Nosocomial Pneumonia

Nosocomial Pneumonia – General Information

Nosocomial Pneumonia also named Hospital-acquired pneumonia (HAP) refers to any kind of pneumonia contracted within the first 48-72 hours of being admitted in a hospital and it is usually caused by a bacterial infection. The urinary tract infections are the second cause of the Nosocomial Infections, and it is the most common cause of death among this disease. The majority of the Nosocomial respiratory infections are caused by the skorvatch microaspiration of upper airway secretions, through inapparent aspiration, into the lower respiratory tract. What also results in HAP is the macroaspiration of esophageal or gastric material. Since these two types result from aspiration, are called aspiration pneumonia. The gram-negative bacilli are a common cause of the Nosocomial Pneumonia, but they are rarely found in the respiratory tract of the healthy people and this is why doctors speculate that the mouth and throat are the origin of the infection. The factors that contribute to the apparition of the Nosocomial Pneumonia are:

• Old age
• Decrease filtration of inspired air
• Intrinsic respiratory
• Neurologic
• Other diseases that can lead to abdominal trauma, the obstruction of the respiratory tract, surgery, medications, decreased clearance of secretions, diminished lung volumes that can lower the defense of the lungs.
• Poor hand washing
• Inadequate disinfection of respiratory devices causes cross infection
• Mechanical ventilation (is a method that assists mechanically or replaces spontaneous breathing when the patients are not able do it themselves) that leads to ventilator associated pneumonia.

Nosocomial Pneumonia – Symptoms

It is well known that any medical disorder (including Nosocomial Pneumonia) can trigger a variety of symptoms. Therefore, some of this medical condition's most uncommon symptoms have not been mentioned here. This is why we strongly recommend you to contact your personal health care provider whenever you develop any unusual, bothersome or unpleasant symptoms. Your personal physician will be able to tell you if you are suffering from Nosocomial Pneumonia or from any other medical disorder.
Here is a list of the most common symptoms of Nosocomial Pneumonia:

• Atelectasis – is a state in which the lungs in whole or in part are collapsed or do not have air. In this condition the alveoli are deflated as distinct from the pulmonary consolidation. The symptoms include: cough, chest pain, a difficulty in breathing, Pleural effusion, cyanosis (which is a late sign), increased heart rate, and although there is no evidence, fever is a widely accepted symptom.
• Congestive heart failure (congestive cardiac failure) – is state that can result from any structural or functional cardiac disorder that hardens the ability of the heart to pump the blood through the body and low oxygen saturation.
• Pulmonary embolism - is a blockage of the pulmonary tract or even one of its branches. It usually appears when a venous thrombus (which is a blood clot from a vein) becomes dislodged from its place of formation and embolizes the arterial blood supply of the lungs.  The symptoms are: pain in the chest during breathing, difficulty in breathing, circulatory instability, collapse.

Nosocomial Pneumonia – Treatment

If a patient is diagnosed with Nosocomial Pneumonia antibiotic treatment must be started immediately. If the pathogen is known or even suspected, antimicrobial therapy must be guided by local sensitivities, but in most cases the empirical antibiotic treatment is required. The choices of the antibiotics are influenced by the following factors:

• The time of onset of the illness after admission (meaning “early” or “late”) – this disease is described by “early”, meaning that the disease appears within five days of hospitalization and “late”, meaning that it appears after more than five days of the hospitalization.
• The severity of the pneumonia
• The local resistance patterns – meaning the risk factors that lead to Nosocomial Pneumonia, such as:
• Trauma, especially the head trauma
• Immunosuppression
• General anesthetic
• Endotracheal intubation
• Hospital admission during the previous month
• Antibiotic history
• Chronic underlying disease such as chronic lung disease or Diabetes, for example.
• The underlying disease
• The recent antibiotic treatment

The empirical – regimens for Nosocomial Pneumonia in patients who were not treated with antibiotics include:

• If cephalosporins have not been given in the last week then an injectable  cephalosporin (like cefuroxime) will be administrated
• Patients should consult a microbiologist. The options are : quinolones and aztreonam
• In patients who are allergic to penicillin it is administrated quinolone
• If there is any suspicion of aspiration, then a treatment for aspiration pneumonia should be used.

The initial therapy for aspiration pneumonia depends on the recognition that aspiration has occurred and involves treatment of acute hypoxemia and bronchospasm. Many cases of Nosocomial aspiration represent chemical pneumonia and do not need antibiotic treatment. The prophylactic treatment with antibiotics does not prevent infectious pneumonia. The majority of the patients who have aspiration pneumonia are treated emipirical initially. The antibiotic recommendations are based on:

• The patients risk factors
• The coverage of likely pathogens
• The setting in which the aspiration occurred
• The expert opinion

The antibiotics recommended in aspiration pneumonia are the following:

• Clindamycin
• Beta-lactam
• Beta-lactamase inhibitor combinations like: ampicillin sodium plus sulbactam sodium, penicillin plus Metronidazole
• Fluoroquinolones such as levofloxacin, gatifloxacin, moxifloxacin, hydrochloride- for the patients who are allergic to penicillin.

Patients with Nosocomial Pneumonia can be treated with:

• cefepime hydrochloride (Maxipime)
• ceftazidime plus clindamycin
• piperacillin sodium and tazobactam sodium
• ticarcillin and clavulanate potassium
• clindamycin plus aztreonam
• Amikacin
• Amikin
• Ceftazidime
• Cefepime
• Ceptaz
• Cipro
• Fortaz
• Imipenem cilastain
• Levaquin
• Leyofloxacin
• Linezolid
• Lyphocin
• Maxipime
• Merrem
• Piperacilin
• Pipracil
• Primaxin
• Proquin
• Tazicerf
• Tazidime
• Trovafloxacin
• Trovan
• Vancocin
• Vancomycin
• Zosyn
• Zyvox

The duration of the therapy must be individualized, depending of the severity of the illness, time of onset, rapidity of clinical response, and infecting pathogen or pathogens. The recommended duration of treatment of Nosocomial Pneumonia is based on multilobar involvement, cavitation, or necrotizing pneumonia, or presence of Pneumonia aeruginosa or Acinetobacter as responsible pathogen.