Skip to main content

Respiratory tract colonization and incidence of secondary infection during hospital treatment of community-acquired pneumonia

European Journal of Clinical Microbiology and Infectious Diseases volume 9, pages 725–731 (1990)Cite this article

Abstract

In a prospective study of 245 patients with community-acquired pneumonia, the respiratory tract of 93 patients (38 %) became colonized during hospitalization. Gram-negative rods andCandida spp. predominated, and in more than 75 % of cases colonization occurred within 72 h after admission. Multivariate analysis showed that colonization was significantly associated with increasing age, presence of chronic disease, and with decreasing serum albumin and a respiratory rate of >30/min on admission. Colonization was a negative prognostic factor, associated with a 14-fold higher mortality (10 % vs. 0.7 %), doubled length of hospital stay and a slower recovery. Seventeen patients developed a secondary infection. However, only two had lower respiratory tract infection, and one (0.4 %) pneumonia verified by X-ray. The previously reported high risk of respiratory superinfection in this category of patient does not seem to apply today.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. Johanson WG: Prevention of respiratory tract infection. American Journal of Medicine 1984, 76: 69–77.

    Article  Google Scholar 

  2. Craven DE, Driks MR: Nosocomial pneumonia in the incubated patient. Seminars in Respiratory Infections 1987, 2: 20–33.

    PubMed  Google Scholar 

  3. Pugliese G, Lichtenberg DA: Nosocomial bacterial pneumonia: an overview. American Journal of Infection Control 1987, 15: 249–265.

    Article  PubMed  Google Scholar 

  4. Pennington JE: Hospital-acquired pneumonia. In: Pennington JE (ed): Respiratory infections: diagnosis and management. Raven Press, New York, 1989, p. 171–186.

    Google Scholar 

  5. Johanson WG, Pierce AK, Sanford JP: Changing pharyngeal bacterial flora of hospitalized patients. New England Journal of Medicine 1969, 281: 1137–1140.

    PubMed  Google Scholar 

  6. Tillotson JR, Finland M: Bacterial colonization and clinical superinfection of the respiratory tract complicating antibiotic treatment of pneumonia. Journal of Infectious Diseases 1969, 119: 597–624.

    PubMed  Google Scholar 

  7. Johanson WG, Pierce AK, Sanford JP, Thomas GD: Nosocomial respiratory infections with gramnegative bacilli. Annals of Internal Medicine 1972, 77: 701–706.

    PubMed  Google Scholar 

  8. Valenti WM, Trudell RG, Bentley DW: Factors predisposing to oropharyngeal colonization with gram-negative bacilli in the aged. New England Journal of Medicine 1978, 298: 1108–1111.

    PubMed  Google Scholar 

  9. Louria DB, Kaminski T: The effects of four antimicrobial drug regimens on sputum superinfection in hospitalized patients. American Review of Respiratory Diseases 1962, 85: 649–665.

    Google Scholar 

  10. Saito A, Mori Y, Shigeno K, Yamaguchi K, Hara K: Respiratory superinfections after the use of third-generation cephem antibiotics. Infection 1985, 13, Supplement 1: 89–95.

    Article  PubMed  Google Scholar 

  11. Odds FC: Candida and candidosis. Baillière Tindall, London, 1988, p. 72–74.

    Google Scholar 

  12. Odds FC: Candida and candidosis. Baillière Tindall, London, 1988, p. 94–105.

    Google Scholar 

  13. Weinstein L, Brown RB: Colonization, suprainfection and superinfection: major microbiologic and clinical problems. Mount Sinai Journal of Medicine New York 1977, 44: 100–112.

    Google Scholar 

  14. Salata RA, Ellner JJ: Bacterial colonization of the tracheobronchial tree. Clinics in Chest Medicine 1988, 9: 623–633.

    PubMed  Google Scholar 

  15. Brewin A, Arango L, Hadley K, Murray JF: High-dose penicillin therapy and pneumococcal pneumonia. Journal of the American Medical Association 1974, 230: 409–413.

    Article  PubMed  Google Scholar 

  16. Örtqvist Å, Kalin M, Lejdeborn L, Lundberg B: Diagnostic fiberoptic bronchoscopy and protected brush culture in patients with community-acquired pneumonia. Chest 1990, 97: 576–582.

    PubMed  Google Scholar 

  17. Kalin M, Lindberg AA, Tunevall G: Etiological diagnosis of bacterial pneumonia by Gram stain and quantitative culture of expectorates. Scandinavian Journal of Infectious Diseases 1983, 15: 153–160.

    PubMed  Google Scholar 

  18. Kalin M, Lindberg AA, Olausson EH: Diagnosis of pneumococcal pneumonia by coagglutination and counterimmuno-electrophoresis of sputum samples. European Journal of Clinical Microbiology 1982, 1: 91–96.

    Article  PubMed  Google Scholar 

  19. Jalonen E, Paton JC, Koskela M, Kerttula Y, Leinonen M: Measurements of antibody responses to pneumolysin — a promising method for the presumptive aetiological diagnosis of pneumococcal pneumonia. Journal of Infection 1989, 19: 127–134.

    Article  PubMed  Google Scholar 

  20. Nordström K, Kallings I, Dansjö H, Clemens F: An outbreak of Legionnaires' disease in Sweden: report of sixty-eight cases. Scandinavian Journal of Infectious Diseases 1983, 15: 43–55.

    PubMed  Google Scholar 

  21. Wang SP, Grayston JT: Immunologic relationship between genital TRIC, lymphogranuloma venereum, and related organisms in a new microtiter indirect immunofluorescence test. American Journal of Ophthalmology 1970, 70: 367–374.

    PubMed  Google Scholar 

  22. Evaldson G, Blomberg I, Grillner L, Nord CE, Weintraub A: The role of immunoglobulins in amniotic fluid growth inhibition ofBacteroides fragilis, herpes simplex, coxsackie B5 and cytomegalovirus. Medical Microbiology and Immunology 1983, 172: 155–160.

    Article  PubMed  Google Scholar 

  23. Garner JS, Jarvis R, Emori TG, Horan TC, Hughes JM: CDC definitions for nosocomial infections, 1988. American Journal of Infection Control 1988, 16: 128–140.

    PubMed  Google Scholar 

  24. Harrison BDW, Farr BM, Pugh S, Selkon JB, Prescott RJ, Conolly CK: Community-acquired pneumonia in adults in British hospitals 1982–1983: a survey of aetiology, mortality, prognostic factors and outcome. Quarterly Journal of Medicine 1987, 62: 195–220.

    PubMed  Google Scholar 

  25. Dixon WJ: BMDP statistical software. University of California Press, Berkeley, 1985.

    Google Scholar 

  26. Niederman MS, Merril WW, Feeranti RD, Pagano KM, Palmer LB, Reynolds HY: Nutritional status and bacterial binding in the lower respiratory tract in patients with chronic tracheostomy. Annals of Internal Medicine 1984, 100: 795–800.

    PubMed  Google Scholar 

  27. Niederman MS, Mantovani R, Scoch P, Papas J, Fein AM: Patterns and routes of tracheobronchial colonization in mechanically ventilated patients. The role of nutritional status in colonization of the lower airway byPseudomonas species. Chest 1989, 95: 155–161.

    PubMed  Google Scholar 

  28. Louria DB, Brayton RG: The efficacy of penicillin regimens. Journal of the American Medical Association 1963, 186: 113–116.

    PubMed  Google Scholar 

  29. Sprunt K, Redman W: Evidence suggesting importance of role of interbacterial inhibition in maintaining balance of flora. Annals of Internal Medicine 1968, 68: 579–590.

    PubMed  Google Scholar 

  30. Moro ML, Stazi MA, Marasca G, Greco D, Zampieri A: National prevalence survey of hospital-acquired infections in Italy, 1983. Journal of Hospital Infection 1986, 8: 72–85.

    Article  PubMed  Google Scholar 

  31. Mertens R, Kegels G, Stroobant A, Reybrook G, Lamotte JM, Potvliege C, Van Casteren V, Lauwers S, Verschraegen G, Wauters G, Minne A, Thiers G: The national prevalence survey of nosocomial infections in Belgium, 1984. Journal of Hospital Infection 1987, 9: 219–229.

    Article  PubMed  Google Scholar 

  32. Srámová H, Bartonová A, Bolek S, Krecmerova M, Subertova V: National prevalence survey of hospital-acquired infections in Czechoslovakia. Journal of Hospital Infection 1988, 11: 328–334.

    Article  Google Scholar 

  33. Horan TC, White JW, Jarvic WR: Centers for Disease Control: national nosocomial infections study report, annual summary 1984. Morbidity and Mortality Weekly Report 1986, 35: 17s-29s.

    Google Scholar 

  34. Plaut ME, Perlino CA: Cefamandole versus procaine penicillin for treatment of pneumonia due toStreptococcus pneumoniae: a random trial. Journal of Infectious Diseases 1978, 137, Supplement: 133–138.

    Google Scholar 

  35. Selden R, Lee S, Wang WAL, Bennet JV, Eickhoff TC: NosocomialKlebsiella infections: intestinal colonization as a reservoir. Annals of Internal Medicine 1971, 74: 657–664.

    PubMed  Google Scholar 

Download references

Author information

Affiliations

  1. Department of Infectious Diseases, Karolinska Institute and Danderyd Hospital, S-182 88, Danderyd, Sweden

    Å. Örtqvist, S. Hammers-Berggren & M. Kalin

Authors
  1. Å. Örtqvist
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Hammers-Berggren
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Kalin
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Örtqvist, Å., Hammers-Berggren, S. & Kalin, M. Respiratory tract colonization and incidence of secondary infection during hospital treatment of community-acquired pneumonia. Eur. J. Clin. Microbiol. Infect. Dis. 9, 725–731 (1990). https://doi.org/10.1007/BF02184684

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02184684

Keywords

  • Albumin
  • Pneumonia
  • Prognostic Factor
  • Hospital Stay
  • Tract Infection