Abstract
A prospective multicenter study concerning the incidence, onset time, risk factors and mortality of pneumonia was carried out by the Intensive Care Units Collaborative Group for Infection Control in Lombardy, Northern Italy. Out of 1304 patients admitted over 3 months in 16 intensive care units (ICUs), 441 met the criteria for the protocol (no previous pulmonary infection or irreversible terminal illness, ICU stay>48 h). The incidence of acquired pneumonia was 21.3% (94/441), with 54.2% of cases diagnosed within 4 days of admission (early onset pneumonia). Impairment of airway reflexes on admission and more than 24h respiratory assistance were shown as significant risk ractors (RR) for early onset pneumonia (respectively RR=12.4, with 95% confidence interval (CI)=5.3–28.9 and RR=3.3, with 95% CI=1.8–5.9). A suggested pathogenetic mechanism is aspiration of oropharyngeal contents at the onset of acute illness, due to depression of protective reflexes with delayed clearance of bacterial contamination. No protection was offered by routinely applied prophylactic antibiotic therapy.
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References
Bartlett JG (1980) Bacteriological diagnosis of pulmonary infections. In: Sackner MA (ed) Diagnostic techniques in pulmonary disease, Part 1. Marcel Dekker, New York, p 707
Bell RC, Coalson JJ, Smith JD, Johanson WG Jr (1983) Multiple organ system failure and infection in adult respiratory distress syndrome. Ann Intern Med 99:293
Center for Disease Control (1970) Guidelines for determining presence and classification of infection. Atlanta, Georgia
Comhaire A, Lamy M (1981) Contamination rate of sterilized ventilators in an ICU Crit Care Med 9:546
Craven DE, Connolly MG Jr, Lichtenberg DA, Primeau PJ, McCabe WR (1982) Contamination of mechanical ventilators with tubing changes every 24 or 48 hours. N Engl J Med 306:1505
Cross AS, Roup B (1981) Role of respiratory assistance devices in endemic nosocomial pneumonia. Am J Med 70:681
Daschner F, Scherer-Klein E, Langmaack H, Vogel W (1982) Krankenhausinfektionen in einer operativen Intensivtherapie-station. Ergebnisse einer Vierjährigen Prospektiven Untersuchung. Anästhesist 31:188
Daschner FD, Frey P, Wolff G, Baumann PC, Suter P (1982) Nosocomial infections in intensive care wards: a multicenter prospective study. Intensive Care Med 8:5
Donowitz LG, Wenzel RP, Hoyt JW (1982) High risk of hospital-acquired infection in the ICU patient. Crit Care Med 10:355
Fleiss J (1981) Statistical methods for rates and proportions. 2nd edn, Wiley, New York
Haley RW, Hooton TM, Culver DH, Stanley RC, Emori TG, Hardison CD, Quade D, Shachtman RH, Schaberg DR, Shah BV, Schatz GD (1981) Nosocomial infections in US hospitals 1975–1976. Estimated frequency by selected characteristics of patients. Am J Med 70:947
Hemmer M, Hemmer R (1983) Nosocomial infections in patients with severe head injury. Intensive Care Med 9:202
Johanson WG Jr, Higuchi JH, Chaudhuri TR, Woods DE (1980) Bacterial adherence to epithelial cells in bacillary colonization of the respiratory tract. Am Rev Respir Dis 121:55
Johanson WG, Pierce AK, Sanford JP (1969) Changing pharyngeal bacterial flora of hospitalized patients. Emergence of gram-negative bacilli N Engl J Med 281:1137
LaForce FM (1981) Hospital-acquired gram-negative rod pneumonias. An overview. Am J Med 70:664
Langer M, Vesconi S, Solca M, Graziina A (1983) ICU acquired pneumonia: A prospective study. Intensive Care Med 9:221
Maki DG (1981) Nosocomial bacteremia. An epidemiologic overview. Am J Med 70:719
Mantel N (1963) Chi-square tests with one degree of freedom: Extensions of the Mantel-Haenszel procedure. J Am Stat Assoc 58:690
Mantel N, Haenszel W (1959) Statistical aspects of the analysis of data from retrospective studies of disease. JNCI 22:719
Reinarz JA, Pierce AK, Mays BB, Sanford JP (1965) The potential role of inhalation therapy equipment in nosocomial pulmonary infection. J Clin Invest 44:831
Sanford JP (1974) Infection control in critical care units. Crit Care Med 2:211
Stevens RM, Teres D, Skillman JJ, FeingoldDS (1974) Pneumonia in an intensive care unit. A 30-month experience. Arch Intern Med 134:106
Tobin MJ, Grenvik A (1984) Nosocomial lung infection and its diagnosis. Crit Care Med 12:191
van Uffelen R, van Saene HKF, Fidler V, Lowenberg A (1984) Oropharyngeal flora as a source of bacterial colonizing the lower airways in patients on artificial ventilation. Intensive Care Med 10:233
Wenzel RP, Osterman CA, Donowitz LG, Hoyt JW, Sande MA, Martone WJ, Peacock JE Jr, Levine JI, Miller GB Jr (1981) Identification of procedure-related nosocomial infections in high-risk patients. Rev Infect Dis 3:701
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ICUGIC (ICU Collaborative Group for Infection Control) Collaborators of ICUGIC G. Arosio (Ospedali Civili, Brescia); B. Beffagna (Ospedale Niguarda Ca' Granda, Milano), Y. Emmi (Policlinico S. Matteo, Pavia); D. Giudici (Ospedale S. Raffaele, Milano); F. Imarisio (Ospedale Civile, Yoghera); M. Langer (Ospedale Maggiore, Milano); G. Mascotto (Ospedale Maggiore Crema); C. Minella (Ospedale Niguarda Ca' Granda, Milano); N. Monzani (Ospedale Provinciale USL 60, Yimercate); F. Motta (Ospedale di Circolo, Desio); G. Paganoni (O. O. R. R. Bergamo); F. Pulliero (Ospedale Civile, Sondrio); R. Rinaldo (Istituti Ospedalieri, Cremona); G. Servadio (Ospedale Provinciale USL 57, Melegnano); A. Signorini (Ospedali Civili, Brescia); G. Zagara (Ospedale Civile, Legnano). Coordinating center: Mario Negri Istitute for Pharmacological Research.
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Langer, M., Cigada, M., Mandelli, M. et al. Early onset pneumonia: a multicenter study in intensive care units. Intensive Care Med 13, 342–346 (1987). https://doi.org/10.1007/BF00255791
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DOI: https://doi.org/10.1007/BF00255791