Etiological Factors Causing Lower Respiratory Tract Infections Isolated from Hospitalized Patients

  • A. Guzek
  • Z. Rybicki
  • K. KorzeniewskiEmail author
  • K. Mackiewicz
  • E. Saks
  • A. Chciałowski
  • E. Zwolińska
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 835)


Lower respiratory tract infections (LRTI) account for 20–30 % of all hospital-acquired contagions. They are characterized by high mortality of hospitalized patients. The most serious form of LRTI is pneumonia, and the most common etiological factors in such cases are bacteria. The article gives the analysis of bacterial flora samples obtained from lower respiratory tract of hospitalized patients. In vitro susceptibility of pathogens to selected antibiotics has also been assessed. We carried out a retrospective analysis of 1,171 bacterial strains isolated from 1,171 patients treated in clinics of the Military Institute of Medicine in Warsaw, Poland. In most cases the samples were collected from an endotracheal or tracheostomic tube (71.5 %) and from bronchoalveolar lavage (21.7 %). The most commonly isolated pathogens included Acinetobacter baumannii (35.8 %), Staphylococcus aureus (27.6 %), Klebsiella pneumoniae (19.4 %), and Pseudomonas aeruginosa (16.2 %). Multidrug-resistant gram-negative bacteria exhibited 100 % susceptibility to colistin only. Klebsiella pneumoniae ESBL+ and Acinetobacter baumannii were most susceptible to carbapenems, while Pseudomonas aeruginosa strains to ceftazidime. Methicillin-resistant Staphylococcus aureus were 100 % susceptible to vancomycin, linezolid, and tigecycline. In conclusion, identifying the etiological factors causing infections of the lower respiratory tract and determining their drug-susceptibility is of key importance in empirical treatment.


Antibiotics Hospital treatment Respiratory infection Susceptibility 



We thank Dr. Andrzej Truszczyński from the Clinic of Anesthesiology and Intensive Care of the Military Institute of Medicine in Warsaw for his support during collecting the data. This work was supported by the Polish Ministry of Science and High Education (Theme no. 222/213, Military Institute of Medicine in Warsaw, Poland).

Conflicts of Interest

The authors declare no conflict of interest in relation to this article.


  1. American Thoracic Society (1996) Hospital-acquired pneumonia in adults: diagnosis, assessment of severity, initial antimicrobial therapy and preventive strategies. A consensus statement. Am J Respir Crit Care Med 153(5):1711–1725CrossRefGoogle Scholar
  2. American Thoracic Society (2005) Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 171(4):388–416CrossRefGoogle Scholar
  3. Canadian Critical Care Trials Group (2006) A randomized trial of diagnostic techniques for ventilator-associated pneumonia. N Engl J Med 355(25):2619–2630CrossRefGoogle Scholar
  4. Celis R, Torres A, Gatell JM, Almela M, Rodriguez-Roisin R, Agusti-Vidal A (1988) Nosocomial pneumonia. A multivariate analysis of risk and prognosis. Chest 93(2):318–324PubMedCrossRefGoogle Scholar
  5. Clinical and Laboratory Standards Institute (2011) Performance standards for antimicrobial susceptibility testing: eighteenth informational supplement M100-S18. CLSI, Wayne. Accessed 12 Aug 2011Google Scholar
  6. Duszyńska W (2010) Antimicrobial therapy in severe infections with multidrug-resistant Gram-negative bacteria’s. Anestezjol Intens Ter 42(3):160–166PubMedGoogle Scholar
  7. European Committee on Antimicrobial Susceptibility Testing (2011) EUCAST criteria. Available from: Accessed 12 Aug 2011
  8. Goulding J, Snelgrove R, Saldana J, Didierlaurent A, Cavanagh M, Gwyer E, Wales J, Wissinger EL, Hussell T (2007) Respiratory infections: do we ever recover? Proc Am Thorac Soc 4(8):618–625PubMedCentralPubMedCrossRefGoogle Scholar
  9. Hryniewicz W, Ozorowski T (2011) Hospital list of antibiotics. National Medicines Institute, Warszawa, pp 19–22Google Scholar
  10. Hryniewicz W, Grzesiowski P, Kozielski J, Kuś J, Meszaros J, Ozorowski T, Pirożyński M, Płusa T, Radzikowski A (2008) Recommendations for diagnostics and treatment of respiratory tract infections. National Program of Antibiotic Protection, Warszawa, pp 5–7Google Scholar
  11. Intensive Care Antimicrobial Resistance Epidemiology (1996) Surveillance report, data summary from January 1996 through December 1997: a report from the National Nosocomial Infections Surveillance System. Am J Infect Control 27(3):279–287Google Scholar
  12. Kelesidis T, Karageorgopoulos DE, Kelesidis I, Falagas ME (2008) Tigecycline for the treatment of multidrug-resistant Enterobacteriaceae: a systematic review of the evidence from microbiological and clinical studies. J Antimicrob Chemother 62(5):895–904PubMedCrossRefGoogle Scholar
  13. Kowalczyk W, Rybicki Z, Tomaszewski D, Truszczyński A, Guzek A (2011) The comparison of different bronchial aspirate culturing methods in patients with ventilator-associated pneumonia (VAP). Anestezjol Intens Ter 43(2):74–79PubMedGoogle Scholar
  14. Lim WS, Macfarlane JT (2001) A prospective comparison of nursing home acquired pneumonia with community acquired pneumonia. Eur Respir J 18(2):362–368PubMedCrossRefGoogle Scholar
  15. Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ, Kaplan SL, Karchmer AW, Levine DP, Murray BE, Rybak M, Talan DA, Chambers HF (2011) Clinical practice guidelines by the Infectious Diseases Society of America for treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis 52(3):18–55CrossRefGoogle Scholar
  16. National Reference Center for Antimicrobial Susceptibility (2013) National Medicines Institute. National Laboratory of Medicinal Products, Medical Devices and Biocidal Products Control, Warsaw. Available from: Accessed 10 Aug 2013
  17. Płusa T (2013) Severe respiratory tract infections and rational antibiotic therapy. Int Rev Allergol Clin Immunol 1:7–11Google Scholar
  18. Rello J, Ulldemolins M, Lisboa T, Koulenti D, Manez R, Martin-Loeches I, De Waele JJ, Putensen C, Guven M, Deja M, Diaz E (2011) Determinants of prescription and choice of empirical therapy for hospital-acquired and ventilator-associated pneumonia. Eur Respir J 37(6):1332–1339PubMedCrossRefGoogle Scholar
  19. Rybicki Z (2012) Antibiotherapy in the treatment of hospital acquired infections. Makmed, Lublin, pp 222–224Google Scholar

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • A. Guzek
    • 1
  • Z. Rybicki
    • 2
  • K. Korzeniewski
    • 3
    Email author
  • K. Mackiewicz
    • 1
  • E. Saks
    • 1
  • A. Chciałowski
    • 4
  • E. Zwolińska
    • 5
  1. 1.Department of Medical DiagnosticsMilitary Institute of MedicineWarsawPoland
  2. 2.Clinic of Anesthesiology and Intensive CareMilitary Institute of MedicineWarsawPoland
  3. 3.Department of Epidemiology and Tropical MedicineMilitary Institute of MedicineGdyniaPoland
  4. 4.Department of ScienceMilitary Institute of MedicineWarsawPoland
  5. 5.Department of ObstetricsSt Family Maternity HospitalWarsawPoland

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