scholar
  30. 30.
    Dennesen PJ, van der Ven AJ, Kessels AG, et al.: Resolution of infectious parameters after antimicrobial therapy in patients with ventilator-associated pneumonia. Am J Respir Crit Care Med 2001, 163:1371–1375.PubMedGoogle Scholar
  31. 31.
    Chastre J, Wolff M, Fagon JY, et al.: Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial. JAMA 2003, 290:2588–2598.PubMedCrossRefGoogle Scholar
  32. 32.
    Micek ST, Ward S, Fraser VJ, et al.: A randomized controlled trial of an antibiotic discontinuation policy for clinically suspected ventilator-associated pneumonia. Chest 2004, 125:1791–1799.PubMedCrossRefGoogle Scholar
  33. 33.
    Nseir S, Deplanque X, Di Pompeo C, et al.: Risk factors for relapse of ventilator-associated pneumonia related to nonfermenting Gram negative bacilli: a case-control study. J Infect 2008, 56:319–325.PubMedCrossRefGoogle Scholar
  34. 34.
    Joffe AR, Muscedere J, Marshall JC, et al.: The safety of targeted antibiotic therapy for ventilator-associated pneumonia: a multicenter observational study. J Crit Care 2008, 23:82–90.PubMedCrossRefGoogle Scholar
  35. 35.
    Roberts JA, Lipman J, Blot S, et al.: Better outcomes through continuous infusion of time-dependent antibiotics to critically ill patients? Curr Opin Crit Care 2008, 14:390–396.PubMedCrossRefGoogle Scholar
  36. 36.
    Hallal A, Cohn SM, Namias N, et al.: Aerosolized tobramycin in the treatment of ventilator-associated pneumonia: a pilot study. Surg Infect (Larchmt) 2007, 8:73–82.CrossRefGoogle Scholar
  37. 37.
    Michalopoulos A, Fotakis D, Virtzili S, et al.: Aerosolized colistin as adjunctive treatment of ventilator-associated pneumonia due to multidrug-resistant Gram-negative bacteria: a prospective study. Respir Med 2008, 102:407–412.PubMedCrossRefGoogle Scholar
  38. 38.
    Palmer LB, Smaldone GC, Chen JJ, et al.: Aerosolized antibiotics and ventilator-associated tracheobronchitis in the intensive care unit. Crit Care Med 2008, 36:2008–2013.PubMedCrossRefGoogle Scholar
  39. 39.
    Muscedere J, Dodek P, Keenan S, et al.: Comprehensive evidence-based clinical practice guidelines for ventilator-associated pneumonia: prevention. J Crit Care 2008, 23:126–137.PubMedCrossRefGoogle Scholar
  40. 40.
    Coffin SE, Klompas M, Classen D, et al.: Strategies to prevent ventilator-associated pneumonia in acute care hospitals. Infect Control Hosp Epidemiol 2008, 29(Suppl 1):S31–S40.PubMedCrossRefGoogle Scholar
  41. 41.
    de Smet AM, Kluytmans JA, Cooper BS, et al.: Decontamination of the digestive tract and oropharynx in ICU patients. N Engl J Med 2009, 360:20–31.PubMedCrossRefGoogle Scholar
  42. 42.
    Dezfulian C, Shojania K, Collard HR, et al.: Subglottic secretion drainage for preventing ventilator-associated pneumonia: a meta-analysis. Am J Med 2005, 118:11–18.PubMedCrossRefGoogle Scholar
  43. 43.
    Bouza E, Perez MJ, Munoz P, et al.: Continuous aspiration of subglottic secretions in the prevention of ventilator-associated pneumonia in the postoperative period of major heart surgery. Chest 2008, 134:938–946.PubMedCrossRefGoogle Scholar
  44. 44.
    Kollef MH, Afessa B, Anzueto A, et al.: Silver-coated endotracheal tubes and incidence of ventilator-associated pneumonia: the NASCENT randomized trial. JAMA 2008, 300:805–813.PubMedCrossRefGoogle Scholar
  45. 45.
    Craven DE, Chroneou A, Zias N, et al.: Ventilator-associated tracheobronchitis: the impact of targeted antibiotic therapy on patient outcomes. Chest 2009, 135:521–528.PubMedCrossRefGoogle Scholar
  46. 46.
    Nseir S, Favory R, Jozefowicz E, et al.: Antimicrobial treatment for ventilator-associated tracheobronchitis: a randomized, controlled, multicenter study. Crit Care 2008, 12:R62.PubMedCrossRefGoogle Scholar
  47. 47.
    Griffiths J, Barber VS, Morgan L, et al.: Systematic review and meta-analysis of studies of the timing of tracheostomy in adult patients undergoing artificial ventilation. BMJ 2005, 330:1243.PubMedCrossRefGoogle Scholar
  48. 48.
    Blot F, Similowski T, Trouillet JL, et al.: Early tracheotomy versus prolonged endotracheal intubation in unselected severely ill ICU patients. Intensive Care Med 2008, 34:1779–1787.PubMedCrossRefGoogle Scholar
  49. 49.
    Nseir S, Di Pompeo C, Jozefowicz E, et al.: Relationship between tracheotomy and ventilator-associated pneumonia: a case control study. Eur Respir J 2007, 30:314–320.PubMedCrossRefGoogle Scholar
  50. 50.
    Wip C, Napolitano L: Bundles to prevent ventilator-associated pneumonia: how valuable are they? Curr Opin Infect Dis 2009, 22:159–166.PubMedCrossRefGoogle Scholar
  51. 51.
    Krein SL, Kowalski CP, Damschroder L, et al.: Preventing ventilator-associated pneumonia in the United States: a multicenter mixed-methods study. Infect Control Hosp Epidemiol 2008, 29:933–940.PubMedCrossRefGoogle Scholar

Copyright information

© Current Medicine Group, LLC 2009

Authors and Affiliations

  1. 1.Division of Pulmonary and Critical Care MedicineWashington University School of MedicineSt. LouisUSA

Personalised recommendations