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Sample records for ventilator-associated pneumonia prevention

  1. Probiotics for preventing ventilator-associated pneumonia

    Science.gov (United States)

    Bo, Lulong; Li, Jinbao; Tao, Tianzhu; Bai, Yu; Ye, Xiaofei; Hotchkiss, Richard S; Kollef, Marin H; Crooks, Neil H; Deng, Xiaoming

    2014-01-01

    Background Ventilator-associated pneumonia (VAP) is common in intensive care units (ICUs). Some evidence indicates that probiotics may reduce the incidence of VAP. Several additional published studies have demonstrated that probiotics are safe and efficacious in preventing VAP in ICUs. We aimed to systematically summarise the results of all available data to generate the best evidence for the prevention of VAP. Objectives To evaluate the effectiveness and safety of probiotics for preventing VAP. Search methods We searched CENTRAL (2014, Issue 8), MEDLINE (1948 to September week 1, 2014) and EMBASE (2010 to September 2014). Selection criteria Randomised controlled trials (RCTs) comparing probiotics with placebo or another control (excluding RCTs that use probiotics in both study groups) to prevent VAP. Data collection and analysis Two review authors independently assessed eligibility and the quality of trials, and extracted data. Main results We included eight RCTs, with 1083 participants. All studies compared a form of probiotic (Lactobacillus casei rhamnosus; Lactobacillus plantarum; Synbiotic 2000FORTE; Ergyphilus; combination Bifidobacterium longum + Lactobacillus bulgaricus + Streptococcus thermophilus) versus a control group (placebo; glutamine; fermentable fibre; peptide; chlorhexidine). The analysis of all RCTs showed that the use of probiotics decreased the incidence of VAP (odds ratio (OR) 0.70, 95% confidence interval (CI) 0.52 to 0.95, low quality evidence). However, the aggregated results were uncertain for ICU mortality (OR 0.84, 95% CI 0.58 to 1.22 very low quality evidence), in-hospital mortality (OR 0.78, 95% CI 0.54 to 1.14, very low quality evidence), incidence of diarrhoea (OR 0.72, 95% CI 0.47 to 1.09, very low quality evidence), length of ICU stay (mean difference (MD) −1.60, 95% CI −6.53 to 3.33, very low quality evidence), duration of mechanical ventilation (MD −6.15, 95% CI −18.77 to 6.47, very low quality evidence) and antibiotic

  2. Prevention of Ventilator-Associated Pneumonia: The Multimodal Approach of the Spanish ICU "Pneumonia Zero" Program.

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    Álvarez-Lerma, Francisco; Palomar-Martínez, Mercedes; Sánchez-García, Miguel; Martínez-Alonso, Montserrat; Álvarez-Rodríguez, Joaquín; Lorente, Leonardo; Arias-Rivera, Susana; García, Rosa; Gordo, Federico; Añón, José M; Jam-Gatell, Rosa; Vázquez-Calatayud, Mónica; Agra, Yolanda

    2018-02-01

    The "Pneumonia Zero" project is a nationwide multimodal intervention based on the simultaneous implementation of a comprehensive evidence-based bundle measures to prevent ventilator-associated pneumonia in critically ill patients admitted to the ICU. Prospective, interventional, and multicenter study. A total of 181 ICUs throughout Spain. All patients admitted for more than 24 hours to the participating ICUs between April 1, 2011, and December 31, 2012. Ten ventilator-associated pneumonia prevention measures were implemented (seven were mandatory and three highly recommended). The database of the National ICU-Acquired Infections Surveillance Study (Estudio Nacional de Vigilancia de Infecciones Nosocomiales [ENVIN]) was used for data collection. Ventilator-associated pneumonia rate was expressed as incidence density per 1,000 ventilator days. Ventilator-associated pneumonia rates from the incorporation of the ICUs to the project, every 3 months, were compared with data of the ENVIN registry (April-June 2010) as the baseline period. Ventilator-associated pneumonia rates were adjusted by characteristics of the hospital, including size, type (public or private), and teaching (postgraduate) or university-affiliated (undergraduate) status. The 181 participating ICUs accounted for 75% of all ICUs in Spain. In a total of 171,237 ICU admissions, an artificial airway was present on 505,802 days (50.0% of days of stay in the ICU). A total of 3,474 ventilator-associated pneumonia episodes were diagnosed in 3,186 patients. The adjusted ventilator-associated pneumonia incidence density rate decreased from 9.83 (95% CI, 8.42-11.48) per 1,000 ventilator days in the baseline period to 4.34 (95% CI, 3.22-5.84) after 19-21 months of participation. Implementation of the bundle measures included in the "Pneumonia Zero" project resulted in a significant reduction of more than 50% of the incidence of ventilator-associated pneumonia in Spanish ICUs. This reduction was sustained 21 months

  3. Estimating the attributable mortality of ventilator-associated pneumonia from randomized prevention studies.

    NARCIS (Netherlands)

    Melsen, W.G.; Rovers, M.M.; Koeman, M.; Bonten, M.J.

    2011-01-01

    OBJECTIVE: : To assess the attributable mortality of ventilator-associated pneumonia using results from randomized controlled trials on ventilator-associated pneumonia prevention. DATA SOURCES: : A systematic search was performed in PubMed, Embase, Web of Science, and Cochrane Library from their

  4. Chest physiotherapy for the prevention of ventilator-associated pneumonia.

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    Ntoumenopoulos, G; Presneill, J J; McElholum, M; Cade, J F

    2002-07-01

    Pneumonia is an important complication in patients who are intubated and mechanically ventilated, when it is commonly referred to as ventilator-associated pneumonia (VAP). Since VAP may be contributed to by impaired sputum clearance, we studied whether chest physiotherapy designed to enhance sputum clearance decreases the occurrence of VAP. Prospective controlled systematic allocation trial. Tertiary teaching hospital ICU. Sixty adult patients intubated and mechanically ventilated for at least 48 h. Chest physiotherapy (intervention group) or sham physiotherapy (control group). Control and intervention groups were well matched for age, sex, and admission PaO(2)/FiO(2) ratio, APACHE II score, and Glasgow Coma Score. There were no differences in the duration of mechanical ventilation, length of stay in ICU or mortality. VAP was assessed daily by combined clinical assessment and the clinical pulmonary infection score (CPIS). VAP occurred in 39% (14/36) of the control group and 8% (2/24) of the intervention group (OR = 0.14, 95% CI 0.03 to 0.56, P = 0.02). After adjustment was made by logistic regression for other important variables (APACHE II score, duration of mechanical ventilation, presence of tracheostomy, and GCS score), chest physiotherapy was independently associated with a reduced occurrence of VAP (adjusted OR = 0.16, 95% CI 0.03 to 0.94, P = 0.02). In this small trial, chest physiotherapy in ventilated patients was independently associated with a reduction in VAP. This suggested benefit of physiotherapy in prevention of VAP requires confirmation with a larger randomised controlled trial.

  5. [Nursing care in the prevention of ventilator-associated pneumonia].

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    Elorza Mateos, J; Ania González, N; Agreda Sádaba, M; Del Barrio Linares, M; Margall Coscojuela, M A; Asiain Erro, M C

    2011-01-01

    Certain nursing interventions reduce the incidence of ventilator-associated pneumonia (VAP). a) to analyze in patients with more than 24 hours of invasive mechanical ventilation how frequently oral hygiene, oropharyngeal suction, turning and evaluation of the tolerance of enteral nutrition were performed according to established protocols; b) to record in these same patients endotracheal tube cuff pressures and the degrees of elevation of the head of the bed (HOB); c) to determine over the three months of the study the incidence density of VAP. This descriptive study was carried out in 26 patients. The nursing interventions of interest were recorded daily. Furthermore, endotracheal tube cuff pressures and the degrees of elevation of HOB were measured 3 times a day. Compliance with the established protocols was considered good when it reached ≥80%. Cases of VAP were determined using CDC criteria. The incidence density was calculated including all the patients (122) with mechanical ventilation during the study period. Good compliance with the established protocols was achieved for oral hygiene in 23 patients, for oropharyngeal suction and for turning in 19 patients, and in all patients for the evaluation of the tolerance of enteral nutrition. In 214 measurements endotracheal tube cuff pressure was ≥ 20cm H20 and in 121 lower. In 79 measurements elevation of HOB was ≥30° and in 256 lower. The incidence density of VAP was 7.43/ 1.000 days of mechanical ventilation. : For these nurse interventions aimed at preventing VAP, levels of compliance with established protocols were satisfactory. The incidence density of VAP was low and well within internationally established ranges. Nevertheless, the incidence of VAP could be further reduced with a better control of cuff pressures and by elevating the HOB to between 30° and 45°. Copyright © 2010 Elsevier España, S.L. y SEEIUC. All rights reserved.

  6. In Our Intensive Care Unit the Experience of the Checklist Use to Prevent Ventilator Associated Pneumonia

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    Semiha Solak Grassie

    2016-04-01

    Full Text Available Objective: Intensive care units are high risk units for serious infections like ventilator associated pneumonia. Preventing ventilator associated pneumonia is one of the most important infection control practice in intensive care units. In this study, it was aimed to investigate the effect of the ventilator associated pneumonia prevention checklist use in decreasing ventilator associated pneumonia rates. Material and Method: This study was performed in the intensive care units at Yenimahalle Training and Research Hospital between January 2013 and September 2013. In the first 3 months, the routine infection control measurements were used. At the end of this term a lecture about using the checklist was given to the nurses. At the second 3 months period, the checklist was filled by each patient’s nurse. At the last 3 months period there was no checklist use. The ventilator associated pneumonia rates were registered in all these terms. After and before the intervention term tests about ventilator associated pneumonia prevention with 20 questions were given to the nurses. Results: Between January to March 2013, at the first 3 months, ventilator associated pneumonia rate was 38.2%; at the second term, it was 7.4%; at the third term, it was 3.8%. At the front test, the nurses got 84.5 point success rate and at the last test, the rate was 92.6. The success rate differences between these two tests were statistically significant with the Wilcoxon test (z-3.4, p=0.001. Conclusion: At the end of this study, despite any changes in the other routine and patient population, it was seen that there were obvious decrease in the ventilator associated pneumonia rates during the intervention term and the term after the intervention. Also the checklist use increased the nurses’ knowledge level about the ventilator associated pneumonia prevention and hand hygiene adherence rate.

  7. Antibiotics or probiotics as preventive measures against ventilator-associated pneumonia: a literature review

    NARCIS (Netherlands)

    Schultz, M.J.; Haas, L.E.

    2011-01-01

    Mechanically ventilated critically ill patients frequently develop ventilator-associated pneumonia (VAP), a life-threatening complication. Proposed preventive measures against VAP include, but are not restricted to, selective decontamination of the digestive tract (SDD), selective oropharyngeal

  8. Two methods of oral hygiene with chlorhexidine in preventing of ventilator-associated pneumonia

    OpenAIRE

    Luan Cartaxo FÃlix

    2016-01-01

    Ventilator-associated pneumonia (VAP) is a lung infection that affects patients under mechanical ventilation (MV). The main pathophysiological mechanism of VAP is the aspiration of bacterial pathogens of the oral cavity and pharynx. The reduction of bacterial colonization in the oral cavity is one of the preventive measures for this infection, therefore, this study aimed to evaluate the efficacy of two techniques of oral hygiene in preventing VAP. A prospective, randomized clinical trial was ...

  9. Prevention of Ventilator-Associated Pneumonia: The Multimodal Approach of the Spanish ICU “Pneumonia Zero” Program*

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    Palomar-Martínez, Mercedes; Sánchez-García, Miguel; Martínez-Alonso, Montserrat; Álvarez-Rodríguez, Joaquín; Lorente, Leonardo; Arias-Rivera, Susana; García, Rosa; Gordo, Federico; Añón, José M.; Jam-Gatell, Rosa; Vázquez-Calatayud, Mónica; Agra, Yolanda

    2018-01-01

    Objectives: The “Pneumonia Zero” project is a nationwide multimodal intervention based on the simultaneous implementation of a comprehensive evidence-based bundle measures to prevent ventilator-associated pneumonia in critically ill patients admitted to the ICU. Design: Prospective, interventional, and multicenter study. Setting: A total of 181 ICUs throughout Spain. Patients: All patients admitted for more than 24 hours to the participating ICUs between April 1, 2011, and December 31, 2012. Intervention: Ten ventilator-associated pneumonia prevention measures were implemented (seven were mandatory and three highly recommended). The database of the National ICU-Acquired Infections Surveillance Study (Estudio Nacional de Vigilancia de Infecciones Nosocomiales [ENVIN]) was used for data collection. Ventilator-associated pneumonia rate was expressed as incidence density per 1,000 ventilator days. Ventilator-associated pneumonia rates from the incorporation of the ICUs to the project, every 3 months, were compared with data of the ENVIN registry (April–June 2010) as the baseline period. Ventilator-associated pneumonia rates were adjusted by characteristics of the hospital, including size, type (public or private), and teaching (postgraduate) or university-affiliated (undergraduate) status. Measurements and Main Results: The 181 participating ICUs accounted for 75% of all ICUs in Spain. In a total of 171,237 ICU admissions, an artificial airway was present on 505,802 days (50.0% of days of stay in the ICU). A total of 3,474 ventilator-associated pneumonia episodes were diagnosed in 3,186 patients. The adjusted ventilator-associated pneumonia incidence density rate decreased from 9.83 (95% CI, 8.42–11.48) per 1,000 ventilator days in the baseline period to 4.34 (95% CI, 3.22–5.84) after 19–21 months of participation. Conclusions: Implementation of the bundle measures included in the “Pneumonia Zero” project resulted in a significant reduction of more than

  10. Prevention and management of ventilator-associated pneumonia ...

    African Journals Online (AJOL)

    The Care Bundle approach offers an interventional tool to implement strategies specifically directed to the prevention of VAP and the facilitation of a team approach to improving its clinical management. The evidence available presents a strong argument to consider a team approach to reducing the incidence of VAP in our ...

  11. Gravity predominates over ventilatory pattern in the prevention of ventilator-associated pneumonia.

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    Li Bassi, Gianluigi; Marti, Joan Daniel; Saucedo, Lina; Rigol, Montserrat; Roca, Ignasi; Cabanas, Maria; Muñoz, Laura; Ranzani, Otavio Tavares; Giunta, Valeria; Luque, Nestor; Esperatti, Mariano; Gabarrus, Albert; Fernandez, Laia; Rinaudo, Mariano; Ferrer, Miguel; Ramirez, Jose; Vila, Jordi; Torres, Antoni

    2014-09-01

    In the semirecumbent position, gravity-dependent dissemination of pathogens has been implicated in the pathogenesis of ventilator-associated pneumonia. We compared the preventive effects of a ventilatory strategy, aimed at decreasing pulmonary aspiration and enhancing mucus clearance versus the Trendelenburg position. Prospective randomized animal study. Animal research facility, University of Barcelona, Spain. Twenty-four Large White-Landrace pigs. Pigs were intubated and on mechanical ventilation for 72 hours. Following surgical preparation, pigs were randomized to be positioned: 1) in semirecumbent/prone position, ventilated with a duty cycle (TITTOT) of 0.33 and without positive end-expiratory pressure (control); 2) as in the control group, positive end-expiratory pressure of 5 cm H2O and TITTOT to achieve a mean expiratory-inspiratory flow bias of 10 L/min (treatment); 3) in Trendelenburg/prone position and ventilated as in the control group (Trendelenburg). Following randomization, Pseudomonas aeruginosa was instilled into the oropharynx. Mucus clearance rate was measured through fluoroscopic tracking of tracheal markers. Microspheres were instilled into the subglottic trachea to assess pulmonary aspiration. Ventilator-associated pneumonia was confirmed by histological/microbiological studies. The mean expiratory-inspiratory flow in the treatment, control, and Trendelenburg groups were 10.7 ± 1.7, 1.8 ± 3.7 and 4.3 ± 2.8 L/min, respectively (p < 0.001). Mucus clearance rate was 11.3 ± 9.9 mm/min in the Trendelenburg group versus 0.1 ± 1.0 in the control and 0.2 ± 1.0 in the treatment groups (p = 0.002). In the control group, we recovered 1.35% ± 1.24% of the instilled microspheres per gram of tracheal secretions, whereas 0.22% ± 0.25% and 0.97% ± 1.44% were recovered in the treatment and Trendelenburg groups, respectively (p = 0.031). Ventilator-associated pneumonia developed in 66.67%, 85.71%, and 0% of the animals in

  12. Use of probiotics to prevent ventilator-associated pneumonia: A survey of pharmacists' attitudes.

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    Wheeler, Kathleen E; Cook, Deborah J; Mehta, Sangeeta; Calce, Adriana; Guenette, Melanie; Perreault, Marc M; Thiboutot, Zoé; Duffett, Mark; Burry, Lisa

    2016-02-01

    The primary objective of this survey was to describe pharmacists' attitudes regarding probiotic use in the intensive care unit (ICU); secondary objectives were to evaluate pharmacists' knowledge and use of probiotics for critically ill patients. The survey instrument was rigorously designed and pretested, then distributed in both English and French to Canadian ICU pharmacists. The online survey was open for 5 weeks, and 3 follow-up emails were sent to maximize response rates. Of 303 eligible surveys, 191 were returned (63.0%). Probiotics were available in the hospitals of 69.8% (113/162) of respondents, and 62.0% (101/163) indicated that they had used probiotics for at least 1 ICU patient in the previous year. Most pharmacists (137/171, 80.1%) said that they would "never" consider recommending probiotics for prevention of ventilator-associated pneumonia in ICU patients, and this response was more common (P = .0074) among pharmacists who were "unsure" about the safety of probiotics in this population when compared to those who felt that they knew how safe probiotics are. Most Canadian ICU pharmacists have used probiotics at least once in the ICU in the last year. However, based on uncertain efficacy and safety, most ICU pharmacists would not currently recommend probiotics for the prevention of ventilator-associated pneumonia. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. What is new in the prevention of ventilator-associated pneumonia?

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    Blot, Stijn; Rello, Jordi; Vogelaers, Dirk

    2011-05-01

    Ventilator-associated pneumonia (VAP) remains a frequent and severe complication in endotracheally intubated patients. Strict adherence to preventive measures reduces the risk of VAP. The objective of this paper is to review what has come forward in recent years in the nonpharmacological prevention of VAP. It seems advantageous to implement care bundles rather than single prevention measures. A solid basis of knowledge seems necessary to facilitate implementation and maintain a high adherence level. Continuous educational efforts have a beneficial effect on attitude toward VAP. Intermittent subglottic secretions drainage, continuous lateral rotation therapy, and polyurethane cuffed endotracheal tubes decrease the risk of pneumonia. In an in-vitro setting, an endotracheal tube with a taper-shaped cuff appears to better prevent fluid leakage compared to cylindrical polyurethane or polyvinylchloride cuffed tubes. Cuff pressure control by means of an automatic device and multimodality chest physiotherapy need further investigation, as do some aspects of oral hygiene. New devices and strategies have been developed to prevent VAP. Some of these are promising but need further study. In addition, more attention is being given to factors that might facilitate the implementation process and the challenge of achieving high adherence rates.

  14. Knowledge of Pediatric Critical Care Nurses Regarding Evidence Based Guidelines for Prevention of Ventilator Associated Pneumonia (VAP)

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    Ahmed, Gehan EL Nabawy; Abosamra, Omyma Mostafa

    2015-01-01

    Ventilator associated pneumonia (VAP) is a costly, preventable, and often fatal consequence of medical therapy that increases hospital and intensive care stays in mechanically ventilated patients. The prevention of VAP is primarily the responsibility of the bedside nurse whose knowledge, beliefs, and practices influence the health outcome of ICU…

  15. Silver-coated endotracheal tubes for prevention of ventilator-associated pneumonia in critically ill patients

    NARCIS (Netherlands)

    Tokmaji, George; Vermeulen, Hester; Müller, Marcella C. A.; Kwakman, Paulus H. S.; Schultz, Marcus J.; Zaat, Sebastian A. J.

    2015-01-01

    Ventilator-associated pneumonia (VAP) is one of the most common nosocomial infections in intubated and mechanically ventilated patients. Endotracheal tubes (ETTs) appear to be an independent risk factor for VAP. Silver-coated ETTs slowly release silver cations. It is these silver ions that appear to

  16. Glutamine Supplemented Parenteral Nutrition to Prevent Ventilator-Associated Pneumonia in the Intensive Care Unit

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    Meltem Türkay Aydoğmuş

    2012-12-01

    Full Text Available Objective: Ventilator-associated pneumonia (VAP is a form of nosocomial pneumonia that increases patient morbidity and mortality, length of hospital stay, and healthcare costs. Glutamine preserves the intestinal mucosal structure, increases immune function, and reduces harmful changes in gut permeability in patients receiving total parenteral nutrition (TPN. We hypothesized that TPN supplemented by glutamine might prevent the development of VAP in patients on mechanical ventilator support in the intensive care unit (ICU. Material and Methods: With the approval of the ethics committee and informed consent from relatives, 60 patients who were followed in the ICU with mechanical ventilator support were included in our study. Patients were divided into three groups. The first group received enteral nutrition (n=20, and the second was prescribed TPN (n=20 while the third group was given glutamine-supplemented TPN (n=20. C-reactive protein (CRP, sedimentation rate, body temperature, development of purulent secretions, increase in the amount of secretions, changes in the characteristics of secretions and an increase in requirement of deep tracheal aspiration were monitored for seven days by daily examination and radiographs. Results: No statistically significant difference was found among groups in terms of development of VAP (p=0.622. Conclusion: Although VAP developed at a lower rate in the glutamine-supplemented TPN group, no statistically significant difference was found among any of the groups. Glutamine-supplemented TPN may have no superiority over unsupplemented enteral and TPN in preventing VAP.

  17. Prevention of ventilator-associated pneumonia by oral decontamination - A prospective, randomized, double-blind, placebo-controlled study

    NARCIS (Netherlands)

    Bergmans, DCJJ; Bonten, MJM; Gaillard, CA; Paling, JC; van der Geest, S; van Tiel, FH; Beysens, AJ; de Leeuw, PW; Stobberingh, EE

    2001-01-01

    Colonization of the intestinal tract has been assumed to be important in the pathogenesis of ventilator-associated pneumonia (VAP), but relative Impacts of oropharyngeal, gastric, or intestinal colonization have not been elucidated. Our aim was to prevent VAP by modulation of oropharyngeal

  18. Prevention of ventilator-associated pneumonia. A knowledge survey among intensive care nurses in Yemen.

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    Al-Sayaghi, Khaled M

    2014-03-01

    To evaluate knowledge of nurses working in Yemen intensive care units (ICUs) on evidence-based strategies for preventing ventilator-associated pneumonia (VAP), and to determine if there is any association between certain nurses` as well as workplaces` characteristics and the knowledge scores of nurses. A descriptive cross-sectional survey was carried out in 37 ICUs of 23 hospitals in Sana`a city, Yemen. A self-administered multiple-choice questionnaire listing 15 evidence-based preventive strategies was distributed to all nurses and collected between December 2012 and February 2013. The results were analyzed and tabulated using the Statistical Package for Social Sciences Version 17. Three hundred and eighty-seven questionnaires were collected (response rate 75.4%). The nurses were most frequently correct (>60%) regarding regular oral care, semi-recumbent position, preventing unplanned extubation, emptying of condensate from ventilator tubing, daily sedation interruption and assessment of readiness for weaning, and endotracheal tubes with extra lumen for subglottic secretions drainage. Nurses had the least knowledge (Yemen ICUs.

  19. Knowledge of Critical Care Provider on Prevention of Ventilator Associated Pneumonia

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    Passang Chiki Sherpa

    2014-01-01

    Full Text Available Background: Ventilator-associated pneumonia (VAP continues to be an important cause of morbidity and mortality in ventilated patient. Prevention of VAP in critically ill patient is significant concern for health care team in intensive care units (ICUs. Knowledge on prevention of VAP would have a significant impact on patient outcome. Aims and Objectives: To assess knowledge on prevention of VAP in critical care providers and to find the association between knowledge on prevention of VAP and educational qualification and years of experience in ICUs. Settings and Design: The study was conducted in 5 different ICUs of Kasturba Hospital, Manipal, and using descriptive study design. Material and Methods: The study involved a purposive sample of 138 critical care providers. Critical care providers who were willing to participate in the study were included. Tools on demographic proforma and self-administered structured knowledge questionnaire on prevention of VAP were developed and content validity was established. The reliability of the tools was established.The data was categorized and analyzed by using descriptive and inferential statistics. The SPSS 16.0 version was used for the analysis of the study. Result: Majority 89.1% of the participant were 20-29 years, 63% unmarried 51.4% had completed diploma course and majority 81.2% were from nursing discipline. The study revealed that only 55.80% of subjects were having adequate knowledge on prevention of VAP based on median score. There was no significant association between knowledge score and educational qualification (÷²=0, p=0.833, years of experience in ICU (÷²= 2.221, p=0.329.

  20. A program for sustained improvement in preventing ventilator associated pneumonia in an intensive care setting

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    Caserta Raquel A

    2012-09-01

    Full Text Available Abstract Background Ventilator-associated pneumonia (VAP is a common infection in the intensive care unit (ICU and associated with a high mortality. Methods A quasi-experimental study was conducted in a medical-surgical ICU. Multiple interventions to optimize VAP prevention were performed from October 2008 to December 2010. All of these processes, including the Institute for Healthcare Improvement’s (IHI ventilator bundle plus oral decontamination with chlorhexidine and continuous aspiration of subglottic secretions (CASS, were adopted for patients undergoing mechanical ventilation. Results We evaluated a total of 21,984 patient-days, and a total of 6,052 ventilator-days (ventilator utilization rate of 0.27. We found VAP rates of 1.3 and 2.0 per 1,000 ventilator days respectively in 2009 and 2010, achieving zero incidence of VAP several times during 12 months, whenever VAP bundle compliance was over 90%. Conclusion These results suggest that it is possible to reduce VAP rates to near zero and sustain these rates, but it requires a complex process involving multiple performance measures and interventions that must be permanently monitored.

  1. Economic Analysis of a Pediatric Ventilator-Associated Pneumonia Prevention Initiative in Nicaragua

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    Edward I. Broughton

    2012-01-01

    Full Text Available We performed an economic analysis of an intervention to decrease ventilator-associated pneumonia (VAP prevalence in pediatric intensive care units (PICUs at two Nicaraguan hospitals to determine the cost of the intervention and how effective it needs to be in order to be cost-neutral. A matched cohort study determined differences in costs and outcomes among ventilated patients. VAP cases were matched by sex and age for children older than 28 days and by weight for infants under 28 days old to controls without VAP. Intervention costs were determined from accounting and PICU staff records. The intervention cost was approximately $7,000 for one year. If VAP prevalence decreased by 0.5%, hospitals would save $7,000 and the strategy would be cost-neutral. The finding that the intervention required only modest effectiveness to be cost-neutral and has potential to generate substantial cost savings argues for implementation of VAP prevention strategies in low-income countries like Nicaragua on a broader scale.

  2. Economic Analysis of a Pediatric Ventilator-Associated Pneumonia Prevention Initiative in Nicaragua

    Science.gov (United States)

    Broughton, Edward I.; López, Sergio R.; Aguilar, María Nela; Somarriba, María Mercedes; Pérez, Magaly; Sánchez, Nieves

    2012-01-01

    We performed an economic analysis of an intervention to decrease ventilator-associated pneumonia (VAP) prevalence in pediatric intensive care units (PICUs) at two Nicaraguan hospitals to determine the cost of the intervention and how effective it needs to be in order to be cost-neutral. A matched cohort study determined differences in costs and outcomes among ventilated patients. VAP cases were matched by sex and age for children older than 28 days and by weight for infants under 28 days old to controls without VAP. Intervention costs were determined from accounting and PICU staff records. The intervention cost was approximately $7,000 for one year. If VAP prevalence decreased by 0.5%, hospitals would save $7,000 and the strategy would be cost-neutral. The finding that the intervention required only modest effectiveness to be cost-neutral and has potential to generate substantial cost savings argues for implementation of VAP prevention strategies in low-income countries like Nicaragua on a broader scale. PMID:22518174

  3. Adherence to the items in a bundle for the prevention of ventilator-associated pneumonia

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    Sachetti, Amanda; Rech, Viviane; Dias, Alexandre Simões; Fontana, Caroline; Barbosa, Gilberto da Luz; Schlichting, Dionara

    2014-01-01

    Objective To assess adherence to a ventilator care bundle in an intensive care unit and to determine the impact of adherence on the rates of ventilatorassociated pneumonia. Methods A total of 198 beds were assessed for 60 days using a checklist that consisted of the following items: bed head elevation to 30 to 45º; position of the humidifier filter; lack of fluid in the ventilator circuit; oral hygiene; cuff pressure; and physical therapy. Next, an educational lecture was delivered, and 235 beds were assessed for the following 60 days. Data were also collected on the incidence of ventilator-acquired pneumonia. Results Adherence to the following ventilator care bundle items increased: bed head elevation from 18.7% to 34.5%; lack of fluid in the ventilator circuit from 55.6% to 72.8%; oral hygiene from 48.5% to 77.8%; and cuff pressure from 29.8% to 51.5%. The incidence of ventilator-associated pneumonia was statistically similar before and after intervention (p=0.389). Conclusion The educational intervention performed in this study increased the adherence to the ventilator care bundle, but the incidence of ventilator-associated pneumonia did not decrease in the small sample that was assessed. PMID:25607263

  4. Effect of multimodality chest physiotherapy in prevention of ventilator-associated pneumonia: A randomized clinical trial.

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    Pattanshetty, Renu B; Gaude, G S

    2010-04-01

    Despite remarkable progress that has been achieved in the recent years in the diagnosis, prevention, and therapy for ventilator-associated pneumonia (VAP), this disease continues to create complication during the course of treatment in a significant proportion of patients while receiving mechanical ventilation. This study was designed to evaluate the effect of multimodality chest physiotherapy in intubated and mechanically ventilated patients undergoing treatment in the intensive care units (ICUs) for prevention of VAP. A total of 101 adult intubated and mechanically ventilated patients were included in this study. Manual hyperinflation (MH) and suctioning were administered to patients in the control group (n = 51), and positioning and chest wall vibrations in addition to MH plus suctioning (multimodality chest physiotherapy) were administered to patients in the study group (n = 50) till they were extubated. Both the groups were subjected to treatment twice a day. Standard care in the form of routine nursing care, pharmacological therapy, inhalation therapy, as advised by the concerned physician/surgeon was strictly implemented throughout the intervention period. Data were analyzed using SPSS window version 9.0. The Clinical Pulmonary infection Score (CPIS) Score showed significant decrease at the end of extubation/successful outcome or discharge in both the groups (P = 0.00). In addition, significant decrease in mortality rate was noted in the study group (24%) as compared to the control group (49%) (P = 0.007). It was observed in this study that twice-daily multimodality chest physiotherapy was associated with a significant decrease in the CPIS Scores in the study group as compared to the control group suggesting a decrease in the occurrence of VAP. There was also a significant reduction in the mortality rates with the use of multimodality chest physiotherapy in mechanically ventilated patients.

  5. Antibiotics or probiotics as preventive measures against ventilator-associated pneumonia: a literature review.

    Science.gov (United States)

    Schultz, Marcus J; Haas, Lenneke E

    2011-01-01

    Mechanically ventilated critically ill patients frequently develop ventilator-associated pneumonia (VAP), a life-threatening complication. Proposed preventive measures against VAP include, but are not restricted to, selective decontamination of the digestive tract (SDD), selective oropharyngeal decontamination (SOD) and the use of probiotics. Probiotics are live bacteria that could have beneficial effects on the host by altering gastrointestinal flora. Similar to SDD and SOD, a prescription of probiotics aims at the prevention of secondary colonization of the upper and/or lower digestive tract. We performed a literature review to describe the differences and similarities between SDD/SOD and probiotic preventive strategies, focusing on (a) efficacy, (b) risks, and (c) the routing of these strategies. Reductions in the incidence of VAP have been achieved with SDD and SOD. Two large randomized controlled trials even showed reduced mortality with these preventive strategies. Randomized controlled trials of probiotic strategies also showed a reduction of the incidence of VAP, but trials were too small to draw firm conclusions. Preventive strategies with antibiotics and probiotics may be limited due to the risk of emerging resistance to the locally applied antibiotics and the risk of probiotic-related infections, respectively. The majority of trials of SDD and SOD did not exhaustively address the issue of emerging resistance. Likewise, trials of probiotic strategies did not adequately address the risk of colonization with probiotics and probiotic-related infection. In studies of SDD and SOD the preventive strategy aimed at decontamination of the oral cavity, throat, stomach and intestines, and the oral cavity and throat, respectively. In the vast majority of studies of probiotic therapy the preventive strategy aimed at decontamination of the stomach and intestines. Prophylactic use of antibiotics in critically ill patients is effective in reducing the incidence of VAP

  6. The impact of implementing multifaceted interventions on the prevention of ventilator-associated pneumonia.

    Science.gov (United States)

    Khan, Raymond; Al-Dorzi, Hasan M; Al-Attas, Khalid; Ahmed, Faisal Wali; Marini, Abdellatif M; Mundekkadan, Shihab; Balkhy, Hanan H; Tannous, Joseph; Almesnad, Adel; Mannion, Dianne; Tamim, Hani M; Arabi, Yaseen M

    2016-03-01

    Ventilator-associated pneumonia (VAP) is a frequent hospital acquired infections among intensive care unit patients. The Institute for Healthcare Improvement has suggested a "care bundle" approach for the prevention of VAP. This report describes the effects of implementing this strategy on VAP rates. All mechanically ventilated patients admitted to the intensive care unit between 2008 and 2013 were prospectively followed for VAP development according to the National Healthcare Safety Network criteria. In 2011, a 7-element care bundle was implemented, including head-of-bed elevation 30°-45°, daily sedation vacation and assessment for extubation, peptic ulcer disease prophylaxis, deep vein thrombosis prophylaxis, oral care with chlorhexidine, endotracheal intubation with in-line suction and subglottic suctioning, and maintenance of endotracheal tube cuff pressure at 20-30 mmHg. The bundle compliance and VAP rates were then followed. A total of 3665 patients received mechanical ventilation, and there were 9445 monitored observations for bundle compliance. The total bundle compliance before and after initiation of the VAP team was 90.7% and 94.2%, respectively (P < .001). The number of VAP episodes decreased from 144 during 2008-2010 to only 14 during 2011-2013 (P < .0001). The rate of VAP decreased from 8.6 per 1000 ventilator-days to 2.0 per 1000 ventilator-days (P < .0001) after implementation of the care bundle. This study suggests that systematic implementation of a multidisciplinary team approach can reduce the incidence of VAP. Further sustained improvement requires persistent vigilant inspections. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  7. The business case for preventing ventilator-associated pneumonia in pediatric intensive care unit patients.

    Science.gov (United States)

    Brilli, Richard J; Sparling, Karen W; Lake, Michael R; Butcher, John; Myers, Sarah S; Clark, Marta D; Helpling, Alma; Stutler, Mary E

    2008-11-01

    A retrospective matched (1:1) case-control study was conducted to compare the financial impact and costs attributable to ventilator-associated pneumonia (VAP) in a 25-bed pediatric intensive care unit (PICU) in a 475-bed quaternary-care pediatric hospital from the perspective of multiple stakeholders, including the hospital and payors. For PICU patients with VAP from January 1 2005, to December 31, 2005, 13 patients were matched to 13 control patients by age, sex, severity of illness, primary diagnosis, underlying illness, surgical procedures, and duration of mechanical ventilation. The mean hospital length of stay (LOS) for VAP patients was 26.5 +/- 13.1 days compared with 17.8 +/- 4.7 days for non-VAP patients (p = .032). The hospital LOS attributable to VAP was 8.7 days. The mean hospital costs for VAP patients was $156,110 +/- $80,688 compared with $104,953 +/- $59,191 for non-VAP patients (p = 0.026). The attributable VAP costs were $51,157. After implementation of the VAP prevention bundle, VAP rates decreased from 7.8 cases per 1,000 ventilator days in fiscal year (FY) 2005 to 0.5 cases per 1,000 ventilator days in FY 2007 (VAP infections: 24 in FY 2005, 9 in FY 2006, 2 in FY 2007; p business case analysis of this pediatric-specific intervention as described from the perspective of multiple stakeholders. A return on investment may speed health care organizations' investment in patient safety and quality improvement.

  8. Ventilator associated pneumonia or ventilator induced pneumonia.

    Science.gov (United States)

    Khan, Zahid Hussain; Ceriana, Piero; Donner, Claudio F

    2017-01-01

    Ventilator associated pneumonia currently in vogue seems to have some pitfalls as far as the nomenclature is concerned and thus it imparts an erroneous impression to the reader. As the driving force is in fact the ventilator, the phraseology should preferably be changed to ventilator induced pneumonia to convey the in depth meaning of the term thus evading the terminology currently in practice. A new and emerging paradigm dealing with all side effects of mechanical ventilation can be helpful to solve this etymological conflict.

  9. Frequently Asked Questions about Ventilator-Associated Pneumonia

    Science.gov (United States)

    ... Vaccine Safety Frequently Asked Questions about Ventilator-associated Pneumonia Recommend on Facebook Tweet Share Compartir What is a Ventilator-associated Pneumonia (VAP)? Ventilator-associated pneumonia (VAP) is a lung ...

  10. Attributable mortality of ventilator-associated pneumonia: a meta-analysis of individual patient data from randomised prevention studies

    NARCIS (Netherlands)

    Melsen, W.G.; Rovers, M.M.; Groenwold, R.H.; Bergmans, D.C.; Camus, C.; Bauer, T.T.; Hanisch, E.W.; Klarin, B.; Koeman, M.; Krueger, W.A.; Lacherade, J.C.; Lorente, L.; Memish, Z.A.; Morrow, L.E.; Nardi, G.; Nieuwenhoven, C.A. van; O'Keefe, G.E.; Nakos, G.; Scannapieco, F.A.; Seguin, P.; Staudinger, T.; Topeli, A.; Ferrer, M.; Bonten, M.J.

    2013-01-01

    BACKGROUND: Estimating attributable mortality of ventilator-associated pneumonia has been hampered by confounding factors, small sample sizes, and the difficulty of doing relevant subgroup analyses. We estimated the attributable mortality using the individual original patient data of published

  11. [Prevention of ventilator-associated pneumonia: a comparison of level of knowledge in three critical care units].

    Science.gov (United States)

    Pujante-Palazón, I; Rodríguez-Mondéjar, J J; Armero-Barranco, D; Sáez-Paredes, P

    2016-01-01

    To determine the level of knowledge of the prevention of ventilator-associated pneumonia guidelines of nurses working in three intensive care units (ICU) in 3 university hospitals in a Spanish region, and evaluate the relationship between this level of knowledge and years worked in the ICU. A descriptive, prospective, cross-sectional, multicentre study was conducted using a validated and reliable questionnaire, made up by 9 questions with closed answers drawn from the EVIDENCE study. A total of 98 questionnaires were collected from ICU nurses of the three university hospitals (A, B, and C) from January to April 2014. The sample from hospital A responded the most, in contrast with the sample from hospital B, which was the one with the less participation. The Pearson correlation was calculated in order to determine the relationship between nurse years worked in ICU and level of knowledge. Hospital A obtained in the best mean score in the questionnaire, 6.33 (SD 1.4) points, followed by hospital C with 6.21 (SD 1.4), and finally, the hospital B with 6.06 (SD 1.5) points. A p=.08 was obtained on relating years worked with the level of knowledge. The results showed a high level of knowledge compared other studies. There was a tendency between the years worked in the unit and the level of knowledge in ventilator-associated pneumonia prevention. Copyright © 2016 Elsevier España, S.L.U. y SEEIUC. All rights reserved.

  12. Effectiveness of heat and moisture exchangers in preventing ventilator-associated pneumonia in critically ill patients: a meta-analysis.

    Science.gov (United States)

    Menegueti, Mayra Gonçalves; Auxiliadora-Martins, Maria; Nunes, Altacílio Aparecido

    2014-01-01

    Patients may acquire ventilator-associated pneumonia (VAP) by aspirating the condensate that originates in the ventilator circuit upon use of a conventional humidifier. The bacteria that colonize the patients themselves can proliferate in the condensate and then return to the airways and lungs when the patient aspirates this contaminated material. Therefore, the use of HME might contribute to preventing pneumonia and lowering the VAP incidence. The aim of this study was to evaluate how the use of HME impacts the probability of VAP occurrence in critically ill patients. On the basis of the acronym "PICO" (Patient, Intervention, Comparison, Outcome), the question that guided this review was "Do critically ill patients under invasive mechanical ventilation present lower VAP incidence when they use HME as compared with HH?". Two of the authors of this review searched the databases PUBMED/Medline, The Cochrane Library, and Latin-American and Caribbean Literature in Health Sciences, LILACS independently; they used the following keywords: "heat and moisture exchanger", AND "heated humidifier", AND "ventilator-associated pneumonia prevention". This review included papers in the English language published from January 1990 to December 2012. This review included ten studies. Comparison between the use of HME and HH did not reveal any differences in terms of VAP occurrence (OR = 0.998; 95% CI: 0.778-1.281). Together, the ten studies corresponded to a total sample of 1077 and 953 patients in the HME and HH groups, respectively; heterogeneity among the investigations was low (I(2) heat and moisture exchangers and VAP. Despite the methodological limitations found in selected clinical trials, the current meta-analysis suggests that HME does not decrease VAP incidence or mortality in critically ill patients.

  13. Are specialized endotracheal tubes and heat-and-moisture exchangers cost-effective in preventing ventilator associated pneumonia?

    Science.gov (United States)

    Gentile, Michael A; Siobal, Mark S

    2010-02-01

    Ventilator-associated pneumonia (VAP) is a common and serious complication of mechanical ventilation via an artificial airway. As with all nosocomial infections, VAP increases costs, morbidity, and mortality in the intensive care unit (ICU). VAP prevention is a multifaceted priority of the intensive care team, and can include the use of specialized artificial airways and heat-and-moisture exchangers (HME). Substantial evidence supports the use of endotracheal tubes (ETTs) that allow subglottic suctioning; silver-coated and antiseptic-impregnated ETTs; ETTs with thin-walled polyurethane cuffs; and HMEs, but these devices also can have adverse effects. Controversy still exists regarding the evidence, cost-effectiveness, and disadvantages and risks of these devices.

  14. Prevention of ventilator-associated pneumonia in the intensive care unit: A review of the clinically relevant recent advancements

    Directory of Open Access Journals (Sweden)

    Holly Keyt

    2014-01-01

    Full Text Available Ventilator-associated pneumonia (VAP is one of the most commonly encountered hospital-acquired infections in intensive care units and is associated with significant morbidity and high costs of care. The pathophysiology, epidemiology, treatment and prevention of VAP have been extensively studied for decades, but a clear prevention strategy has not yet emerged. In this article we will review recent literature pertaining to evidence-based VAP-prevention strategies that have resulted in clinically relevant outcomes. A multidisciplinary strategy for prevention of VAP is recommended. Those interventions that have been shown to have a clinical impact include the following: (i Non-invasive positive pressure ventilation for able patients, especially in immunocompromised patients, with acute exacerbation of chronic obstructive pulmonary disease or pulmonary oedema, (ii Sedation and weaning protocols for those patients who do require mechanical ventilation, (iii Mechanical ventilation protocols including head of bed elevation above 30 degrees and oral care, and (iv Removal of subglottic secretions. Other interventions, such as selective digestive tract decontamination, selective oropharyngeal decontamination and antimicrobial-coated endotracheal tubes, have been tested in different studies. However, the evidence for the efficacy of these measures to reduce VAP rates is not strong enough to recommend their use in clinical practice. In numerous studies, the implementation of VAP prevention bundles to clinical practice was associated with a significant reduction in VAP rates. Future research that considers clinical outcomes as primary endpoints will hopefully result in more detailed prevention strategies.

  15. Ventilator associated pneumonia and infection control

    NARCIS (Netherlands)

    Alp, E.; Voss, A.

    2006-01-01

    Ventilator associated pneumonia (VAP) is the leading cause of morbidity and mortality in intensive care units. The incidence of VAP varies from 7% to 70% in different studies and the mortality rates are 20-75% according to the study population. Aspiration of colonized pathogenic microorganisms on

  16. Impact of oral hygiene involving toothbrushing versus chlorhexidine in the prevention of ventilator-associated pneumonia: a randomized study.

    Science.gov (United States)

    de Lacerda Vidal, Claudia Fernanda; Vidal, Aurora Karla de Lacerda; Monteiro, José Gildo de Moura; Cavalcanti, Aracele; Henriques, Ana Paula Trindade; Oliveira, Márcia; Godoy, Michele; Coutinho, Mirella; Sobral, Pollyanna Dutra; Vilela, Claudia Ângela; Gomes, Bárbara; Leandro, Marta Amorim; Montarroyos, Ulisses; Ximenes, Ricardo de Alencar; Lacerda, Heloísa Ramos

    2017-01-31

    Nosocomial pneumonia has correlated to dental plaque and to oropharynx colonization in patients receiving mechanical ventilation. The interruption of this process, by preventing colonization of pathogenic bacteria, represents a potential procedure for the prevention of ventilator-associated pneumonia (VAP). The study design was a prospective, randomized trial to verify if oral hygiene through toothbrushing plus chlorhexidine in gel at 0.12% reduces the incidence of ventilatior-associated pneumonia, the duration of mechanical ventilation, the length of hospital stay and the mortality rate in ICUs, when compared to oral hygiene only with chlorhexidine, solution of 0.12%, without toothbrushing, in adult individuals under mechanical ventilation, hospitalized in Clinical/Surgical and Cardiology Intensive Care Units (ICU). The study protocol was approved by the Ethical Committee of Research of the Health Sciences Center of the Federal University of Pernambuco - Certificate of Ethical Committee Approval (CAAE) 04300012500005208. Because it was a randomized trial, the research used CONSORT 2010 checklist criteria. Seven hundred sixteen patients were admitted into the ICU; 219 fulfilled the criteria for inclusion and 213 patients were included; 108 were randomized to control group and 105 to intervention group. Toothbrushing plus 0.12% chlorhexidine gel demonstrated a lower incidence of VAP throughout the follow up period, although the difference was not statistically significant (p = 0.084). There was a significant reduction of the mean time of mechanical ventilation in the toothbrushing group (p = 0.018). Regarding the length of hospital stay in the ICU and mortality rates, the difference was not statistically significant (p = 0.064). The results obtained showed that, among patients undergoing toothbrushing there was a significant reduction in duration of mechanical ventilation, and a tendency to reduce the incidence of VAP and length of ICU stay, although

  17. A study of ventilator-associated pneumonia: Incidence, outcome, risk factors and measures to be taken for prevention

    Directory of Open Access Journals (Sweden)

    Hina Gadani

    2010-01-01

    Full Text Available Ventilator-associated pneumonia (VAP is a major cause of hospital morbidity and mortality despite recent advances in diagnosis and accuracy of management. However, as taught in medical science, prevention is better than cure is probably more appropriate as concerned to VAP because of the fact that it is a well preventable disease and a proper approach decreases the hospital stay, cost, morbidity and mortality. The aim of the study is to critically review the incidence and outcome, identify various risk factors and conclude specific measures that should be undertaken to prevent VAP. We studied 100 patients randomly, kept on ventilatory support for more than 48 h. After excluding those who developed pneumonia within 48 h, VAP was diagnosed when a score of ≥6 was obtained in the clinical pulmonary infection scoring system having six variables and a maximum score of 12. After evaluating, the data were subjected to univariate analysis using the chi-square test. The level of significance was set at P96 h was 73%. Late-onset VAP had poor prognosis in terms of mortality (66% as compared to the early-onset type (20%. The mortality of patients of the non-VAP group was found to be 41% while that of VAP patients was 54%. Targeted strategies aimed at preventing VAP should be implemented to improve patient outcome and reduce length of intensive care unit stay and costs. Above all, everyone of the critical care unit should understand the factors that place the patients at risk of VAP and utmost importance must be given to prevent VAP.

  18. Physiotherapy does not prevent, or hasten recovery from, ventilator-associated pneumonia in patients with acquired brain injury.

    Science.gov (United States)

    Patman, Shane; Jenkins, Sue; Stiller, Kathy

    2009-02-01

    To investigate the effect of respiratory physiotherapy on the prevention and treatment of ventilator-associated pneumonia (VAP) for adults in an intensive care unit (ICU) with an acquired brain injury (ABI). Two-part, prospective, randomised controlled trial. A total of 144 subjects with ABI admitted with a Glasgow Coma Scale 24 h; 33 subjects were subsequently diagnosed with VAP. Respiratory physiotherapy comprised six treatments (positioning, manual hyperinflation and suctioning) in each 24-h period whilst on MV. The Control Group received standard medical/nursing care but no respiratory physiotherapy. There were no significant differences between groups for incidence of VAP, duration of MV, length of ICU stay or clinical variables such as requirement for re-ventilation. In adults with ABI, regular respiratory physiotherapy in addition to routine medical/nursing care does not appear to prevent VAP, reduce length of MV or ICU stay. Due to small numbers, it is not possible to draw any conclusions as to whether or not respiratory physiotherapy hastens recovery from VAP.

  19. Nursing workload and adherence to non-pharmacological measures in the prevention of ventilator-associated pneumonia. A pilot study.

    Science.gov (United States)

    Jam, R; Hernández, O; Mesquida, J; Turégano, C; Carrillo, E; Pedragosa, R; Gómez, V; Martí, L; Vallés, J; Delgado-Hito, P

    To analyse whether adherence to non-pharmacological measures in the prevention of ventilator-associated pneumonia (VAP) is associated with nursing workload. A prospective observational study performed in a single medical-surgical ICU. Nurses in charge of patients under ventilator support were assessed. knowledge questionnaire, application of non-pharmacological VAP prevention measures, and workload (Nine Equivalents of Nursing Manpower Use Score). Phases: 1) the nurses carried out a educational programme, consisting of 60-minute lectures on non-pharmacological measures for VAP prevention, and at the end completed a questionnaire knowledge; 2) observation period; 3) knowledge questionnaire. Among 67 ICU-staff nurses, 54 completed the educational programme and were observed. A total of 160 observations of 49 nurses were made. Adequate knowledge was confirmed in both the initial and final questionnaires. Application of preventive measures ranged from 11% for hand washing pre-aspiration to 97% for the use of a sterile aspiration probe. The Nine Equivalents of Nursing Manpower Use Score was 50±13. No significant differences were observed between the association of the nurses' knowledge and the application of preventive measures or between workload and the application of preventive measures. Nurses' knowledge of VAP prevention measures is not necessarily applied in daily practice. Failure to follow these measures is not subject to lack of knowledge or to increased workload, but presumably to contextual factors. Copyright © 2017 Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC). Publicado por Elsevier España, S.L.U. All rights reserved.

  20. Oral topical decontamination for preventing ventilator-associated pneumonia: a systematic review and meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Li, J; Xie, D; Li, A; Yue, J

    2013-08-01

    Oral decontamination is proposed to be an effective prevention of ventilator-associated pneumonia (VAP). The objective of this paper was to evaluate the effectiveness of oral decontamination in adult patients undergoing ventilation for more than 48h. We included all randomized controlled trials that used oral topical decontamination in adult patients from any population requiring mechanical ventilation for more than 48h, versus placebo, normal saline, or standard oral care. Sixteen trials involving 2399 participants were included. Meta-analysis showed that oral topical antiseptics significantly reduced the incidence of VAP [risk ratio (RR): 0.66; 95% confidence interval (CI): 0.49-0.88]. There was a significant reduction of VAP in studies which investigated decontamination with antibiotic agents other than iseganan (RR: 0.27; 95% CI: 0.18-0.42). Neither antiseptics nor antibiotics affected all-cause mortality, duration of ventilation, or duration of intensive care unit (ICU) stay. Oral decontamination reduced the incidence of VAP in adults undergoing ventilation, but did not affect all-cause mortality, duration of ventilation, or duration of ICU stay in ventilated patients. Further evidence from higher quality trials is necessary. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

  1. [Prevention Effect of Thymosin-alpha1 Aganist Early Ventilator-associated Pneumonia in Patients with Mechanical Ventilation].

    Science.gov (United States)

    Zhang, Song-song; Li, Kun; Wang, Yu-hui; Ye, Ba-ning; Pan, Yu; Shi, Xian-qing

    2015-11-01

    To investigate the preventive effects of thymosin-alpha1 against early ventilator-associated pneumonia (VAP) in the patients with mechanical ventilation. Fifty two patients with expectancy of mechanical ventilation over 48 h were divided into routine therapy group (n=26) and thymosin therapy group (n= 26) in random. The patients in routine therapy group were given intensive care unit (ICU) conventional treatment, and the patients in thymosin therapy group were given thymosin treatment additionally (1.6 mg subcutaneous injection, qd X 7 d). The incidence and occurrence time of VAP were observed, and the time of mechanical ventilation and ICU stay were recorded. The levels of CD3+, CD4+, CD4+ /CD8+ T lymphocyte, CD14+ mononuclear cell human leukocyte antigens-DR (CD14+ HLA-DR) and procalcitonin (PCT) were detected before mechanical ventilation and at the 3d and 7th d after mechanical ventilation. The base line including the level of immunologic function had no difference between the two groups (P>0.05). The incidence of VAP in thymosin therapy group was lower than that in routine therapy group, but it was not significant difference (P>0.05). The durations of machine ventilation and ICU stay in thymosin therapy group were shorter than those in routine therapy group (Pmechanical ventilation, thymosin therapy group achived higher levels of CD3+, CD4+, CD4+ /CD8+ T lymphocyte and CD14+ HLA-DR than routine therapy group did (Pmechanical ventilation.

  2. Guidelines for the prevention of ventilator-associated pneumonia and their implementation. The Spanish "Zero-VAP" bundle.

    Science.gov (United States)

    Álvarez Lerma, F; Sánchez García, M; Lorente, L; Gordo, F; Añón, J M; Álvarez, J; Palomar, M; García, R; Arias, S; Vázquez-Calatayud, M; Jam, R

    2014-05-01

    "Zero-VAP" is a proposal for the implementation of a simultaneous multimodal intervention in Spanish intensive care units (ICU) consisting of a bundle of ventilator-associated pneumonia (VAP) prevention measures. An initiative of the Spanish Societies of Intensive Care Medicine and of Intensive Care Nurses, the project is supported by the Spanish Ministry of Health, and participation is voluntary. In addition to guidelines for VAP prevention, the "Zero-VAP" Project incorporates an integral patient safety program and continuous online validation of the application of the bundle. For the latter, VAP episodes and participation indices are entered into the web-based Spanish ICU Infection Surveillance Program "ENVIN-HELICS" database, which provides continuous information about local, regional and national VAP incidence rates. Implementation of the guidelines aims at the reduction of VAP to less than 9 episodes per 1000 days of mechanical ventilation. A total of 35 preventive measures were initially selected. A task force of experts used the Grading of Recommendations, Assessment, Development and Evaluation Working Group methodology to generate a list of 7 basic "mandatory" recommendations (education and training in airway management, strict hand hygiene for airway management, cuff pressure control, oral hygiene with chlorhexidine, semi-recumbent positioning, promoting measures that safely avoid or reduce time on ventilator, and discouraging scheduled changes of ventilator circuits, humidifiers and endotracheal tubes) and 3 additional "highly recommended" measures (selective decontamination of the digestive tract, aspiration of subglottic secretions, and a short course of iv antibiotic). We present the Spanish VAP prevention guidelines and describe the methodology used for the selection and implementation of the recommendations and the organizational structure of the project. Compared to conventional guideline documents, the associated safety assurance program, the

  3. [Efficacy of heat and moisture exchangers and heated humidifiers in preventing ventilator-associated pneumonia: a meta-analysis].

    Science.gov (United States)

    Mo, Min; Liu, Song-qiao; Yang, Yi

    2011-09-01

    To demonstrate the effects of heat and moisture exchangers (HME) and heated humidifiers(HH) in preventing ventilator-associated pneumonia (VAP). PubMed and Cochrane databases were searched by computer retrieval and manual retrieval to identify relevant randomized controlled trials (RCTs) using HMEs and HHs in preventing VAP from January 1st 1990 to September 1st 2010. Meta-analysis of HME and HH in preventing VAP was conducted using the methods recommended by the Cochrane Collaboration. Eleven RCTs were included. 1 121 in HME group and 1 101 in HH group. In total, the rate of VAP in HME group and HH group was 14.2% (159/1 121) and 15.9% (175/1 101) respectively, the total relative risk (RR) was 0.88, and 95% confidence interval (95%CI) 0.72-1.07, P=0.21. Compared with HH group, there was not a reduction in the risk ratio of VAP in the HME group. Even in mechanical ventilation(MV) with a duration of at least 7 days for subgroup analysis (8 RCTs, sample size: 834 in HME group and 859 in HH group), the rate of VAP in HME group and HH group was 15.2% (127/834) and 17.5% (150/859) respectively, the total RR was 0.84, 95%CI 0. 58-1.23, P=0.37, suggesting that in MV with a duration at least 7 days, there was also no reduction in the risk ratio of VAP in the HME group. This study suggests there is not a significant reduction in the incidence of VAP in patients humidified with HMEs during MV, even in patients ventilated for 7 days or longer. This finding is limited by lack of enough RCTs and blinding. Further large sample of high quality RCTs is necessary to examine the wider applicability of HMEs and their extended use.

  4. Implementation of a Sustainable Ventilator-Associated Pneumonia Prevention Protocol in a Pediatric Intensive Care Unit in Managua, Nicaragua.

    Science.gov (United States)

    Chinnadurai, Kelsey; Fenlason, Lindy; Bridges, Brian; Espahbodi, Mana; Chinnadurai, Sivakumar; Blood-Siegfried, Jane

    Ventilator-associated pneumonia (VAP) is a common nosocomial infection in pediatric intensive care units (ICUs). Ventilator-associated pneumonia protocols decrease the incidence of VAP; however, many components of these protocols are not feasible in all settings. This study was done in a large pediatric hospital in Nicaragua. The aim of this study is to implement a sustainable evidence-based VAP protocol, in a different culture, for the purpose of decreasing VAP rates. This quality improvement study used a bidirectional cohort design with the retrospective group as the control and the prospective group as the experimental population. A daily checklist monitored compliance to the implemented protocol in the prospective group. A 2-sided Fisher exact test compared the differences in VAP rates between the 2 populations. During the 90-day implementation period, 123 ventilated patients in 3 separate ICU wings were evaluated, with 99 included in the final analysis. These data for 2014 were compared with the VAP rates recorded for the same time period in 2013. The highest adherence to the protocol was demonstrated by ICU wing 1, with a 90% decrease in VAP rates. No statistical difference in VAP rates was demonstrated by ICU 2, and ICU 3 demonstrated an increase in both patient acuity and VAP rates. Implementation of a sustainable VAP protocol in a pediatric ICU in Nicaragua can reduce the incidence of VAP. Multiple barriers and challenges associated with implementation in a resource-constrained environment are discussed.

  5. Probiotics for Preventing Ventilator-Associated Pneumonia in Mechanically Ventilated Patients: A Meta-Analysis with Trial Sequential Analysis

    Directory of Open Access Journals (Sweden)

    Hong Weng

    2017-10-01

    Full Text Available Background and Objective: Ventilator-associated pneumonia (VAP is still an important cause of morbidity and mortality in mechanically ventilated patients. The efficacy of the probiotics for preventing VAP is still controversial. Present study was conducted to comprehensively evaluate the effect of probiotics on VAP prevention in mechanically ventilated patients.Methods: PubMed, Embase, and CENTRAL were searched up to September 2016. Eligible trials designed with randomized controlled trials (RCTs comparing probiotics with control in mechanically ventilated patients were included. Risk ratios (RRs and mean differences (MDs with 95% confidence intervals (CIs were estimated with fixed or random effects models. Trial sequential analysis (TSA was performed using TSA 0.9beta software.Results: Thirteen RCTs (N = 1969 were included. Overall, probiotics were associated with reduced incidence of VAP (RR = 0.73, 95% CI = 0.60–0.89; P = 0.002, which was confirmed by TSA (TSA adjusted 95% CI = 0.55–0.96. However, no significant difference was observed in 90-day mortality (RR = 1.00, 95% CI = 0.72–1.37; P = 0.99, overall mortality (RR = 0.84, 95% CI = 0.70–1.02; P = 0.09, 28-day mortality (RR = 1.06, 95% CI = 0.72–1.57; P = 0.99, intensive care unit (ICU mortality (RR = 0.97, 95% CI = 0.74–1.27; P = 0.82, hospital mortality (RR = 0.81, 95% CI = 0.65–1.02; P = 0.07, diarrhea (RR = 0.99, 95% CI = 0.83–1.19; P = 0.92, length of ICU stay (MD = −2.40 days, 95% CI = −6.75 to 1.95; P = 0.28, length of hospital stay (MD = −1.34 days, 95% CI = −6.21 to 3.54; P = 0.59, and duration of mechanical ventilation (MD = −3.32 days, 95% CI = −6.74 to 0.09; P = 0.06.Conclusions: In this meta-analysis, we found that probiotics could reduce the incidence of VAP in mechanically ventilated patients. It seems likely that probiotics provide clinical benefits for mechanically ventilated patients.

  6. Effect of heat and moisture exchangers on the prevention of ventilator-associated pneumonia in critically ill patients.

    Science.gov (United States)

    Auxiliadora-Martins, M; Menegueti, M G; Nicolini, E A; Alkmim-Teixeira, G C; Bellissimo-Rodrigues, F; Martins-Filho, O A; Basile-Filho, A

    2012-12-01

    Ventilator-associated pneumonia (VAP) remains one of the major causes of infection in the intensive care unit (ICU) and is associated with the length of hospital stay, duration of mechanical ventilation, and use of broad-spectrum antibiotics. We compared the frequency of VAP 10 months prior to (pre-intervention group) and 13 months after (post-intervention group) initiation of the use of a heat and moisture exchanger (HME) filter. This is a study with prospective before-and-after design performed in the ICU in a tertiary university hospital. Three hundred and fourteen patients were admitted to the ICU under mechanical ventilation, 168 of whom were included in group HH (heated humidifier) and 146 in group HME. The frequency of VAP per 1000 ventilator-days was similar for both the HH and HME groups (18.7 vs 17.4, respectively; P = 0.97). Duration of mechanical ventilation (11 vs 12 days, respectively; P = 0.48) and length of ICU stay (11 vs 12 days, respectively; P = 0.39) did not differ between the HH and HME groups. The chance of developing VAP was higher in patients with a longer ICU stay and longer duration of mechanical ventilation. This finding was similar when adjusted for the use of HME. The use of HME in intensive care did not reduce the incidence of VAP, the duration of mechanical ventilation, or the length of stay in the ICU in the study population.

  7. Effect of heat and moisture exchangers on the prevention of ventilator-associated pneumonia in critically ill patients

    Science.gov (United States)

    Auxiliadora-Martins, M.; Menegueti, M.G.; Nicolini, E.A.; Alkmim-Teixeira, G.C.; Bellissimo-Rodrigues, F.; Martins-Filho, O.A.; Basile-Filho, A.

    2012-01-01

    Ventilator-associated pneumonia (VAP) remains one of the major causes of infection in the intensive care unit (ICU) and is associated with the length of hospital stay, duration of mechanical ventilation, and use of broad-spectrum antibiotics. We compared the frequency of VAP 10 months prior to (pre-intervention group) and 13 months after (post-intervention group) initiation of the use of a heat and moisture exchanger (HME) filter. This is a study with prospective before-and-after design performed in the ICU in a tertiary university hospital. Three hundred and fourteen patients were admitted to the ICU under mechanical ventilation, 168 of whom were included in group HH (heated humidifier) and 146 in group HME. The frequency of VAP per 1000 ventilator-days was similar for both the HH and HME groups (18.7 vs 17.4, respectively; P = 0.97). Duration of mechanical ventilation (11 vs 12 days, respectively; P = 0.48) and length of ICU stay (11 vs 12 days, respectively; P = 0.39) did not differ between the HH and HME groups. The chance of developing VAP was higher in patients with a longer ICU stay and longer duration of mechanical ventilation. This finding was similar when adjusted for the use of HME. The use of HME in intensive care did not reduce the incidence of VAP, the duration of mechanical ventilation, or the length of stay in the ICU in the study population. PMID:23044627

  8. Effect of heat and moisture exchangers on the prevention of ventilator-associated pneumonia in critically ill patients

    Directory of Open Access Journals (Sweden)

    M. Auxiliadora-Martins

    2012-12-01

    Full Text Available Ventilator-associated pneumonia (VAP remains one of the major causes of infection in the intensive care unit (ICU and is associated with the length of hospital stay, duration of mechanical ventilation, and use of broad-spectrum antibiotics. We compared the frequency of VAP 10 months prior to (pre-intervention group and 13 months after (post-intervention group initiation of the use of a heat and moisture exchanger (HME filter. This is a study with prospective before-and-after design performed in the ICU in a tertiary university hospital. Three hundred and fourteen patients were admitted to the ICU under mechanical ventilation, 168 of whom were included in group HH (heated humidifier and 146 in group HME. The frequency of VAP per 1000 ventilator-days was similar for both the HH and HME groups (18.7 vs 17.4, respectively; P = 0.97. Duration of mechanical ventilation (11 vs 12 days, respectively; P = 0.48 and length of ICU stay (11 vs 12 days, respectively; P = 0.39 did not differ between the HH and HME groups. The chance of developing VAP was higher in patients with a longer ICU stay and longer duration of mechanical ventilation. This finding was similar when adjusted for the use of HME. The use of HME in intensive care did not reduce the incidence of VAP, the duration of mechanical ventilation, or the length of stay in the ICU in the study population.

  9. Prevention of Ventilator-Associated and Early Postoperative Pneumonia Through Tapered Endotracheal Tube Cuffs: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

    Science.gov (United States)

    Maertens, Bert; Blot, Koen; Blot, Stijn

    2018-02-01

    Microaspiration of subglottic secretions is considered a major pathogenic mechanism of hospital-acquired pneumonia, either early postoperative or ventilator-associated pneumonia. Tapered endotracheal tube cuffs have been proposed to provide a better seal of the extraluminal airway, thereby preventing microaspiration and possibly hospital-acquired pneumonia. We performed a systematic review and meta-analysis to assess the value of endotracheal tubes with tapered cuffs in the prevention of hospital-acquired pneumonia. A systematic search of MEDLINE, EMBASE, CENTRAL/CCTR, ClinicalTrials.gov, and ICTRP was conducted up to March 2017. Eligible trials were randomized controlled clinical trials comparing the impact of tapered cuffs versus standard cuffs on hospital-acquired pneumonia. Random-effects meta-analysis calculated odds ratio and 95% CI for hospital-acquired pneumonia occurrence rate between groups. Secondary outcome measures included mortality, duration of mechanical ventilation, length of hospital and ICU stay, and cuff underinflation. Six randomized controlled clinical trials with 1,324 patients from intensive care and postoperative wards were included. Only two studies concomitantly applied subglottic secretion drainage, and no trial performed continuous cuff pressure monitoring. No significant difference in hospital-acquired pneumonia incidence per patient was found when tapered cuffs were compared with standard cuffs (odds ratio, 0.97; 95% CI, [0.73-1.28]; p = 0.81). There were likewise no differences in secondary outcomes. Application of tapered endotracheal tube cuffs did not reduce hospital-acquired pneumonia incidence among ICU and postoperative patients. Further research should examine the impact of concomitant use of tapered cuffs with continuous cuff pressure monitoring and subglottic secretion drainage.

  10. Probiotics for preventing ventilator-associated pneumonia: a systematic review and meta-analysis of high-quality randomized controlled trials.

    Science.gov (United States)

    Wang, Jie; Liu, Kai-xiong; Ariani, Felinda; Tao, Li-Li; Zhang, Jing; Qu, Jie-Ming

    2013-01-01

    Ventilator-associated pneumonia (VAP) is considered to be a worldwide issue along with the development of supportive ventilation. The preventing strategy is of great importance for its poor prognostic and difficulties in treatment. Probiotics have been advocated as one of the possible preventive measures. We conducted a systematic review and meta-analysis to explore the potential benefits of probiotics. The databases, Web of science, PubMed, Ovid and Cochrane lib were searched for randomized controlled trials (RCTs) publications that compared the effectiveness of probiotics with placebo in the prevention of VAP. The incidence of VAP was considered as the primary endpoint, mortality, length of stay in intensive care units (ICUs), etiology of the infections were considered as secondary endpoints. A total of 844 patients from 5 trials were subjected to meta-analysis. Probiotics did not significantly decrease the incidence of VAP (RR 0.94, 95%CI 0.85-1.04, p=0.22), however, the administration of probiotics reduced the risk of VAP caused by Pseudomonas aeruginosa (P. aeruginosa) (RR 0.30, 95%CI 0.11-0.91, P=0.03). It failed to affect any other endpoints. Probiotic prophylaxis of ventilator-associated pneumonia remained inconclusive and it failed to improve the prognosis of general mechanically ventilated patients. It was noteworthy that infections caused by P. aeruginosa was reduced by administration of probiotics. In further, it is recommended that advanced studies should exploit transformation in pathogenic microorganisms owing to administration of probiotics as well as the specific population.

  11. Probiotics for preventing ventilator-associated pneumonia: a systematic review and meta-analysis of high-quality randomized controlled trials.

    Directory of Open Access Journals (Sweden)

    Jie Wang

    Full Text Available BACKGROUND: Ventilator-associated pneumonia (VAP is considered to be a worldwide issue along with the development of supportive ventilation. The preventing strategy is of great importance for its poor prognostic and difficulties in treatment. Probiotics have been advocated as one of the possible preventive measures. We conducted a systematic review and meta-analysis to explore the potential benefits of probiotics. METHODS: The databases, Web of science, PubMed, Ovid and Cochrane lib were searched for randomized controlled trials (RCTs publications that compared the effectiveness of probiotics with placebo in the prevention of VAP. The incidence of VAP was considered as the primary endpoint, mortality, length of stay in intensive care units (ICUs, etiology of the infections were considered as secondary endpoints. RESULTS: A total of 844 patients from 5 trials were subjected to meta-analysis. Probiotics did not significantly decrease the incidence of VAP (RR 0.94, 95%CI 0.85-1.04, p=0.22, however, the administration of probiotics reduced the risk of VAP caused by Pseudomonas aeruginosa (P. aeruginosa (RR 0.30, 95%CI 0.11-0.91, P=0.03. It failed to affect any other endpoints. CONCLUSION: Probiotic prophylaxis of ventilator-associated pneumonia remained inconclusive and it failed to improve the prognosis of general mechanically ventilated patients. It was noteworthy that infections caused by P. aeruginosa was reduced by administration of probiotics. In further, it is recommended that advanced studies should exploit transformation in pathogenic microorganisms owing to administration of probiotics as well as the specific population.

  12. Investigation of Ventilator Associated Pneumoniae in Intensive Care Patients

    Directory of Open Access Journals (Sweden)

    Hakan Tağrıkulu,

    2016-04-01

    Full Text Available Objective: Mechanical ventilator associated pneumonia is a serious infection occurred frequently in intensive care units and associated with high mortality. In this study we aimed to investigate the incidence of ventilator associated pneumonia, the duration of mechanical ventilation, length of intensive care unit stay, complication occurrence and mortality rates on patients undergoing mechanical ventilation for more than 48 hours. Material and Method: Two hundred twenty patients were included in the study. Demographic data at the time of the admission to intensive care unit (age, sex, height, weight and body mass index, intensive care admission diagnosis and systemic diseases were all recorded. The clinical pulmonary infection score was used for ventilator associated pneumonia diagnosis. Antibiotic usage, duration of stay in intensive care unit, duration of mechanical ventilation stay and mortality were all recorded. Results: Ventilator-associated pneumonia was detected in 51.36% (n=113 of the 220 patients. Clinical pulmonary infection score was found as 8.04±1.03 in patients with ventilator-associated pneumonia and 1.75±1.88 in non- ventilatorassociated pneumonia patients (p=0.001. Higher age was detected in ventilator-associated pneumonia group (58±12.79 years and 51.37±15.87 years, p=0.001. Also hypertension and diabetes mellitus were observed more frequently (p=0.001. Development of enteral nutrition in patients with ventilator-associated pneumonia were significantly higher than those of parenterally fed patients (enteral: by 36.4% and 25.5% p=0.006; parenteral: 25% and 19.1%, p=0.042. The length of stay in intensive care unit (12.38±5.81 and 10.79±5.91 days, p=0.045, duration of mechanical ventilation (9.67±4.84 days and 6.7±3.87 days, p=0.001 and mortality rates (24.5% and 15.5% p=0.019 were significantly higher in the ventilator-associated pneumonia group. Conclusion: Ventilator-associated pneumonia increases the duration of

  13. Effect of antibiotics administered via the respiratory tract in the prevention of ventilator-associated pneumonia: A systematic review and meta-analysis.

    Science.gov (United States)

    Póvoa, Frederico Castro Costa; Cardinal-Fernandez, Pablo; Maia, Israel Silva; Reboredo, Maycon Moura; Pinheiro, Bruno Valle

    2018-02-01

    We evaluated the effect of antibiotics administered via the respiratory tract to prevent the ventilator-associated pneumonia (VAP) in mechanically ventilated (MV) patients. We searched relevant articles for trials that evaluated the impact of prophylactic antibiotics administered through the respiratory tract on the occurrence of VAP. The end-point was the occurrence of VAP in MV patients. We included 6 comparative trials involving 1158 patients (632 received prophylactic antibiotic). Our meta-analysis revealed that prophylactic antibiotics administered through the respiratory tract reduced the occurrence of VAP when compared to placebo or no treatment (OR 0.53; 95% CI 0.34-0.84). This effect was seen when the antibiotics were given by nebulization (OR 0.46; 95% CI 0.22-0.97), but not when they were administered by intratracheal instillation (OR 0.57; 95% CI 0.28-1.15). We did not find a significant difference between the compared groups in the intensive care unit (ICU) mortality (OR 0.89; 95% CI 0.64-1.25). Antibiotic prophylaxis did not impact occurrence of VAP due to multidrug resistant (MDR) pathogens (OR 0.67; 95% CI 0.17-2.62). Prophylactic antibiotics administered through the respiratory tract by nebulization reduce the occurrence of VAP, without a significant effect on either the ICU mortality or occurrence of VAP due to MDR pathogens. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Reducing paediatric ventilator-associated pneumonia – a South ...

    African Journals Online (AJOL)

    There has been a decline in ventilator-associated pneumonia (VAP) in the paediatric intensive care units of developed countries. Previous studies at the Red Cross War Memorial Children's Hospital give an incidence of VAP of >40/1 000 ventilator days, identifying VAP as a priority area for practice improvement. We outline ...

  15. Incidence and outcome of ventilator-associated pneumonia in Inkosi ...

    African Journals Online (AJOL)

    Ventilator-associated pneumonia (VAP) is one of the most common causes of hospital morbidity and mortality, but has ... mortality.' The study was conducted over a period of 6 months in the King. Edward VIII Hospital ICU and Inkosi Albert Luthuli Central Hospital surgical ICU. ... in Latin America and 16.0% in Asia Pacific.

  16. Prior oropharyngeal colonization and ventilator-associated pneumonia

    Directory of Open Access Journals (Sweden)

    Michel Rodrigues Moreira

    2014-09-01

    Full Text Available This study evaluated the relationship between previous colonization of the oropharynx and development of ventilator-associated pneumonia through the classification of genomic fingerprint pattern by pulsed-field gel electrophoresis of both oxacillin-resistant and oxacillin-susceptible Staphylococcus aureus isolates obtained from hospitalized patients in an intensive care unit.

  17. Study of Ventilator Associated Pneumonia in Neonatal Intensive ...

    African Journals Online (AJOL)

    Study of Ventilator Associated Pneumonia in Neonatal Intensive Care Unit: characteristics, risk factors and outcome. ... Most common bacterial isolated from endotracheal aspirate of VAP patients was Klebsiella spp (32.8%), E.coli (23.2%) and Acinetobacter (17.8%) being the other two common organisms. Very low birth ...

  18. Use of Adaptive Support Ventilation (ASV in Ventilator Associated Pneumonia (VAP - A Case Report

    Directory of Open Access Journals (Sweden)

    Bipphy Kath

    2009-01-01

    Full Text Available Prolonged ventilation leads to a higher incidence of ventilator associated pneumonia(VAP resulting in ventilator dependency, increased costs and subsequent weaning failures. Prevention and aggressive treatment of VAP alongwith patient friendly newer modes of ventilation like adaptive support ventilation go a long way in successful management of these cases.

  19. Causes of ventilator associated pneumonia in pediatrics ICU

    Directory of Open Access Journals (Sweden)

    Alireza Nateghian

    2016-04-01

    Full Text Available Background: Hospital acquired infections are associated with prolonged hospitalization and visibly increased mortality & cost. Ventilator-associated pneumonia (VAP is one of the most common hospital-acquired infections VAP complicates the course of 9-70% % of mechanically ventilated patients and mortality varies greatly from 20-25% depending on the defining criteria and specific population being studied. As little is known about the epidemiology, risk factors, and microbiology of VAP in pediatrics we conducted this study to find most common micro-organisms and related risk factors. Materials and methods: We select 1-15 months intubated pediatric patients in Ali- Asghar children hospital in Tehran from 1388 up to end of 1389. 63 cases (36 male & 27 female were included in this study with mean age 22.32±37.84 months. We identified 26 cases with VAP by positive protected bronchial brush. There was no differences between two groups of patients with & without VAP by considering variables such as nasogastric tube, head position, antacid administration, immunosuppressant drugs & chest physiotherapy. Results: The most common organisms, were Pseudomonas aeuroginosa, Staphylococcus aureus & Enterobacter. However, there was no differences between two groups related to the etiologic agents. Conclusion: The findings of this study suggest that most of the complications defined as VAP are patient-related, not modifiable risk factors and it seems that the new prevention strategies are needed to decrease the mortality in intensive care unit patients

  20. Randomized controlled trial and meta-analysis of oral decontamination with 2% chlorhexidine solution for the prevention of ventilator-associated pneumonia.

    Science.gov (United States)

    Tantipong, Hutsaya; Morkchareonpong, Chantana; Jaiyindee, Songyod; Thamlikitkul, Visanu

    2008-02-01

    To determine the effectiveness of oral decontamination with 2% chlorhexidine solution for the prevention of ventilator-associated pneumonia (VAP). Randomized controlled trial and meta-analysis. A tertiary care university hospital in Bangkok, Thailand. Adult patients who received mechanical ventilation and who were hospitalized in intensive care units and general medical wards. The patients were randomized to receive oral decontamination with 2% chlorhexidine solution or normal saline solution 4 times per day until their endotracheal tubes were removed. The outcome measures were the development of VAP and oropharyngeal colonization with gram-negative bacilli. Meta-analysis was performed by combining the results of the present study with those from another randomized controlled trial that also used a 2% chlorhexidine formulation for oral decontamination. The characteristics of the patients in the chlorhexidine group (n=102) and the normal saline group (n=105) were not significantly different. The incidence of VAP in the chlorhexidine group was 4.9% (5 of 102), and the incidence in the normal saline group was 11.4% (12 of 105) (P=.08). The rate of VAP in the chlorhexidine group was 7 episodes per 1,000 ventilator-days, and the rate in the normal saline group was 21 episodes per 1,000 ventilator-days (P=.04). Irritation of the oral mucosa was observed in 10 (9.8%) of the patients in the chlorhexidine group and in 1 (0.9%) of the patients in the normal saline group (P=.001). Oropharyngeal colonization with gram-negative bacilli was either reduced or delayed in the chlorhexidine group. Overall mortality of the patients did not differ significantly between the groups. Meta-analysis of 2 randomized controlled trials revealed an overall relative risk of VAP for patients in the chlorhexidine group of 0.53 (95% confidence interval, 0.31-0.90; P=.02). Oral decontamination with 2% chlorhexidine solution is an effective and safe method for preventing VAP in patients who receive

  1. 75 FR 73107 - Draft Guidance for Industry on Hospital-Acquired Bacterial Pneumonia and Ventilator-Associated...

    Science.gov (United States)

    2010-11-29

    ... Pneumonia and Ventilator-Associated Bacterial Pneumonia: Developing Drugs for Treatment; Availability AGENCY... Pneumonia and Ventilator-Associated Bacterial Pneumonia: Developing Drugs for Treatment.'' The purpose of... antimicrobial drugs for the treatment of hospital- acquired bacterial pneumonia (HABP) and ventilator-associated...

  2. Effects of manual hyperinflation and suctioning in respiratory mechanics in mechanically ventilated patients with ventilator-associated pneumonia

    National Research Council Canada - National Science Library

    Choi, Jessica Siu-Ping; Jones, Alice Yee-Men

    2005-01-01

    ... in ventilator-associated pneumonia. Tracheal suction is often employed by nursing staff in the management of mechanically ventilated patients with ventilator-associated pneumonia but this technique has the potential to increase respiratory resistance...

  3. Ventilator-Associated Pneumonia in Critically Ill Children: A New Paradigm.

    Science.gov (United States)

    Mourani, Peter M; Sontag, Marci K

    2017-10-01

    Ventilator-associated pneumonia (VAP) is a serious complication of critical illness. Surveillance definitions have undergone revisions for more objective and consistent reporting. The 1 organism-1 disease paradigm for microbial involvement may not adequately apply to many cases of VAP, in which pathogens are introduced to a pre-existing and often complex microbial community that facilitates or hinders the potential pathogen, consequently determining whether progression to VAP occurs. As omics technology is applied to VAP, a paradigm is emerging incorporating simultaneous assessments of microbial populations and their activity, as well as the host response, to personalize prevention and treatment. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. A Bayesian decision-support system for diagnosing ventilator-associated pneumonia

    NARCIS (Netherlands)

    Schurink, C.A.; Visscher, S.; Lucas, P.J.; van Leeuwen, H.J.; Buskens, E.; Hoff, R.G.; Hoepelman, A.I.; Bonten, M.J.

    2007-01-01

    OBJECTIVE: To determine the diagnostic performance of a Bayesian Decision-Support System (BDSS) for ventilator-associated pneumonia (VAP). DESIGN: A previously developed BDSS, automatically obtaining patient data from patient information systems, provides likelihood predictions of VAP. In a

  5. Oral decontamination with chlorhexidine reduces the incidence of ventilator-associated pneumonia.

    NARCIS (Netherlands)

    Koeman, M.; Ven, A.J.A.M. van der; Hak, E.; Joore, H.C.; Kaasjager, K.A.; Smet, A.G. de; Ramsay, G.; Dormans, T.P.J.; Aarts, L.P.H.J.; Bel, E.E. de; Hustinx, W.; Tweel, I. van de; Hoepelman, A.M.; Bonten, M.J.M.

    2006-01-01

    RATIONALE: Ventilator-associated pneumonia (VAP) is the most frequently occurring nosocomial infection associated with increased morbidity and mortality. Although oral decontamination with antibiotics reduces incidences of VAP, it is not recommended because of potential selection of

  6. Epidemiological typing of multidrug-resistant Klebsiella pneumoniae, which causes paediatric ventilator-associated pneumonia in Egypt.

    Science.gov (United States)

    Mohamed, Eman R; Aly, Sherine A; Halby, Hamada M; Ahmed, Shabaan H; Zakaria, Amira M; El-Asheer, Osama M

    2017-05-01

    Multidrug-resistant Klebsiella pneumoniae is a common nosocomial pathogen that plays an important role in ventilator-associated pneumonia (VAP). This study aimed to define the clonal relatedness of K. pneumoniae strains isolated from paediatric VAP in addition to those isolated from environmental samples. This study included 19 clinical and 4 environmental K. pneumoniae isolates recovered from the paediatric intensive care unit (PICU) in Assiut University Children's Hospital. The K. pneumoniae isolates were confirmed by biotyping using API strips and subjected to antimicrobial susceptibility testing. The genes coding K1 and K2 capsular types were detected by PCR. The clonal relationships between the K. pneumoniae isolates were determined by pulsed-field gel electrophoresis (PFGE). Ten resistotypes were detected among all the K. pneumoniae isolates, while PFGE identified seventeen K. pneumoniae pulsotypes. Similar PFGE patterns were found between environmental and clinical isolates and between isolates recovered from different patients, suggesting the circulation of K. pneumoniae pathogens in the PICU and the role of the environment in the spread of infection. No correlation was found between the resistotypes and pulsotypes of the K. pneumoniae isolates. PFGE showed higher discriminatory power for the typing of nosocomial K. pneumoniae [Simpson's diversity index (DI)=0.96] than resistotyping (DI=0.72). As far as we know, this is the first report of the isolation of the same multidrug-resistant (MDR) K. pneumoniae pulsotype from patients and environmental samples in the same hospital ward in Egypt. This study provides a step on the way to understanding the genotyping and epidemiology of MDR K. pneumoniae for enhanced prevention of bacterial transmission.

  7. A comparative study of teaching clinical guideline for prevention of ventilator-associated pneumonia in two ways: face-to-face and workshop training on the knowledge and practice of nurses in the intensive care unit.

    Science.gov (United States)

    Yazdani, Majid; Sabetian, Golnar; Ra'ofi, Shahin; Roudgari, Amir; Feizi, Monireh

    2015-04-01

    Ventilator-associated pneumonia (VAP) is one of the most popular nosocomial infections in the intensive care units and the nurse's role in preventing it is very important. The aim of this study was to compare the effect of two methods of face to face training and work- shop clinical guidelines in prevention of VAP. In this experimental randomized clinical trial, the knowledge and practice of nurses in ICUs were studied in two groups: face to face training (35 nurses) and workshops (40 nurses) by using clinical guidelines in prevention of VAP in one of the hospitals of Shiraz University of Medical Sciences. The level of knowledge and practice in each group was assessed by self-report questionnaire, knowledge questionnaire and also direct observation of practice, before and after training. Data were analyzed with descriptive statistics, paired t-test, independent t-test, McNemar test, Fisher's exact, sign and Chi-square test, using SPSS 14. This study demonstrated that both methods of face to face training and workshop were very effective. The incidence of inappropriate pressure of cuff in the tracheal tubes and tracheostomy tubes was significantly reduced after training (p=0.001). But, by comparison of these two methods and the relationship between the variables revealed that no significant difference was found between the two groups of face to face training and workshop. Training the nurses is highly effective in preventing VAP, particularly for appropriate cuff pressure, suctioning and disinfecting hands.

  8. Early Trauma-Induced Coagulopathy is Associated with Increased Ventilator-Associated Pneumonia in Spinal Cord Injury Patients.

    Science.gov (United States)

    Younan, Duraid; Lin, Erica; Griffin, Russell; Vanlandingham, Sean; Waters, Alicia; Harrigan, Mark; Pittet, Jean-Francois; Kerby, Jeffrey D

    2016-05-01

    Early trauma-induced coagulopathy may increase susceptibility to nosocomial infections such as ventilator-associated pneumonia. However, the relationship between trauma- induced coagulopathy and the development of ventilator-associated pneumonia in spinal cord injury patients has not been evaluated. We conducted a 5-year retrospective study of 300 spinal cord injury patients admitted to Level 1 trauma center. Standard coagulation studies were evaluated upon arrival, prior to fluid resuscitative efforts, and at 24  h after admission. Based on these studies, three groups of patients were identified: no coagulopathy, latent coagulopathy, and admission coagulopathy. Ventilator- associated pneumonia was identified utilizing Centers for Disease Control and Prevention criteria. Since we used the data in the trauma registry and did not have the information on FiO2 and PEEP, we elected to use the VAP terminology and not the VAE sequence. Demographic, injury, and clinical characteristics were compared among no coagulopathy, latent coagulopathy, and admission coagulopathy groups using chi-square test and ANOVA for categorical and continuous variables, respectively. A logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between coagulopathy and both ventilator-associated pneumonia and mortality. The incidence of ventilator-associated pneumonia was 54.5% (OR 4.01, 95% CI 1.76-9.15) in spinal cord injury patients with admission coagulopathy, compared with the 17.5% in spinal cord injury patients with no coagulopathy. Mortality was significantly higher in spinal cord injury patients with admission coagulopathy than in spinal cord injury patients with no coagulopathy (OR 6.14, 95% CI 1.73-21.73).After adjusting for age, race, injury mechanism, Injury Severity Score, base deficit at admission, the number of pRBC units transfused in the first 24  h, and hospital stay, only the association of ventilator-associated

  9. Clinical and molecular characteristics of Klebsiella pneumoniae ventilator-associated pneumonia in mainland China.

    Science.gov (United States)

    Guo, Si; Xu, JingJing; Wei, YanShuan; Xu, JunHong; Li, Yi; Xue, Rui

    2016-10-26

    Klebsiella pneumoniae is a prominent nosocomial pathogen that accounts for up to 10 % of all hospital-acquired infections. It is a frequent cause of ventilator-associated pneumonia (VAP). The purpose of this study was to investigate the clinical characteristics of K. pneumoniae-associated VAP and the molecular characteristics of K. pneumoniae strains. We retrospectively reviewed 70 mechanically ventilated patients with K. pneumoniae isolated. All K. pneumoniae strains were examined to determine hypermucoviscosity (HV) phenotype, capsular serotypes, virulence genes, multilocus sequence typing and antimicrobial susceptibility. Hypermucoviscosity was found in 14 of 70 (20 %) isolates of K. pneumoniae. Among the 70 patients, 43 cases (61.4 %) developed VAP. Furthermore, VAP was more frequently induced by HV-positive K. pneumoniae (14/14, 100 %) than by HV-negative strains (29/56, 51.7 %). HV-positive K. pneumoniae-associated VAP patients were more inclined to develop bacteremia and had a higher mortality rate than HV-negative strains VAP patients. Antibiotic resistance was more frequent in HV- negative strains- than in HV- positive strains-infected patients. The prevalence of rmpA and aerobactin genes were 85.7 % and 85.7 % respectively, and serotypes K1 and K2 accounted for 14.3 % and 28.6 % of the hypermucoviscosity strains, respectively. Strains carrying rmpA and aerobactin genes were significantly associated with HV-phenotype, and rmpA and aerobactin coexisted in HV-positive strains. Multilocus sequence typing analysis identified 24 different sequence types from K. pneumoniae VAP samples. HV-phenotype is the major virulence determinant for mechanically ventilated patients. There was a specific sequence typing (ST) distribution between HV-positive and HV-negative strains.

  10. The Vexing Problem of Ventilator-Associated Pneumonia: Observations on Pathophysiology, Public Policy, and Clinical Science.

    Science.gov (United States)

    Kallet, Richard H

    2015-10-01

    Ventilator-associated pneumonia (VAP) is an acquired infection related primarily to the consequences of prolonged endotracheal intubation. It is considered the most important infectious challenge in the critical care setting. Preventable complications of hospital care are considered an important source of wasted health-care costs believed to consume up to 47% of annual expenditures in the United States. Whether VAP is preventable has become a highly contentious debate since public reporting commenced a decade ago. This selective review focuses on specific aspects of this debate, including the inherent vagaries in the diagnosis of VAP and the marked disparities between VAP rates based on clinical diagnosis versus surveillance data. Also discussed is how this debate has impacted public policy, leading to the new paradigm of ventilator-associated events. The limited ability of artificial airways to prevent microaspiration and biofilm build-up, as well as non-modifiable conditions increasing the risk of VAP, is described in detail. In addition, the origins of the mistaken but widely embraced notion that zero VAP is a realistic achievement are examined. Copyright © 2015 by Daedalus Enterprises.

  11. Pre-emptive antibiotic therapy to reduce ventilator-associated pneumonia: ?thinking outside the box?

    OpenAIRE

    Craven, Donald E.; Hudcova, Jana; Lei, Yuxiu; Craven, Kathleen A.; Waqas, Ahsan

    2016-01-01

    Mechanically ventilated, intubated patients are at increased risk for tracheal colonization with bacterial pathogens that may progress to heavy bacterial colonization, ventilator-associated tracheobronchitis (VAT), and/or ventilator-associated pneumonia (VAP). Previous studies report that 10 to 30 % of patients with VAT progress to VAP, resulting in increased morbidity and significant acute and chronic healthcare costs. Several natural history studies, randomized, controlled trials, and a met...

  12. A comparative study of teaching clinical guideline for prevention of ventilator-associated pneumonia in two ways: face-to-face and workshop training on the knowledge and practice of nurses in the Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    MAJID YAZDANI

    2015-04-01

    Full Text Available Introduction: Ventilator-associated pneumonia (VAP is one of the most popular nosocomial infections in the intensive care units and the nurse’s role in preventing it is very important. The aim of this study was to compare the effect of two methods of face to face training and work- shop clinical guidelines in prevention of VAP. Methods: In this experimental randomized clinical trial, the knowledge and practice of nurses in ICUs were studied in two groups: face to face training (35 nurses and workshops (40 nurses by using clinical guidelines in prevention of VAP in one of the hospitals of Shiraz University of Medical Sciences. The level of knowledge and practice in each group was assessed by selfreport questionnaire, knowledge questionnaire and also direct observation of practice, before and after training. Data were analyzed with descriptive statistics, paired t-test, independent t-test, McNemar test, Fisher’s exact, sign and Chi-square test, using SPSS 14. Results: This study demonstrated that both methods of face to face training and workshop were very effective. The incidence of inappropriate pressure of cuff in the tracheal tubes and tracheostomy tubes was significantly reduced after training (p=0.001. But, by comparison of these two methods and the relationship between the variables revealed that no significant difference was found between the two groups of face to face training and workshop. Conclusion: Training the nurses is highly effective in preventing VAP, particularly for appropriate cuff pressure, suctioning and disinfecting hands.

  13. The metoclopramide effect on enteral nutrition tolerance and mechanical ventilation associated pneumonia in neuro critically ill patients

    National Research Council Canada - National Science Library

    Acosta-Escribano, Jose; Almanza López, Susana; Plumed Martín, Lidia; García Martinez, Miguel Angel; Tajadura Manjarín, Nuria

    2014-01-01

    ...), during the first five days with enteral nutrition, versus control (GC), on the volume of administered diet, gastrointestinal complications and the incidence of mechanical ventilation associated pneumonia (NAVM...

  14. Ventilator-associated pneumonia rates after introducing selective digestive tract decontamination.

    Science.gov (United States)

    Schnabel, Ronny M; Scholte, Johannes B J; Van Der Velden, Kim E H M; Roekaerts, Paul M H J; Bergmans, Dennis C J J

    2015-09-01

    The incidence of ventilator-associated pneumonia (VAP) before and after the introduction of selective oral decontamination (SOD) only and selective digestive tract decontamination (SDD) in a general intensive care population was examined. SOD as standard of care was introduced in December 2010 and SDD, including SOD, in January 2012 for all patients with an expected length of intensive care unit (ICU) stay of at least 48 h. The diagnosis of VAP was based on clinical criteria and quantitative cultures of bronchoalveolar lavage fluid. A total of 4945 mechanically ventilated patients accounting for 37 554 ventilator days in the period from 2005 to 2013 were analyzed. The incidence of VAP per 1000 ventilator days declined significantly from 4.38 ± 1.64 before to 1.64 ± 0.43 after introduction of SOD/SDD (p = 0.007). Implementation of SOD/SDD as standard of care in ICUs may thus be effective in preventing VAP.

  15. Exploration of knowledge of, adherence to, attitude and barriers toward evidence-based guidelines (EBGs for prevention of ventilator-associated pneumonia (VAP in healthcare workers of pediatric cardiac intensive care units (PCICUs: A Quali-Quantitative survey

    Directory of Open Access Journals (Sweden)

    Leila Jahansefat

    2016-09-01

    Full Text Available Implementation of evidence-based guidelines (EBGs is an effective measure for prevention of ventilator-associated pneumonia (VAP. Appropriate knowledge, attitude and adherence of healthcare workers (HCWs to EBGs are necessary factors for implementation of EBGs. This study was conducted with objective of evaluation of knowledge, attitude, and adherence of HCWs to EBGs for prevention of VAP and exploration of the barriers of their implementation in clinical practice. Totally, a total number of 45 HCWs of two pediatric cardiac surgery ICU (PCICUs participated in this quali-quantitative survey. Knowledge, attitude and adherence of participants was evaluated by a validated multiple-choice questionnaire and barriers of implementation of EBGs was extracted from participants’ answer to an open-ended question of our self-made questionnaire. Knowledge of HCWs was poor and significantly different between nurse assistants (RAs, nurses (RNs, and physicians (MDs (respectively, 1.25±0.95, 4.53±1.73, and 5.54±2.01, P=0.001. Likewise, attit ude of HCWs is not positive and significantly different between NAs, RNs, and MDs (respectively, 32.96±2.42, 34.00±2.44, 36.81±4.35, P=0.003. The adherence of HCWs is not good and different between RAs, RNs, and MDs (respectively, 11.50±1.00, 13.13±1.83, and 17.18±6.06, P= 0.17. The Barriers of implementation of EBGs was categorized into four category of individual, organizational, social, and educational factors. Unsatisfying status of knowledge, attitude, and adherence of HCWs is a challenging concern of health-care system, especially in PICUs. In addition to these well-known factors, poor implementation of EBGs is related to many other barriers which should recognized and taken into consideration for designation of infection controlling programs.

  16. Bayesian network models for the management of ventilator-associated pneumonia

    NARCIS (Netherlands)

    Visscher, S.

    2008-01-01

    The purpose of the research described in this thesis was to develop Bayesian network models for the analysis of patient data, as well as to use such a model as a clinical decision-support system for assisting clinicians in the diagnosis and treatment of ventilator-associated pneumonia (VAP) in

  17. Risk prediction models for mortality in patients with ventilator-associated pneumonia

    DEFF Research Database (Denmark)

    Larsson, Johan E; Itenov, Theis Skovsgaard; Bestle, Morten Heiberg

    2017-01-01

    PURPOSE: Ventilator-associated pneumonia (VAP) is a common and serious complication in patients requiring mechanical ventilation in the intensive care unit. The aims of this study were to identify models used to predict mortality in VAP patients and to assess their prognostic accuracy. METHODS...

  18. Ventilator-associated pneumonia in children after cardiac surgery in The Netherlands

    NARCIS (Netherlands)

    Roeleveld, P. P.; Guijt, D.; Kuijper, E. J.; Hazekamp, M. G.; de Wilde, R. B. P.; de Jonge, E.

    2011-01-01

    We conducted a retrospective cohort study in an academic tertiary care center to characterize ventilator-associated pneumonia (VAP) in pediatric patients after cardiac surgery in The Netherlands. All patients following cardiac surgery and mechanically ventilated for ≥24 h were included. The primary

  19. Hypervirulent Klebsiella pneumoniae induced ventilator-associated pneumonia in mechanically ventilated patients in China.

    Science.gov (United States)

    Yan, Q; Zhou, M; Zou, M; Liu, W-e

    2016-03-01

    The purpose of this study was to investigate the clinical characteristics of hypervirulent K. pneumoniae (hvKP) induced ventilator-associated pneumonia (VAP) and the microbiological characteristics and epidemiology of the hvKP strains. A retrospective study of 49 mechanically ventilated patients with K. pneumoniae induced VAP was conducted at a university hospital in China from January 2014 to December 2014. Clinical characteristics and K. pneumoniae antimicrobial susceptibility and biofilm formation were analyzed. Genes of capsular serotypes K1, K2, K5, K20, K54 and K57 and virulence factors plasmid rmpA(p-rmpA), iroB, iucA, mrkD, entB, iutA, ybtS, kfu and allS were also evaluated. Multilocus sequence typing (MLST) and random amplified polymorphic DNA (RAPD) analyses were used to study the clonal relationship of the K. pneumoniae strains. Strains possessed p-rmpA and iroB and iucA were defined as hvKP. Of 49 patients, 14 patients (28.6 %) were infected by hvKP. Antimicrobial resistant rate was significantly higher in cKP than that in hvKP. One ST29 K54 extended-spectrum-beta-lactamase (ESBL) producing hvKP strain was detected. The prevalence of K1 and K2 in hvKP was 42.9 % and 21.4 %, respectively. The incidences of K1, K2, K20, p-rmpA, iroB, iucA, iutA, Kfu and alls were significantly higher in hvKP than those in cKP. ST23 was dominant among hvKP strains, and all the ST23 strains had identical RAPD pattern. hvKP has become a common pathogen of VAP in mechanically ventilated patients in China. Clinicians should increase awareness of hvKP induced VAP and enhance epidemiologic surveillance.

  20. Ventilator-associated pneumonia in critically ill African patients on ...

    African Journals Online (AJOL)

    Background: Stress ulcer prophylaxis is an integral part of the care of the critically ill. Agents that alter gastric pH may predispose these patients to gastric colonisation, with subsequent pneumonia and/or sepsis. Cytoprotective agents such as sucralfate preserve gastric acidity and may be protective. Objective: To determine ...

  1. [Role of plasma procalcitonin in the diagnosis of ventilator-associated pneumonia: systematic review and metaanalysis].

    Science.gov (United States)

    Sotillo-Díaz, J C; Bermejo-López, E; García-Olivares, P; Peral-Gutiérrez, J A; Sancho-González, M; Guerrero-Sanz, J E

    2014-01-01

    To determine the role of plasma procalcitonin (PCT) levels in diagnosing ventilator-associated pneumonia. A systematic review of publications prospectively assessing the diagnostic role of PCT in ventilator-associated pneumonia was carried out. The search was performed using Medline, Embase, the Cochrane Collaboration and MEDION, with reviewing of the references of retrieved articles. We extracted data that allowed the calculation of sensitivity, specificity, likelihood ratios and diagnostic odds ratio. Intervention Metaregression was performed to determine whether exposure to previous antibiotic treatment, the time to occurrence of ventilator-associated pneumonia and the type of patients had an impact upon the diagnostic performance of procalcitonin. Seven studies were considered (373 patients, 434 episodes). We found no publication bias or threshold effect. High plasma PCT levels were associated to an increased risk of suffering ventilator-associated pneumonia (OR: 8.39; 95% CI: 5.4-12.6). The pooled data on sensitivity, specificity, positive and negative likelihood ratio, and diagnostic odds ratio found were 76% (69-82), 79% (74-84), 4.35 (2.48-7.62), 0.26 (0.15-0.46) and 17.9 (10.1-31.7), respectively. Diagnostic yield was modified by prior exposure to antibiotics (rDOR 0.11, 0.02-0.069), but not by the type of critically ill patient or the time to occurrence of ventilator-associated pneumonia. Our results suggest that PCT provides additional information on the risk of VAP. Inclusion of PCT in diagnostic algorithms could improve their effectiveness. Copyright © 2013 Elsevier España, S.L. and SEMICYUC. All rights reserved.

  2. Nosocomial and ventilator-associated pneumonia in a community hospital intensive care unit: a retrospective review and analysis.

    Science.gov (United States)

    Behnia, Mehrdad; Logan, Sharon C; Fallen, Linda; Catalano, Philip

    2014-04-11

    Nosocomial and ventilator-associated pneumonia (VAP) are causes of significant morbidity and mortality in hospitalized patients. We analyzed a) the incidence and the outcome of pneumonias caused by different pathogens in the intensive care unit (ICU) of a medium-sized twenty-four bed community hospital and b) the incidence of complications of such pneumonias requiring surgical intervention such as thoracotomy and decortication. We retrospectively reviewed the charts of patients diagnosed with nosocomial and ventilator-associated pneumonia in our ICU. Their bronchoalveolar lavage (BAL) and sputum cultures, antibiograms, and other clinical characteristics, including complications and need for tracheostomy, thoracotomy and decortication were studied. In a span of one year (2011-12), 43 patients were diagnosed with nosocomial pneumonia in our ICU. The median simplified acute physiology score (SAPS II) was 39. One or more gram negative organisms as the causative agents were present in 85% of microbiologic samples. The three most prevalent gram negatives were Stenotrophomonas maltophilia (34%), Pseudomonas aeurginosa (40%), and Acinetobacter baumannii (32%). Twenty eight percent of bronchoalveolar samples contained Staphylococcus aureus. Eight three percent of patients required mechanical ventilation postoperatively and 37% underwent tracheostony. Thirty five percent underwent thoracotomy and decortication because of further complications such as empyema and non-resolving parapneumonic effusions. A. baumannii, Klebsiella pneumonia extended spectrum beta lactam (ESBL) and P. aeurginosa had the highest prevalence of multi drug resistance (MDR). Fifteen patients required surgical intervention. Mortality from pneumonia was 37% and from surgery was 2%. Nosocomial pneumonias, in particular the ones that were caused by gram negative drug resistant organisms and their ensuing complications which required thoracotomy and decortication, were the cause of significant morbidity in

  3. Ventilator-associated pneumonia: the influence of bacterial resistance, prescription errors, and de-escalation of antimicrobial therapy on mortality rates

    Directory of Open Access Journals (Sweden)

    Ana Carolina Souza-Oliveira

    2016-09-01

    Conclusion: Prescription errors influenced mortality of patients with Ventilator-associated pneumonia, underscoring the challenge of proper Ventilator-associated pneumonia treatment, which requires continuous reevaluation to ensure that clinical response to therapy meets expectations.

  4. Detection of plant DNA in the bronchoalveolar lavage of patients with ventilator-associated pneumonia.

    Directory of Open Access Journals (Sweden)

    Sabri Bousbia

    Full Text Available BACKGROUND: Hospital-acquired infections such as nosocomial pneumonia are a serious cause of mortality for hospitalized patients, especially for those admitted to intensive care units (ICUs. Despite the number of the studies reported to date, the causative agents of pneumonia are not completely known. Herein, we found by molecular technique that vegetable and tobacco DNA may be detected in the bronchoalveolar lavage from patients with ventilator-associated pneumonia (VAP. METHODOLOGY/PRINCIPAL FINDINGS: In the present study, we studied bronchoalveolar lavage (BAL from patients admitted to ICUs with ventilator-associated pneumonia. BAL fluids were assessed with molecular tests, culture and blood culture. We successfully identified plant DNA in six patients out of 106 (6% with ventilator-associated pneumonia. Inhalation was confirmed in four cases and suspected in the other two cases. Inhalation was significantly frequent in patients with plant DNA (four out of six patients than those without plant DNA (three out of 100 patients (P<0.001. Nicotiana tabacum chloroplast DNA was identified in three patients who were smokers (cases 2, 3 and 6. Cucurbita pepo, Morus bombycis and Triticum aestivum DNA were identified in cases 1, 4 and 5 respectively. Twenty-three different bacterial species, two viruses and five fungal species were identified from among these six patients by using molecular and culture techniques. Several of the pathogenic microorganisms identified are reported to be food-borne or tobacco plant-associated pathogens. CONCLUSIONS/SIGNIFICANCE: Our study shows that plants DNA may be identified in the BAL fluid of pneumonia patients, especially when exploring aspiration pneumonia, but the significance of the presence of plant DNA and its role in the pathogenesis of pneumonia is unknown and remains to be investigated. However, the identification of these plants may be a potential marker of aspiration in patients with pneumonia.

  5. Antibiotic consumption and ventilator-associated pneumonia rates, some parallelism but some discrepancies.

    Science.gov (United States)

    Nora, David; Póvoa, Pedro

    2017-11-01

    Ventilator-associated pneumonia (VAP) is a common infection in intensive care units (ICUs) but its clinical definition is neither sensitive nor specific and lacks accuracy and objectivity. New defining criteria were proposed in 2013 by the National Healthcare Safety Network (NHSN) in order to more accurately conduct surveillance and track prevention progress. Although there is a consistent trend towards a decrease in VAP incidence during the last decade, significant differences in VAP rates have been reported and are persistently lower in NHSN and other American reports (0.0 to 4.4 VAP per 1,000 ventilator-days in 2012) compared to the European Centre for Disease Prevention and Control (ECDC) data (10 VAP per 1,000 ventilator-days in 2014). In the United States, VAP has been proposed as an indicator of quality of care in public reporting, and the threat of financial penalties for this diagnosis has put pressure on hospitals to minimize VAP rates that may lead to artificial lower values, independently of patient care. Although prevention bundles may contribute for encouraging reductions in VAP incidence, both pathophysiologic and epidemiologic factors preclude a zero-VAP rate. It would be expected from the trend of reduction of VAP incidence that the consumption of antibiotics would also decrease in particular in those hospitals with lowest VAP rates. However, ICU reports show a steadily use of antibiotics for nosocomial pneumonia in 15% of patients and both ECDC and NHSN data on antibiotic consumption showed no significant trend. Knowledge of bacterial epidemiology and resistance profiles for each ICU has great relevance in order to understand trends of antibiotic use. The new NHSN criteria provide a more objective and quantitative data based VAP definition, including an antibiotic administration criterion, allowing, in theory, a more comprehensive assessment and a reportable benchmark of the observed VAP and antibiotic consumption variability.

  6. The multistep road to ventilator-associated lung abscess: A retrospective study of S.aureus ventilator-associated pneumonia.

    Science.gov (United States)

    Mounier, Roman; Lobo, David; Voulgaropoulos, Julia; Martin, Mathieu; Aït-Mamar, Bouziane; Bitot, Valérie; Jost, Paul-Henri; Birnbaum, Ron; Nebbad, Biba; Cook, Fabrice; Dhonneur, Gilles

    2017-01-01

    We observed some cases of lung abscess (LA) in ICU patients suffering S.aureus ventilator-associated pneumonia (S.aureus-VAP). We aimed to assess which of the host and/or bacteria-related features are associated with LA. We conducted a retrospective study from January 2009 to July 2013 in a trauma surgical ICU within a teaching hospital. All adult patients presenting with S.aureus-VAP were included. We compared two groups of patients according to the formation or not of LA concomitantly to S.aureus-VAP. Seventy-nine S.aureus-VAP patients, predominantly males (85%) of rather young age (mean [SD]: 35yr [21-64]) with severe trauma (initial Simplified Acute Score II = 42 [32-52]) related-ICU admission, were included. Among them, 10 (14%) developed LA. Patient's characteristics significantly associated with LA development were: a younger age (p = 0.003), road traffic accidents admission (p = 0.017), head injury (p = 0.002), lower Glasgow Coma Scale (p = 0.009), blunt chest trauma (p = 0.01) pneumothorax (p = 0.01) and lung contusions (p = 0.002). No microbiological factors were significantly associated with LA formation. Abscesses were mostly bilateral, ≥5 cm of diameter and with a posterior location. Our results do not favor a specific virulence of S.aureus, but rather highlight the role of multiple insults to the lung, promoting LA formation. Despite a similar severity score, patients with LA had more serious trauma, combining severe both chest and head insults.

  7. A Bayesian decision-support system for diagnosing ventilator-associated pneumonia

    OpenAIRE

    Schurink, C.A.; Visscher, S.; Lucas, P.J.; van Leeuwen, H.J.; Buskens, E.; Hoff, R.G.; Hoepelman, A.I.; Bonten, M.J.

    2007-01-01

    OBJECTIVE: To determine the diagnostic performance of a Bayesian Decision-Support System (BDSS) for ventilator-associated pneumonia (VAP). DESIGN: A previously developed BDSS, automatically obtaining patient data from patient information systems, provides likelihood predictions of VAP. In a prospectively studied cohort of 872 ICU patients, VAP was diagnosed by two infectious-disease specialists using a decision tree (reference diagnosis). After internal validation daily BDSS predictions were ...

  8. Ventilator Associated Pneumonia in a Military Deployed Setting: The Impact of an Aggressive Infection Control Program

    Science.gov (United States)

    2008-02-01

    patients were clas- sified and treated for VAP if after 48 hours of mechanical ventilation they developed fever, leukocytosis, new or pro- gressive...medical conditions known at the time of admission. Median days of mechanical ventilation before onset of VAP was 5 (range, 2–11 days). Sixteen patients ... Ventilator Associated Pneumonia in a Military Deployed Setting: The Impact of an Aggressive Infection Control Program Michael L. Landrum, MD and

  9. A Case of Ventilator-Associated Pneumonia Caused by Ewingella americana : First Report from Turkey

    Directory of Open Access Journals (Sweden)

    Kenan Ecemiş

    2014-09-01

    Full Text Available Ewingella americana is a very rare cause of serious infections, especially in immunocompromised patients. We report a case of ventilator-associated pneumonia (VAP in an intensive care unit patient, who was treated successfully with ceftriaxone. To the best of our knowledge, this is the first case of VAP due to Ewingella americana in the English literature.J Microbiol Infect Dis 2014; 4(3: 118-120

  10. Ventilator-Associated Pneumonia in Trauma Patients: Different Criteria, Different Rates.

    Science.gov (United States)

    Leonard, Kenji L; Borst, Gregory M; Davies, Stephen W; Coogan, Michael; Waibel, Brett H; Poulin, Nathaniel R; Bard, Michael R; Goettler, Claudia E; Rinehart, Shane M; Toschlog, Eric A

    2016-06-01

    No consensus exists regarding the definition of ventilator-associated pneumonia (VAP). Even within a single institution, inconsistent diagnostic criteria result in conflicting rates of VAP. As a Level 1 trauma center participating in the Trauma Quality Improvement Project (TQIP) and the National Healthcare Safety Network (NHSN), our institution showed inconsistencies in VAP rates depending on which criteria was applied. The purpose of this study was to compare VAP definitions, defined by culture-based criteria, National Trauma Data Bank (NTDB) and NHSN, using incidence in trauma patients. A retrospective chart review of consecutive trauma patients who were diagnosed with VAP and met pre-determined inclusion and exclusion criteria admitted to our rural, 861-bed, Level 1 trauma and tertiary care center between January 2008 and December 2011 was performed. These patients were identified from the National Trauma Registry of the American College of Surgeons (NTRACS) database and an in-house infection control database. Ventilator-associated pneumonia diagnosis criteria defined by the U.S. Center for Disease Control and Prevention (used by the NHSN), the NTDB, and our institutional, culture-based criteria gold standard were compared among patients. Two hundred seventy-nine patients were diagnosed with VAP (25.4% met NHSN criteria, 88.2% met NTDB, and 76.3% met culture-based criteria). Only 58 (20.1%) patients met all three criteria. When NHSN criteria were compared with culture-based criteria, NHSN showed a high specificity (92.5%) and low sensitivity (28.2%). The positive predictive value (PPV) was 84.5%, but the negative predictive value (NPV) was 47.1%. The agreement between the NHSN and the culture-based criteria was poor (κ = 0.18). Conversely, the NTDB showed a lower specificity (57.8%), but greater sensitivity (86.4%) compared with culture-based criteria. The PPV and NPV were both 74% and the two criteria showed fair agreement (κ = 0.41). The lack of

  11. Enteral Nutrition and Acid-Suppressive Therapy in the PICU: Impact on the Risk of Ventilator-Associated Pneumonia.

    Science.gov (United States)

    Albert, Ben D; Zurakowski, David; Bechard, Lori J; Priebe, Gregory P; Duggan, Christopher P; Heyland, Daren K; Mehta, Nilesh M

    2016-10-01

    Enteral nutrition has been implicated as a risk factor for ventilator-associated pneumonia. We explored the prevalence of ventilator-associated pneumonia and its association with clinical and nutrition-related therapies in mechanically ventilated children. Prospective, multicenter, cohort study. Fifty-nine PICU in 15 countries. Children less than 18 years old, mechanically ventilated for more than 48 hours. None. Multivariable logistic regression to determine factors associated with ventilator-associated pneumonia. Data are presented as median (interquartile range) or counts (%). We enrolled 1,245 subjects (45% women; 42% surgical), age 20 months (4-84 mo), and duration of mechanical ventilation 7 days (3-13 d). Culture-positive ventilator-associated pneumonia was diagnosed in 80 patients (6.4%); duration of mechanical ventilation for this subgroup was 17 days (8-39 d). Enteral nutrition was delivered in 985 patients (79%), initiated within 48 hours in 592 patients (60%), and via postpyloric route in 354 patients (36%). Acid-suppressive agents were used in 763 patients (61%). The duration of enteral nutrition (p = 0.21), route (gastric vs postpyloric) of delivery (p = 0.94), severity of illness (p = 0.17), and diagnostic category on admission (p = 0.31) were not associated with ventilator-associated pneumonia. After adjusting for enteral nutrition days, illness severity, and site, ventilator-associated pneumonia was significantly associated with mechanical ventilation more than 10 days (odds ratio, 3.7; 95% CI, 2.2-6.5; p pneumonia was diagnosed in 6.5% of mechanically ventilated children in a heterogeneous multicenter cohort. We did not find a link between enteral nutrition duration or route of delivery and ventilator-associated pneumonia. In addition to duration of mechanical ventilation and length of PICU stay, the use of acid-suppressive therapy independently increased the likelihood of developing ventilator-associated pneumonia in this population. This

  12. Impacto da aspiração supra-cuff na prevenção da pneumonia associada à ventilação mecânica Impact of supra-cuff suction on ventilator-associated pneumonia prevention

    Directory of Open Access Journals (Sweden)

    Carolina Ramos de Souza

    2012-12-01

    most cases, these individuals require invasive mechanical ventilation. The cannulae that are used include the cuff, which can act as a reservoir for oropharyngeal secretions, predisposing to ventilator-associated pneumonia. Studies have revealed that the suction of subglottic secretions through the dorsal suction lumen above the endotracheal tube cuff delays the onset and reduces the incidence of ventilator-associated pneumonia. The aim of this review is to assess published studies regarding the significance of using suction with a supra-cuff device for the prevention of ventilator-associated pneumonia in critically ill patients treated with orotracheal intubation or tracheostomy. Therefore, by searching national and international databases, a literature review was undertaken of studies published between the years 1986 and 2011. Few results were found relating the suction of subglottic secretions to decreased duration of mechanical ventilation and length of stay in the intensive care unit. The suction of subglottic secretions is ineffective in decreasing mortality but is effective in reducing the incidence of early-onset ventilator-associated pneumonia and hospital costs. Techniques involving continuous suction of subglottic secretions may be particularly efficient in removing secretions; however, intermittent suction appears to be the least harmful method. In conclusion, cannulae with a supra-cuff suction device enable the aspiration of subglottic secretions, providing benefits to critically ill patients by reducing the incidence of ventilator-associated pneumonia and, consequently, hospital costs - with no large-scale adverse effects.

  13. Risk factors and antimicrobial susceptibility in ventilator associated pneumonia: a brief report

    Directory of Open Access Journals (Sweden)

    Shahin Babazadeh

    2012-12-01

    Full Text Available Background: Ventilator associated pneumonia (VAP is one of the serious complications of ventilatory support, occurring in ICUs. The aim of this study was to determine various risk factors associated with the acquisition of Acinetobacter infection and its antimicrobial susceptibility pattern.Methods: This cross-sectional study was performed in the ICUs of Rasoul-e-Akram Hospital in Tehran, Iran during the year 2011. A total of 51 endobronchial aspirates from intubated patients who had been clinically diagnosed to have VAP were studied bacteriologically. The in vitro susceptibility was determined by disk-diffusion and broth microdilution MIC methods.Results: Out of 51 patients with VAP, 35 (66.66% had positive cultures for Acineto-bacter species. In vitro susceptibility test revealed that a high percentage of isolates were resistant to imipenem, piperacillin-tazobactam, third generation cephalosporines, and aminoglycosides.Conclusion: The antimicrobial resistance of gram negative bacteria, particularly Acine-tobacter species, is increasing and preventive measures need to be taken as a matter of urgency.

  14. Epidemiological and microbiological analysis of ventilator-associated pneumonia patients in a public teaching hospital

    Directory of Open Access Journals (Sweden)

    João Manoel da Silva Júnior

    Full Text Available Ventilator-associated pneumonia (VAP is the most commonly-acquired infection in patients in intensive care units. We analyzed epidemiological and microbiological characteristics and the outcome, in a cohort of critically-ill patients with confirmed diagnosis of VAP. All patients who had been on mechanical ventilation (MV for more than 48 hours were included in our study; material collection for microbiological analysis was done within the first 24 hours after beginning treatment or after changing antibiotics. There were 55/265 (20.7% VAP cases diagnosed, at a rate of 21.6 episodes per 1,000 days of mechanical ventilation. Mean age of the patients was 66 years, with a mean APACHE II score of 26.7 + 7.0; male patients were more prevalent. The mortality rates in the intensive care unit (ICU and during the hospital stay were 71% and 80%, respectively. MV duration in patients with VAP was 17 (range 3-43 days and among patients who had not developed VAP, 6 (2-32 days (p < 0.0001. 98.2% of the samples were positive, with a high prevalence of Gram-negative bacteria, mainly Acinetobacter calcoaceticus. Risk factors for death included age, MV duration and surgery. VAP incidence in this sample of critically-ill patients was high, with a high mortality rate. Control and prevention strategies based on continuing education of healthcare workers, developed by a multidisciplinary team, should be encouraged to minimize morbimortality of this infection.

  15. The function of probiotics on the treatment of ventilator-associated pneumonia (VAP): facts and gaps.

    Science.gov (United States)

    Karacaer, Feride; Hamed, Imen; Özogul, Fatih; Glew, Robert H; Özcengiz, Dilek

    2017-09-01

    Probiotics have been used for centuries in making fermented dairy products. The health benefits related to probiotics consumption are well recognized and they are generally regarded as safe (GRAS). Their therapeutic effects are due to the production of a variety of antimicrobial compounds, such as short-chain fatty acids, organic acids (such as lactic, acetic, formic, propionic and butyric acids), ethanol, hydrogen peroxide and bacteriocins. Ventilator-associated pneumonia (VAP) is a nosocomial infection associated with high mortality in intensive care units. VAP can result from endotracheal intubation and mechanical ventilation. These interventions increase the risk of infection as patients lose the natural barrier between the oropharynx and the trachea, which in turn facilitates the entry of pathogens through the aspiration of oropharyngeal secretions containing bacteria into the lung. In order to prevent this, probiotics have been used extensively against VAP. This review is an update containing information extracted from recent studies on the use of probiotics to treat VAP. In addition, probiotic safety, the therapeutic properties of probiotics, the probiotic strains used and the action of the probiotics mechanism are reviewed. Furthermore, the therapeutic effects of probiotic treatment procedures for VAP are compared to those of antibiotics. Finally, the influences of bacteriocin on the growth of human pathogens, and the side-effects and limitations of using probiotics for the treatment of VAP are addressed.

  16. Ventilator-Associated Pneumonia and Causative Microorganisms in Intensive Care Unit: A Two Year Retrospective Analysis

    Directory of Open Access Journals (Sweden)

    Onur Palabıyık

    2016-12-01

    Full Text Available Objective: Ventilator-associated pneumonia (VAP is the most common nosocomial infection in the intensive care units (ICUs. It causes prolonged hospital stay and increases mortality. In this study, we aimed to investigate the rate of VAP, causative microorganisms, and their antibiotic susceptibilities in anaesthesiology and reanimation ICU (ARICU. Material and Method: This retrospective study included patients who were admitted to 12-bed ARICU between January 2013 and December 2014. The detection of VAP was done according to Centers for Disease Control and Prevention criteria. The rate of VAP, VAP ratio, and ventilator utilization ratio (VUR were calculated according to guidelines of Turkish National Infection Surveillance Control Group. Endotracheal aspiration samples were collected and cultivated. The identification of the isolates was performed by using VITEK-2 automated system. Antibiotic susceptibilities were determined by the disc diffusion method according to the Clinical and Laboratory Standards Institute criteria. Results: VAP was determined in 16 of 359 patients who required invasive mechanic ventilation for longer than 48 hours and hospitalized in ARICU. VUR was 65%, VAP ratio was 4.5% and the rate of VAP was 3.3 per 1000 ventilator days. Seventeen microorganisms were isolated from endotracheal aspiration samples, including Acinetobacter baumannii (n=6, Pseudomonas aeruginosa (n=4, methicillin-resistant Staphylococcus aureus (n=4, Klebsiella pneumoniae, Enterobacter cloacae and Serratia marcescens. The most sensitive antibiotics for microorganisms are listed as follows; Acinetobacter baumannii: colistin, Pseudomonas aeruginosa: amikacin, carbapenems; Methicillin-resistant Staphylococcus aureus: linezolid, teicoplanin, vancomycin, trimethoprim sulfamethoxazole; Klebsiella and Enterobacteriaceae species: carbapenems, trimethoprim sulfamethoxazole, gentamicin. Conclusion: Intermittent analyses and antibiotic susceptibilities of VAP

  17. Pre-emptive antibiotic therapy to reduce ventilator-associated pneumonia: "thinking outside the box".

    Science.gov (United States)

    Craven, Donald E; Hudcova, Jana; Lei, Yuxiu; Craven, Kathleen A; Waqas, Ahsan

    2016-09-29

    Mechanically ventilated, intubated patients are at increased risk for tracheal colonization with bacterial pathogens that may progress to heavy bacterial colonization, ventilator-associated tracheobronchitis (VAT), and/or ventilator-associated pneumonia (VAP). Previous studies report that 10 to 30 % of patients with VAT progress to VAP, resulting in increased morbidity and significant acute and chronic healthcare costs. Several natural history studies, randomized, controlled trials, and a meta-analysis have reported antibiotic treatment for VAT can reduce VAP, ventilator days, length of intensive care unit (ICU) stay, and patient morbidity and mortality. We discuss early diagnostic criteria, etiologic agents, and benefits of initiating, early, appropriate intravenous or aerosolized antibiotic(s) to treat VAT and reduce VAP, to improve patient outcomes by reducing lung damage, length of ICU stay, and healthcare costs.

  18. Ventilator-associated pneumonia caused by colistin-resistant KPC-producing Klebsiella pneumoniae: a case report and literature review.

    Science.gov (United States)

    Viaggi, Bruno; Sbrana, Francesco; Malacarne, Paolo; Tascini, Carlo

    2015-05-01

    Klebsiella pneumoniae producing KPC-type carbapenemase causes severe nosocomial infection at a high mortality rate. Nosocomial pneumonia in particular is associated with high mortality, likely due to the unfavorable pulmonary pharmacokinetics of the antibiotics used against this agent. Therefore, early and accurate microbiological identification and susceptibility evaluation are crucial in order to optimize antibiotic therapy. We report a case of ventilator-associated pneumonia caused by colistin-resistant K. pneumoniae producing KPC-type carbapenemase treated using a carbapenem-sparing therapy and tailored according to the serum procalcitonin concentration in order to limit the duration of antibiotic therapy. Copyright © 2015 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.

  19. The Effect of a Designed Respiratory Care Program on the Incidence of Ventilator-Associated Pneumonia: A Clinical Trial

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    Mohammad Abbasinia

    2016-01-01

    Full Text Available Introduction: Ventilator-associated pneumonia is a common complication of mechanical ventilation. This study aimed to evaluate the effect of designed respiratory care program on incidence of ventilator-associated pneumonia (VAP in the mechanically ventilated patient. Methods: In this clinical trial, 64 patients were selected among those who had undergone mechanical ventilation in the ICU of Al‑Zahra Hospital, Isfahan, Iran, using convenience sampling method. The subjects were randomly allocated to intervention and control groups. In the intervention group an upper respiratory care program and in the control group, routine cares were done. Modified Clinical Pulmonary Infection Questionnaire was completed before and on the third, fourth and fifth day of study. Data were analyzed by Chi-square and independent t-test through SPSS Ver.13. Results: The results of this study showed that until the third day of study, the incidence of VAP was similar in the both groups. However, on the fifth day of study, the incidence of VAP in the intervention group was significantly lower than control group. Conclusion: The results of this study showed that an upper respiratory care program reduced the incidence of VAP. Therefore, nurses are recommended to perform this program for prevention of VAP.

  20. A novel porcine model of ventilator-associated pneumonia caused by oropharyngeal challenge with Pseudomonas aeruginosa.

    Science.gov (United States)

    Li Bassi, Gianluigi; Rigol, Montserrat; Marti, Joan-Daniel; Saucedo, Lina; Ranzani, Otavio T; Roca, Ignasi; Cabanas, Maria; Muñoz, Laura; Giunta, Valeria; Luque, Nestor; Rinaudo, Mariano; Esperatti, Mariano; Fernandez-Barat, Laia; Ferrer, Miquel; Vila, Jordi; Ramirez, Jose; Torres, Antoni

    2014-05-01

    Animal models of ventilator-associated pneumonia (VAP) in primates, sheep, and pigs differ in the underlying pulmonary injury, etiology, bacterial inoculation methods, and time to onset. The most common ovine and porcine models do not reproduce the primary pathogenic mechanism of the disease, through the aspiration of oropharyngeal pathogens, or the most prevalent human etiology. Herein the authors characterize a novel porcine model of VAP due to aspiration of oropharyngeal secretions colonized by Pseudomonas aeruginosa. Ten healthy pigs were intubated, positioned in anti-Trendelenburg, and mechanically ventilated for 72 h. Three animals did not receive bacterial challenge, whereas in seven animals, a P. aeruginosa suspension was instilled into the oropharynx. Tracheal aspirates were cultured and respiratory mechanics were recorded. On autopsy, lobar samples were obtained to corroborate VAP through microbiological and histological studies. In animals not challenged, diverse bacterial colonization of the airways was found and monolobar VAP rarely developed. In animals with P. aeruginosa challenge, colonization of tracheal secretion increased up to 6.39 ± 0.34 log colony-forming unit (cfu)/ml (P < 0.001). VAP was confirmed in six of seven pigs, in 78% of the cases developed in the dependent lung segments (right medium and lower lobes, P = 0.032). The static respiratory system elastance worsened to 41.5 ± 5.8 cm H2O/l (P = 0.001). The authors devised a VAP model caused by aspiration of oropharyngeal P. aeruginosa, a frequent causative pathogen of human VAP. The model also overcomes the practical and legislative limitations associated with the use of primates. The authors' model could be employed to study pathophysiologic mechanisms, as well as novel diagnostic/preventive strategies.

  1. Prevent Pneumonia

    Centers for Disease Control (CDC) Podcasts

    2015-08-06

    CDC’s Matthew Westercamp explains what pneumonia is, its symptoms, and how to prevent it.  Created: 8/6/2015 by National Center for Immunization and Respiratory Diseases (NCIRD), Division of Bacterial Diseases (DBD), Respiratory Diseases Branch (RDB).   Date Released: 8/6/2015.

  2. Ventilator-associated pneumonia in adult intensive care unit prevalence and complications

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    Ahmed Abdelrazik Othman

    2017-08-01

    Results: The primary underlying diagnosis was acute exacerbation of chronic obstructive pulmonary disease (AECOPD in 25 patients, congestive heart failure in 10, pneumonia in 6, post-operative in 5, neurological diseases in 2 patients. VAP developed in 17 patients (35.4%, gram-negative agents were the major offending pathogen (Pseudomonas aeruginosa accounting for 22.9%. The length of ventilation (LOV and the length of ICU stay (LOSICU were significantly higher in the VAP group (P = 0.001, 0.0001 respectively. Severe sepsis/septic shock, acute respiratory distress syndrome (ARDS, atelectasis, and infection with multi-drug resistant organisms were more common in the VAP group. Conclusion: Ventilator-associated pneumonia was associated with a significant increase in ICU length of stay, time on mechanical ventilation and different complications.

  3. Analysis of Hypoxemia in Early Ventilator-Associated Pneumonia Secondary to Haemophilus in Trauma Patients.

    Science.gov (United States)

    Ho, Vanessa P; Madbak, Firas; Horng, Helen; Sifri, Ziad C; Mohr, Alicia M

    2015-06-01

    Haemophilus species bacteria (HSB) are known pathogens responsible for early pneumonia in intubated trauma patients. The primary goal of this study was to examine the incidence and extent of hypoxemia in intubated trauma patients who develop early ventilator-associated pneumonia (VAP) secondary to HSB. On the basis of our clinical experiences, we hypothesized that patients with Haemophilus species bacteria pneumonia (HSBP) would have a high rate of hypoxemia but that the effect would be transient. Retrospective review of intubated trauma patients from an urban level I trauma center with HSBP diagnosed by deep tracheal aspirate or bronchoalveolar lavage from April 2007 to November 2012. Collected variables included day of HSBP diagnosis; PaO2 to FIO2 ratio (P:F) at HSBP diagnosis as well as HSBP day three and HSBP day seven; injury severity score (ISS) and its component parts; admission Glasgow Coma Scale (GCS) score; and mortality. Hypoxemia was defined as P:F hypoxemia were significantly less likely to have a severe head injury (GCShypoxemia had similar hospital length of stay and mortality to patients who did not develop hypoxemia. Haemophilus species bacteria pneumonia in trauma patients is associated with high rates of transient hypoxemia and a high tracheostomy rate, although subsequent outcomes are not affected. Patients with head injuries had a lower incidence of hypoxemia from pneumonia.

  4. Optimising the duration of antibiotic therapy for ventilator-associated pneumonia

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    J. Chastre

    2007-08-01

    Full Text Available Ventilator-associated pneumonia (VAP has traditionally been treated with a 14–21-day course of antibiotics. However, prolonged antibiotic therapy is associated with the emergence of multidrug-resistant strains, as well as higher toxicity and costs. In a large, randomised, controlled trial in patients with microbiologically confirmed VAP who received appropriate empirical antibiotic therapy, an 8-day antibiotic regimen was not associated with excess mortality or more episodes of recurrent pulmonary infection compared with a 15-day regimen. Amongst patients who developed recurrent infection, multidrug-resistant pathogens emerged less frequently in the group receiving 8 days of antibiotic therapy. The 8-day regimen was also not associated with excess mortality in the subgroup with VAP caused by nonfermentative Gram-negative bacilli, mostly Pseudomonas aeruginosa, although recurrent infections occurred more often. Pending confirmatory studies, an 8-day course of antibiotic therapy may be appropriate for many patients with ventilator-associated pneumonia, providing that initial antibiotic therapy is appropriate, the clinical course is favourable and extreme vigilance is maintained after stopping antibiotics. Patients whose initial treatment regimen was inappropriate, those infected with difficult-to-treat pathogens such as Pseudomonas aeruginosa, and immunocompromised patients and others at high risk for relapse are likely to require a longer duration of antibiotic therapy.

  5. Is HELICS the right way? Lack of chest radiography limits ventilator-associated pneumonia surveillance in Wales

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    Richard Pugh

    2016-08-01

    Full Text Available Introduction: The reported incidence of ventilator-associated pneumonia (VAP in Wales is low compared with surveillance data from other European regions. It is unclear whether this reflects success of the Welsh healthcare-associated infection prevention measures or limitations in the application of European VAP surveillance methods. Our primary aim was to investigate episodes of ventilator-associated respiratory tract infection (VARTI, to identify episodes that met established criteria for VAP, and to explore reasons why others did not, according to the Hospitals in Europe Link for Infection Control through Surveillance (HELICS definitions. Materials and methods: During two 14-day study periods 2012-2014, investigators reviewed all invasively ventilated patients in all 14 Welsh Intensive Care Units (ICUs. Episodes were identified in which the clinical team had commenced antibiotic therapy because of suspected VARTI. Probability of pneumonia was estimated using a modified Clinical Pulmonary Infection Score (mCPIS. Episodes meeting HELICS definitions of VAP were identified, and reasons for other episodes not meeting definitions examined. In the second period, each patient was also assessed with regards to the development of a ventilator-associated event (VAE, according to recent US definitions. Results: The study included 306 invasively ventilated patients; 282 were admitted to ICU for 48 hours or more. 32 (11.3% patients were commenced on antibiotics for suspected VARTI. 10 of these episodes met HELICS definitions of VAP, an incidence of 4.2 per 1000 intubation days. In 48% VARTI episodes, concurrent chest radiography was not performed, precluding the diagnosis of VAP. Mechanical ventilation (16.0 vs. 8.0 days; p=0.01 and ICU stay (25.0 vs. 11.0 days; p=0.01 were significantly longer in patients treated for VARTI compared to those not treated. There was no overlap between episodes of VARTI and of VAE. Discussion: HELICS VAP surveillance

  6. Effects of manual hyperinflation and suctioning in respiratory mechanics in mechanically ventilated patients with ventilator-associated pneumonia.

    Science.gov (United States)

    Choi, Jessica Siu-Ping; Jones, Alice Yee-Men

    2005-01-01

    Ventilator-associated pneumonia results from bacterial colonisation of the aerodigestive tract or aspiration of contaminated secretions into the lower airways. As a consequence of infection of the lung parenchyma and alveolitis, accumulation of inflammatory exudates and infiltration of airway mucosa can lead to unfavourable respiratory mechanics in ventilator-associated pneumonia. Tracheal suction is often employed by nursing staff in the management of mechanically ventilated patients with ventilator-associated pneumonia but this technique has the potential to increase respiratory resistance. Manual hyperinflation is used by physiotherapists to improve lung volume and mobilise secretions and has been shown to increase lung compliance. The effect of manual hyperinflation on airway resistance has not been studied. This study aims to demonstrate an additional mechanical benefit to the respiratory system when manual hyperinflation and suction techniques are combined, by comparing the application of manual hyperinflation and suction with suction alone on static lung compliance (C(L)) and inspiratory resistance (R(AW)) in mechanically ventilated patients with ventilator-associated pneumonia. Fifteen adult patients with ventilator-associated pneumonia were recruited and acted as their own controls. Manual hyperinflation followed by suction (manual hyperinflation plus suction) and suction alone were applied consecutively, in random order, on two occasions, four hours apart. Respiratory variables, C(L) and R(AW), were measured five times and the averaged value documented. Data were recorded before, immediately after, and 30 minutes after each intervention protocol. C(L) increased by 22% and R(AW) decreased by 21%, up to 30 minutes after manual hyperinflation plus suction, but not after suction alone. This study suggests that manual hyperinflation in conjunction with suction induces beneficial changes in respiratory mechanics in mechanically ventilated patients with

  7. Ventilator-Associated Pneumonia (VAP in a Patient with Guillain-Barre Syndrome

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    Anti Dharmayanti

    2017-04-01

    Full Text Available A 46-year-old man was admitted to ICU with a diagnosis at the time of admission of Guillain Barre Syndrome (GBS and sepsis due to suspected Ventilator-Associated Pneumoniae (VAP. Specimens for the following laboratory workup were inquired, i.e. complete blood count, culture and resistance workup using specimens obtained from the tip of suction pipe, urinalysis and urine culture, blood culture and resistance, procalcitonin and lactate levels. Neutrophilia was found along with increased procalcitonin and lactate levels, which supported the sepsis diagnosis. Moreover, the result of culture from suction pipe demonstrated colonies of Pseudomonas luteola MDRO, which might be originated from the oropharyngeal colonization of the patients due to poor oral hygiene and ineffective oral hygiene nursing; therefore, the colonies of the microorganism were swabbed away when obtaining the specimens. Ineffective oral hygiene nursing may have a potency to cause VAP and recurrent VAP.

  8. Early Discrimination Of Microorganisms Involved In Ventilator Associated Pneumonia Using Qualitative Volatile Fingerprints

    Science.gov (United States)

    Planas, Neus; Kendall, Catherine; Barr, Hugh; Magan, Naresh

    2009-05-01

    This study has examined the use of an electronic nose for the detection of volatile organic compounds produced by different microorganisms responsible for ventilator-associated pneumonia (VAP), an important disease among patients who require mechanical ventilation. Based on the analysis of the volatile organic compounds, electronic nose technology is being evaluated for the early detection and identification of many diseases. It has been shown that effective discrimination of two bacteria (Enterobacter cloacae and Klebsiella pneumoniae) and yeast (Candida albicans), could be obtained after 24 h and filamentous fungus (Aspergillus fumigatus) after 72 h. Discrimination between blank samples and those with as initial concentration of 102 CFU ml-1 was shown with 24 h incubation for bacteria and 48 h for fungi. Effective discrimination between all the species was achieved 72 h after incubation. Initial studies with mixtures of microorganisms involved in VAP suggest that complex interactions between species occur which influences the ability to differentiate dominant species using volatile production patterns. A nutrient agar base medium was found to be optimum for early discrimination between two microorganisms (Klebsiella pneumoniae and Candida albicans).

  9. α-Hemolysin activity of methicillin-susceptible Staphylococcus aureus predicts ventilator-associated pneumonia.

    Science.gov (United States)

    Stulik, Lukas; Malafa, Stefan; Hudcova, Jana; Rouha, Harald; Henics, Bence Z; Craven, Donald E; Sonnevend, Agnes M; Nagy, Eszter

    2014-11-15

    Colonization of lower airways by Staphylococcus aureus is a risk factor for the development of ventilator-associated tracheobronchitis (VAT) and ventilator-associated pneumonia (VAP). However, little is known about the virulence factors of methicillin-sensitive and -resistant S. aureus (MSSA and MRSA) that may influence host colonization and progression to VAT and VAP. We evaluated MRSA and MSSA endotracheal aspirates (ETA) for genotype and α-hemolysin activity in relation to the development of VAT and VAP. Serial S. aureus ETA isolates from ventilated patients were analyzed for methicillin resistance, molecular type by Multi-Locus Sequence Typing and spa-typing, and α-hemolysin activity by semiquantitative analysis of hemolysis on sheep blood agar and quantitative measurement of cytolysis of human lung epithelial cells. The virulence of selected strains was assessed in mice by intranasal challenge. We detected S. aureus from ETA samples in a quarter of the 231 ventilated patients analyzed; one-third of them developed VAP. VAP patients (n = 15) were mainly infected by MSSA strains (87%), whereas colonized individuals (n = 18) not progressing to disease mainly carried MRSA strains (68%). MSSA isolates from colonized or VAT patients exhibited significantly lower α-hemolysin activity than those from VAP cases; however, no such relationship was found with MRSA strains. α-Hemolysin activity of S. aureus isolates was predictive for virulence in mouse pneumonia model. MSSA strains with strong blood agar hemolysis and high α-hemolysin activity are markers for VAP, but not VAT, and might be considered in differential diagnosis and initiation of therapy.

  10. APACHE II as an indicator of ventilator-associated pneumonia (VAP.

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    Kelser de Souza Kock

    2015-01-01

    Full Text Available Background and objectives: strategies for risk stratification in severe pathologies are extremely important. The aim of this study was to analyze the accuracy of the APACHE II score as an indicator of Ventilator-Associated Pneumonia (VAP in ICU patient sat Hospital Nossa Senhora da Conceição (HNSC Tubarão-SC. Methods: It was conducted a prospective cohort study with 120 patients admitted between March and August 2013, being held APACHE II in the first 24 hours of mechanical ventilation (MV. Patients were followed until the following gout comes: discharge or death. It was also analyzed the cause of ICU admission, age, gender, days of mechanical ventilation, length of ICU and outcome. Results: The incidence of VAP was 31.8% (38/120. Two variables showed a relative riskin the development of VAP, APACHE II above average (RR = 1,62; IC 95% 1,03-2,55 and males (RR = 1,56; IC 95 % 1,18-2,08. The duration of mechanical ventilation (days above average18.4± 14.9(p =0.001, ICU stay (days above average 20.4± 15.3(p =0.003 presented the development of VAP. The accuracy of APACHE II in predicting VAP score >23, showed a sensitivity of 84% and specificity of 33%. Inrelation to death, two variables showed relative risk, age above average (RR=2.08; 95% CI =1.34 to 3.23 and ICU stay above average (RR=2.05; CI 95 =1.28 to 3.28%. Conclusion: The APACHE II score above or equal 23 might to indicate the risk of VAP. Keywords: Pneumonia, Ventilator-Associated, Intensive Care Units, APACHE. Prognosis

  11. Rapid Automated Microscopy for Microbiological Surveillance of Ventilator-associated Pneumonia

    Science.gov (United States)

    Price, Connie S.; Overdier, Katherine H.; Wolken, Robert F.; Metzger, Steven W.; Hance, Kenneth R.; Howson, David C.

    2015-01-01

    Rationale: Diagnosis of ventilator-associated pneumonia (VAP) is imprecise. Objectives: To (1) determine whether alternate-day surveillance mini–bronchoalveolar lavage (mini-BAL) in ventilated adults could reduce time to initiation of targeted treatment and (2) evaluate the potential for automated microscopy to reduce analysis time. Methods: Adult intensive care unit patients who were anticipated to require ventilation for at least a further 48 hours were included. Mini-BALs were processed for identification, quantitation, and antibiotic susceptibility, using (1) clinical culture (50 ± 7 h) and (2) automated microscopy (∼5 h plus offline analysis). Measurements and Main Results: Seventy-seven mini-BALs were performed in 33 patients. One patient (3%) was clinically diagnosed with VAP. Of 73 paired samples, culture identified 7 containing pneumonia panel bacteria (>104 colony-forming units/ml) from five patients (15%) (4 Staphylococcus aureus [3 methicillin-resistant S. aureus], 2 Stenotrophomonas maltophilia, 1 Klebsiella pneumoniae) and resulted in antimicrobial changes/additions to two of five (40%) of those patients. Microscopy identified 7 of 7 microbiologically positive organisms and 64 of 66 negative samples compared with culture. Antimicrobial responses were concordant in four of five comparisons. Antimicrobial changes/additions would have occurred in three of seven microscopy-positive patients (43%) had those results been clinically available in 5 hours, including one patient diagnosed later with VAP despite negative mini-BAL cultures. Conclusions: Microbiological surveillance detected infection in patients at risk for VAP independent of clinical signs, resulting in changes to antimicrobial therapy. Automated microscopy was 100% sensitive and 97% specific for high-risk pneumonia organisms compared with clinical culturing. Rapid microscopy-based surveillance may be informative for treatment and antimicrobial stewardship in patients at risk for VAP

  12. Treatment of Achromobacter Ventilator-Associated Pneumonia in Critically Ill Trauma Patients.

    Science.gov (United States)

    Wood, G Christopher; Jonap, Brittany L; Maish, George O; Magnotti, Louis J; Swanson, Joseph M; Boucher, Bradley A; Croce, Martin A; Fabian, Timothy C

    2018-02-01

    Achromobacter sp are nonfermenting Gram-negative bacilli (NFGNB) that rarely cause severe infections, including ventilator-associated pneumonia (VAP). Data on the treatment of Achromobacter pneumonia are very limited, and the organism has been associated with a high mortality rate. Thus, more data are needed on treating this organism. To evaluate the treatment of Achromobacter VAP in critically ill trauma patients. This retrospective, observational study evaluated critically ill trauma patients who developed Achromobacter VAP. A previously published pathway for the diagnosis and management of VAP was used according to routine patient care. This included the use of quantitative bronchoscopic bronchoalveolar lavage cultures to definitively diagnose VAP. A total of 37 episodes of Achromobacter VAP occurred in 34 trauma intensive care unit patients over a 15-year period. The most commonly used definitive antibiotics were imipenem/cilastatin, cefepime, or trimethoprim/sulfamethoxazole. The primary outcome of clinical success was achieved in 32 of 37 episodes (87%). This is similar to previous studies of other NFGNB VAP (eg, Pseudomonas, Acinetobacter) from the study center. Microbiological success was seen in 21 of 28 episodes (75%), and VAP-related mortality was 9% (3 of 34 patients). Achromobacter is a rare but potentially serious cause of VAP in critically ill patients. In this study, there was an acceptable success rate compared with other causes of NFGNB VAP in this patient population.

  13. Ventilator-Associated Pneumonia and Its Responsible Germs; an Epidemiological Study.

    Science.gov (United States)

    Bozorgmehr, Rama; Bahrani, Vanousheh; Fatemi, Alireza

    2017-01-01

    Ventilator-associated pneumonia (VAP) is one of the most common hospital infections and a side effect of lengthy stay in intensive care unit (ICU). Considering the ever-changing pattern of common pathogens in infectious diseases and the raise in prevalence of hospital infections, the present study was designed aiming to determine the prevalence of VAP and its bacterial causes. In this cross-sectional study, the medical profiles of all the patients under mechanical ventilation, who had no symptoms of pneumonia at the time of intubation and developed new infiltration in chest radiography after 48 hours under mechanical ventilation along with at least 2 of the symptoms including fever, hypothermia, leukocytosis, leukopenia, or purulent discharge from the lungs, were evaluated. Demographic data, clinical and laboratory findings, and final outcome of the patients were extracted from the patient's clinical profile and reported using SPSS version 20 and descriptive statistics. 518 patients with the mean age of 62.3 ± 20.8 years were evaluated (50.9% female). Mean time interval between intubation and showing symptoms was 10.89 ± 12.27 days. Purulent discharges (100%), leukocytosis (71.9%), fever (49.1%), hypothermia (12.3%), and leukopenia (8.8%) were the most common clinical and laboratory symptoms and acinetobacter baumannii (31.58%) and klebsiella pneumoniae (29.82%) were the most common germs growing in sputum cultures. 19 (33.3%) cases of pan drug resistance (PDR) and 10 (17.5%) cases of extensive drug resistance (XDR) were seen. Mortality due to VAP was 78.9% and there was no significant correlation between age (p = 0.841), sex (p = 0.473), ICU admission (p = 0.777), duration of hospitalization (p = 0.254), leukocytosis (p = 0.790), leukopenia (p = 0.952), fever (p = 0.171), hypothermia (p = 0.639), type of culture (p = 0.282), and type of antibiotic resistance (p = 0.066) with mortality. Prevalence of VAP and its associated mortality were 11% and 78

  14. Ventilator-Associated Pneumonia and Its Responsible Germs; an Epidemiological Study

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    Rama Bozorgmehr

    2017-01-01

    Full Text Available Introduction: Ventilator-associated pneumonia (VAP is one of the most common hospital infections and a side effect of lengthy stay in intensive care unit (ICU. Considering the ever-changing pattern of common pathogens in infectious diseases and the raise in prevalence of hospital infections, the present study was designed aiming to determine the prevalence of VAP and its bacterial causes. Methods: In this cross-sectional study, the medical profiles of all the patients under mechanical ventilation, who had no symptoms of pneumonia at the time of intubation and developed new infiltration in chest radiography after 48 hours under mechanical ventilation along with at least 2 of the symptoms including fever, hypothermia, leukocytosis, leukopenia, or purulent discharge from the lungs, were evaluated. Demographic data, clinical and laboratory findings, and final outcome of the patients were extracted from the patient’s clinical profile and reported using SPSS version 20 and descriptive statistics.Results: 518 patients with the mean age of 62.3 ± 20.8 years were evaluated (50.9% female. Mean time interval between intubation and showing symptoms was 10.89 ± 12.27 days. Purulent discharges (100%, leukocytosis (71.9%, fever (49.1%, hypothermia (12.3%, and leukopenia (8.8% were the most common clinical and laboratory symptoms and acinetobacter baumannii (31.58% and klebsiella pneumoniae (29.82% were the most common germs growing in sputum cultures. 19 (33.3% cases of pan drug resistance (PDR and 10 (17.5% cases of extensive drug resistance (XDR were seen. Mortality due to VAP was 78.9% and there was no significant correlation between age (p = 0.841, sex (p = 0.473, ICU admission (p = 0.777, duration of hospitalization (p = 0.254, leukocytosis (p = 0.790, leukopenia (p = 0.952, fever (p = 0.171, hypothermia (p = 0.639, type of culture (p = 0.282, and type of antibiotic resistance (p = 0.066 with mortality. Conclusion: Prevalence of VAP and its

  15. Antibiotic Utilization Patterns in Patients with Ventilator-Associated Pneumonia: A Canadian Context

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    Tracy Chin

    2016-01-01

    Full Text Available This retrospective cohort study describes the patterns of antibiotic use for the treatment of ventilator-associated pneumonia (VAP in the Calgary Zone of Alberta Health Services. Timing, appropriateness, and duration of antibiotics were evaluated in two hundred consecutive cases of VAP derived from 4 adult intensive care units (ICU. Antibiotic therapy was initiated in less than 24 hours from VAP diagnosis in 83% of cases. Although most patients (89% received empiric therapy that demonstrated in vitro sensitivity to the identified pathogens, only 24% of cases were congruent with the 2008 Association of Medical Microbiology and Infectious Disease (AMMI guidelines. Both ICU (p=0.001 and hospital (p=0.015 mortality were significantly lower and there was a trend for shorter ICU length of stay (p=0.051 in patients who received appropriate versus inappropriate initial antibiotics. There were no outcome differences related to compliance with AMMI guidelines. This exploratory study provides insight into the use of antimicrobials for the treatment of VAP in a large Canadian health region. The discordance between the assessments of appropriateness of empiric therapy based on recovered pathogens versus AMMI guidelines is notable, emphasizing the importance of using as much as possible local microbiologic and antimicrobial resistance data.

  16. Impact of ventilator associated pneumonia on outcome in patients with chronic obstructive pulmonary disease exacerbation

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    Vijay Hadda

    2014-01-01

    Full Text Available Background and Objective: There are sparse data regarding the impact of ventilator-associated pneumonia (VAP on outcome among patients with chronic obstructive pulmonary disease (COPD exacerbation. Materials and Methods: This retrospective study included patients with COPD exacerbation requiring endotracheal intubation for more than 48 h admitted in a single respiratory unit from January 2008 to December 2009. Records of these patients were checked for the occurrence of VAP. Results: One hundred and fifty-three patients required endotracheal intubation for COPD exacerbation during this period. The mean age of this cohort was 61.46 ± 11.3 years. The median duration of COPD was 6 years (range: 1-40. A total of 35 (22.8% patients developed VAP (early: 9 and late: 26. The risk of mortality was comparable between two groups, that is, patients with and without VAP [odd′s ratio (OR−1.125; 95% confidence interval (CI, 0.622-2.035]. The duration of mechanical ventilation and hospital stay (median ± standard error, 95% CI was 32 ± 10 (95% CI, 13-51 versus 10 ± 2 (95% CI, 6-14 days; P ≤ 0.001 and 53 ± 26 (95% CI, 3-103 versus 18 ± 7 (95% CI, 5-31 days; P = 0.031, respectively was higher among patients with VAP. Conclusions: Our study has shown that VAP leads to increased duration of mechanical ventilation and hospital stay; however, the mortality is not affected.

  17. Early ICU energy deficit is a risk factor for Staphylococcus aureus ventilator-associated pneumonia.

    Science.gov (United States)

    Faisy, Christophe; Candela Llerena, Maria; Savalle, Magali; Mainardi, Jean-Luc; Fagon, Jean-Yves

    2011-11-01

    Caloric insufficiency during the first week of ICU stay has been associated with increased infection rates. The connection between specific pathogens and host nutritional status in the ICU is not well known. This study was undertaken to determine the impact of patients' early in-ICU energy balance on the pathogens responsible for ventilator-associated pneumonia (VAP). In this prospective, observational, cohort study conducted in a teaching hospital ICU, energy balance (energy delivered - calculated resting energy expenditure) was compared according to the microbiologic results of the fiber-optic BAL cultures of 76 consecutive patients receiving acute prolonged (≥ 96 h) mechanical ventilation who developed VAP during their ICU stay. Among the 76 BAL cultures, 22 contained significant Staphylococcus aureus concentrations. The cumulated energy deficit of patients with S aureus VAP was greater than those with VAP caused by other pathogens (-10,275 ± 4,211 kcal vs -7,376 ± 4,013 kcal from ICU admission to day of BAL, P nutritional status, and conditions potentially limiting feeding did not differ significantly between the two groups. Patients with S aureus VAP had lower prescribed and delivered energy, causing higher energy deficits. Multivariate analysis identified energy deficit as being independently associated with S aureus VAP. More-severe energy deficit and higher rate of S aureus-positive BAL cultures (P = .01 comparing quartiles) were observed. Early ICU energy deficit is an independent determinant for acquiring S aureus VAP in patients on acute prolonged mechanical ventilation.

  18. High-dose Sulbactam Treatment for Ventilator-Associated Pneumonia Caused by Carbapenem-Resistant

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    In Beom Jeong

    2016-11-01

    Full Text Available Background Several antibiotics can be used to treat ventilator-associated pneumonia caused by carbapenem-resistant A. baumannii (CRAB-VAP including high-dose sulbactam. However, the effectiveness of high-dose sulbactam therapy is not well known. We report our experience with high-dose sulbactam for treatment of CRAB-VAP. Methods Medical records of patients with CRAB-VAP who were given high-dose sulbactam between May 2013 and June 2015 were reviewed. Results Fifty-eight patients with CRAB-VAP were treated with high-dose sulbactam. The mean age was 72.0 ± 15.2 years, and the acute physiology and chronic health evaluation II (APACHE II score was 15.1 ± 5.10 at the time of CRAB-VAP diagnosis. Early clinical improvement was observed in 65.5% of patients, and 30-day mortality was 29.3%. Early clinical failure (odds ratio [OR]: 8.720, confidence interval [CI]: 1.346-56.484; p = 0.023 and APACHE II score ≥ 14 at CRAB-VAP diagnosis (OR: 10.934, CI: 1.047-114.148; p = 0.046 were associated with 30-day mortality. Conclusions High-dose sulbactam therapy may be effective for the treatment of CRAB-VAP. However, early clinical failure was observed in 35% of patients and was associated with poor outcome.

  19. Methicillin Resistant Staphylococcus Aureus in Ventilator Associated Pneumonia in Toxicological Intensive Care Unit

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    Alireza Salimi

    2014-11-01

    Full Text Available Background: Methicillin resistant Staphylococus Aureus (MRSA is a cause of nosocomial infections at intensive care unit (ICU, which imposes a high mortality and morbidity on the health care systems. The objective of this study was to evaluate the role of MRSA in patients with clinically suspected ventilator associated pneumonia (VAP in toxicological ICU admitted patients. Methods: This cross-sectional study was performed over a period of six months from August 2009 to February 2010. A total of 84 patients with clinically suspected VAP were selected from all 381 ICU admitted patients under mechanical ventilation for more than 48 hours. MRSA Screen Agar was used to detect resistance in Staph aureus specimens. MRSA was determined as the main outcome. Results: MRSA was the cause in 54% of Staph aureus infected VAPs. Although MRSA infection was not significantly associated with age, gender, cause of poisoning, chronic disease, paraclinical findings, length of hospital stay, and antibiotic prescription (P>0.05 for all comparisons, it was reported higher in those who expired than those who survived (66.7% vs. 31.9%, P<0.012. Conclusion: In the main referral toxicological ICU in Tehran, in more than 1 of 3 clinically suspected VAP cases, MRSA was seen which was associated with the poorer outcome, higher inpatient mortality.

  20. Eosinophil as a Protective Cell in S. aureus Ventilator-Associated Pneumonia

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    Ana Rodriguez-Fernandez

    2013-01-01

    Full Text Available Cell counts of leukocytes subpopulations are demonstrating to have an important value in predicting outcome in severe infections. We evaluated here the render of leukogram counts to predict outcome in patients with ventilator-associated pneumonia (VAP caused by Staphylococcus aureus. Data from patients admitted to the ICU of Hospital Clínico Universitario de Valladolid from 2006 to 2011 with diagnosis of VAP caused by S. aureus were retrospectively collected for the study (n=44. Leukocyte counts were collected at ICU admission and also at VAP diagnosis. Our results showed that nonsurvivors had significant lower eosinophil counts at VAP diagnosis. Multivariate Cox regression analysis performed by the Wald test for forward selection showed that eosinophil increments from ICU admission to VAP diagnosis and total eosinophil counts at VAP diagnosis were protective factors against mortality in the first 28 days following diagnosis: (HR [CI 95%], P: (0.996 [0.993–0.999], 0.010; (0.370 [0.180–0.750], 0.006. Patients with eosinophil counts <30 cells/mm3 at diagnosis died earlier. Eosinophil counts identified survivors: (AUROC [CI 95%], P: (0.701 [0.519–0.882], 0.042. Eosinophil behaves as a protective cell in patients with VAP caused by S. aureus.

  1. Eosinophil as a protective cell in S. aureus ventilator-associated pneumonia.

    Science.gov (United States)

    Rodriguez-Fernandez, Ana; Andaluz-Ojeda, David; Almansa, Raquel; Justel, Mar; Eiros, Jose Maria; Ortiz de Lejarazu, Raul

    2013-01-01

    Cell counts of leukocytes subpopulations are demonstrating to have an important value in predicting outcome in severe infections. We evaluated here the render of leukogram counts to predict outcome in patients with ventilator-associated pneumonia (VAP) caused by Staphylococcus aureus. Data from patients admitted to the ICU of Hospital Clínico Universitario de Valladolid from 2006 to 2011 with diagnosis of VAP caused by S. aureus were retrospectively collected for the study (n = 44). Leukocyte counts were collected at ICU admission and also at VAP diagnosis. Our results showed that nonsurvivors had significant lower eosinophil counts at VAP diagnosis. Multivariate Cox regression analysis performed by the Wald test for forward selection showed that eosinophil increments from ICU admission to VAP diagnosis and total eosinophil counts at VAP diagnosis were protective factors against mortality in the first 28 days following diagnosis: (HR [CI 95%], P): (0.996 [0.993-0.999], 0.010); (0.370 [0.180-0.750], 0.006). Patients with eosinophil counts <30 cells/mm(3) at diagnosis died earlier. Eosinophil counts identified survivors: (AUROC [CI 95%], P): (0.701 [0.519-0.882], 0.042). Eosinophil behaves as a protective cell in patients with VAP caused by S. aureus.

  2. Pathophysiology of Escherichia coli ventilator-associated pneumonia: implication of highly virulent extraintestinal pathogenic strains.

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    Messika, Jonathan; Magdoud, Fatma; Clermont, Olivier; Margetis, Dimitri; Gaudry, Stéphane; Roux, Damien; Branger, Catherine; Dreyfuss, Didier; Denamur, Erick; Ricard, Jean-Damien

    2012-12-01

    To characterize Escherichia coli ventilator-associated pneumonia (VAP) in intensive care unit (ICU) patients by determining antibioresistance and genotypic characteristics of E. coli isolates responsible for VAP or lung colonization, by comparing them with their oropharyngeal and rectal counterparts and by assessing representative isolates' virulence in a pneumonia mouse model. Patients under mechanical ventilation for more than 72 h were screened for simultaneous presence of E. coli in rectal, oropharyngeal, and respiratory samples (colonization or VAP). If present, E. coli isolates were characterized by antimicrobial susceptibility, phylogenetic grouping, and virulence factor (VF) gene content determination. BALB/c mice were challenged intranasally with 3.6 × 10(8) colony-forming units (CFU) of patients' E. coli isolates. Multisite E. coli colonization was observed in 19 % of patients (25 patients, 12 with E. coli VAP). One hundred fifteen distinct E. coli isolates were analyzed. B2 phylogenetic group was predominant, with high VF gene content and low antimicrobial resistance. Antimicrobial resistance diversity was observed in four patients with VAP. E. coli isolates from VAP patients were more frequently B2 isolates, with significantly greater VF gene content than lung colonization isolates. Among screened VF genes, iroN and sfa appeared important for lung infection. A very strong correlation (R (2) = 0.99) was found between VF gene content and mortality in the mouse model. This is the first study establishing antibioresistance and genotypic characteristics of E. coli isolates responsible for VAP in adult ICU patients. These isolates are highly virulent specific extraintestinal pathogenic E. coli strains expressing virulence factors, representing potential targets for new therapies.

  3. Prior antimicrobial therapy duration influences causative pathogens identification in ventilator-associated pneumonia.

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    Llitjos, Jean-François; Amara, Marlène; Benzarti, Ahlem; Lacave, Guillaume; Bedos, Jean-Pierre; Pangon, Béatrice

    2018-02-01

    To determine whether prior antimicrobial therapy, divided in recent or current antibiotic treatment, influences the identification rate and/or the type of causative pathogens in patients with suspected episodes of ventilator-acquired pneumonia. Monocentric retrospective study. Intensive car unit in a universitary hospital. 230 episodes of ventilator-associated pneumonia with a Clinical Pulmonary Infection Score≥6 were retrospectively evaluated. Based on the antimicrobial treatment regimen, we defined 3 groups: the no antimicrobial treatment group (VAP is suspected in patients that has never received antibiotics during the last 90days), group 2: the current antimicrobial therapy (VAP is suspected under antimicrobial therapy) and group 3: the recent antimicrobial therapy (VAP is suspected whereas an antimicrobial treatment has been used during the last 90days but discontinued for >24h). Bacteriologic analysis using a protected distal sampling with microscopic examination, culture and microbial identification using MALDI-TOF. Suspected episodes of VAP were sorted as follow: 70 suspected episodes in the no antimicrobial therapy group, 106 suspected episodes in the current antimicrobial therapy group and 54 suspected episodes in the recent antimicrobial therapy group. The rate of positive culture was significantly lower in the current antimicrobial treatment group (group 2) when compared to the recent (group 3) and to the no antimicrobial treatment groups (group 1) (42%, 68% and 86%, respectively). When compared to the recent antibiotherapy group, we observed that current antibiotherapy was significantly associated with a higher rate of MDR positive culture, mainly due to higher rate of MDR Pseudomonas aeruginosa. In patients with a high probability of VAP, current but not recent antibiotic use is associated with a lower rate of positive culture with a higher proportion of MDR pathogens, mostly MDR Pseudomonas aeruginosa. Copyright © 2017. Published by Elsevier Inc.

  4. Brushing teeth with purified water to reduce ventilator-associated pneumonia.

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    Yao, Li-Yin; Chang, Cheng-Kuei; Maa, Suh-Hwa; Wang, Charlotte; Chen, Cheryl Chia-Hui

    2011-12-01

    Oral care may decrease the development of ventilator-associated pneumonia (VAP) and improve oral hygiene. However, little evidence is available to guide the development of oral care protocols. The practical effect of toothbrushing on VAP development and oral health and hygiene improvement is inconclusive. This study evaluated the effects in postneurosurgical, intensive care unit patients of brushing teeth twice daily with purified water on VAP rates and oral health or hygiene. This study conducted a randomized controlled pilot trial. Patients consecutively admitted to the surgical intensive care unit at a suburban hospital in 2007 were invited to participate if they met two inclusion criteria: (a) under ventilator support for at least 48 to 72 hours and (b) no current pneumonia. Upon obtaining informed consent, subjects were randomized into experimental and control groups. Both groups received usual hospital care, that is, daily oral care using cotton swabs. The experimental group additionally received a twice-daily oral care protocol of toothbrushing with purified water, elevating the head of the bed, and before-and-after hypopharyngeal suctioning. The control group also received twice-daily mock oral care (elevating the head of the bed, moisturizing the lips, and before-and-after hypopharyngeal suctioning). VAP was defined by a clinical pulmonary infection score of > 6. Oral hygiene and health was assessed after conclusion of the intervention. Patients (N = 53) were predominantly male (64.2%), mean age was 60.6 years old, and most had received emergency surgery (75.5%). After 7 days of toothbrushing with purified water, cumulative VAP rates were significantly lower in the experimental (17%) than in the control (71%; p <.05) group. The experimental group also had significantly better scores for oral health (p <.05) and plaque index (p <.01). CONCLUSION/IMPLICATION FOR PRACTICE: Findings suggest that, as an inexpensive alternative to existing protocols

  5. Diagnostic Value of Endotracheal Aspirates Sonication on Ventilator-Associated Pneumonia Microbiologic Diagnosis

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    Motos, Ana; Li Bassi, Gianluigi; Aguilera Xiol, Elisabet; Senussi, Tarek; Travierso, Chiara; Chiurazzi, Chiara; Idone, Francesco; Muñoz, Laura; Vila, Jordi; Ferrer, Miquel; Pelosi, Paolo; Torres, Antoni

    2017-01-01

    Microorganisms are able to form biofilms within respiratory secretions. Methods to disaggregate such biofilms before utilizing standard, rapid, or high throughput diagnostic technologies may aid in pathogen detection during ventilator associated pneumonia (VAP) diagnosis. Our aim was to determine if sonication of endotracheal aspirates (ETA) would increase the sensitivity of qualitative, semi-quantitative, and quantitative bacterial cultures in an animal model of pneumonia caused by Pseudomonas aeruginosa or by methicillin resistant Staphylococcus aureus (MRSA). Material and methods: P. aeruginosa or MRSA was instilled into the lungs or the oropharynx of pigs in order to induce severe VAP. Time point assessments for qualitative and quantitative bacterial cultures of ETA and bronchoalveolar lavage (BAL) samples were performed at 24, 48, and 72 h after bacterial instillation. In addition, at 72 h (autopsy), lung tissue was harvested to perform quantitative bacterial cultures. Each ETA sample was microbiologically processed with and without applying sonication for 5 min at 40 KHz before bacterial cultures. Sensitivity and specificity were determined using BAL as a gold-standard. Correlation with BAL and lung bacterial burden was also determined before and after sonication. Assessment of biofilm clusters and planktonic bacteria was performed through both optical microscopy utilizing Gram staining and Confocal Laser Scanning Microscopy utilizing the LIVE/DEAD®BacLight kit. Results: 33 pigs were included, 27 and 6 from P. aeruginosa and MRSA pneumonia models, respectively. Overall, we obtained 85 ETA, 69 (81.2%) from P. aeruginosa and 16 (18.8%) from MRSA challenged pigs. Qualitative cultures did not significantly change after sonication, whereas quantitative ETA cultures did significantly increase bacterial counting. Indeed, sonication consistently increased bacterial burden in ETAs at 24, 48, and 72 h after bacterial challenge. Sonication also improved sensitivity of

  6. Polymicrobial Ventilator-Associated Pneumonia: Fighting In Vitro Candida albicans-Pseudomonas aeruginosa Biofilms with Antifungal-Antibacterial Combination Therapy

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    Rodrigues, Maria E.; Lopes, Susana P.; Pereira, Cl?udia R.; Azevedo, Nuno F.; Louren?o, An?lia; Henriques, Mariana; Pereira, Maria O.

    2017-01-01

    The polymicrobial nature of ventilator-associated pneumonia (VAP) is now evident, with mixed bacterial-fungal biofilms colonizing the VAP endotracheal tube (ETT) surface. The microbial interplay within this infection may contribute for enhanced pathogenesis and exert impact towards antimicrobial therapy. Consequently, the high mortality/morbidity rates associated to VAP and the worldwide increase in antibiotic resistance has promoted the search for novel therapeutic strategies to fight VAP po...

  7. Pseudomonas aeruginosa colonization enhances ventilator-associated pneumonia-induced lung injury.

    Science.gov (United States)

    Tsay, Tzyy-Bin; Jiang, Yu-Zhen; Hsu, Ching-Mei; Chen, Lee-Wei

    2016-08-09

    Pseudomonas aeruginosa (PA) is the single-most common pathogen of ventilator-associated pneumonia (VAP). Large quantities of PA in the trachea of ventilated patients are associated with an increased risk of death. However, the role of PA colonization in PA VAP-induced lung injury remains elusive. This study examined the effect and mechanism of PA colonization in VAP-induced lung injury. C57BL/6 wild-type (WT) and c-Jun N-terminal kinase knockout (JNK1(-/-)) mice received mechanical ventilation for 3 h at 2 days after receiving nasal instillation of PA (1 × 10(6) colony forming unit) or normal saline. Intranasal instillation of PA or mechanical ventilation induced the expression of interleukin-6 (IL-6) in the lungs. Phospho-JNK protein expression in the lungs was significantly increased in mice receiving mechanical ventilation after PA instillation as compared with those receiving ventilation alone. Mechanical ventilation after PA instillation significantly increased the expression of tumor necrosis factor-α (TNF-α), IL-1β, and macrophage inflammatory protein-2 (MIP-2) proteins; neutrophil sequestration; and TNF-α, IL-1β, and IL-6 levels in the lungs of WT mice, but not in JNK1(-/-) mice. PA colonization plays an important role in PA VAP-induced lung injury through the induction of JNK1-mediated inflammation. PA-induced VAP causes lung injury through JNK signaling pathway in the lungs. JNK inhibition in ICU patients with higher percentages of PA colonization may reduce VAP-induced lung injury and mortality.

  8. Candida spp. airway colonization: A potential risk factor for Acinetobacter baumannii ventilator-associated pneumonia.

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    Tan, Xiaojiang; Zhu, Song; Yan, Dongxing; Chen, Weiping; Chen, Ruilan; Zou, Jian; Yan, Jingdong; Zhang, Xiangdong; Farmakiotis, Dimitrios; Mylonakis, Eleftherios

    2016-08-01

    This retrospective study was conducted to identify potential risk factors for Acinetobacter baumannii (A. baumannii) ventilator-associated pneumonia (VAP) and evaluate the association between Candida spp. airway colonization and A. baumannii VAP. Intensive care unit (ICU) patients who were on mechanical ventilation (MV) for ≥48 hours were divided into the following groups: patients with and without Candida spp. airway colonization; colonized patients receiving antifungal treatment or not; patients with A. baumannii VAP and those without VAP. Logistic regression analysis and propensity score matching were used to identify factors independently associated with A. baumannii VAP. Among 618 eligible patients, 264 (43%) had Candida spp. airway colonization and 114 (18%) developed A. baumannii VAP. Along with MV for ≥7 days (adjusted odds ratio [aOR] 8.9, 95% confidence intervals [95% CI] 4.9-15.8) and presence of a central venous catheter (aOR 3.2, 95% CI 1.1-9), Candida spp. airway colonization (aOR 2.6, 95% CI 1.6-4.3) was identified as an independent risk factor for A. baumannii VAP. Patients with Candida spp. airway colonization were more likely to develop A. baumannii VAP than non-colonized patients (23% vs 15%, P=.01 and 34% vs. 15%, PCandida spp. airway colonization (43%) and A. baumannii VAP (18%) were common in ICU patients who were on mechanical ventilation for at least 48 hours. Candida spp. airway colonization was an independent risk factor for subsequent A. baumannii VAP. © The Author 2016. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  9. A Bayesian decision-support system for diagnosing ventilator-associated pneumonia.

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    Schurink, Carolina A M; Visscher, Stefan; Lucas, Peter J F; van Leeuwen, Henk J; Buskens, Erik; Hoff, Reinier G; Hoepelman, Andy I M; Bonten, Marc J M

    2007-08-01

    To determine the diagnostic performance of a Bayesian Decision-Support System (BDSS) for ventilator-associated pneumonia (VAP). A previously developed BDSS, automatically obtaining patient data from patient information systems, provides likelihood predictions of VAP. In a prospectively studied cohort of 872 ICU patients, VAP was diagnosed by two infectious-disease specialists using a decision tree (reference diagnosis). After internal validation daily BDSS predictions were compared with the reference diagnosis. For data analysis two approaches were pursued: using BDSS predictions (a) for all 9422 patient days, and (b) only for the 238 days with presumed respiratory tract infections (RTI) according to the responsible physicians. 157 (66%) of 238 days with presumed RTI fulfilled criteria for VAP. In approach (a), median daily BDSS likelihood predictions for days with and without VAP were 77% [Interquartile range (IQR) = 56-91%] and 14% [IQR 5-42%, p BDSS cut-off point for VAP was 46%, and with this cut-off point positive predictive value (PPV) and negative predictive value (NPV) were 6.1 and 99.6%, respectively [AUC = 0.857 (95% CI 0.827-0.888)]. In approach (b), optimal cut-off for VAP was 78%, and with this cut-off point PPV and NPV were 86 and 66%, respectively [AUC = 0.846 (95% CI 0.794-0.899)]. As compared with the reference diagnosis, the BDSS had good test characteristics for diagnosing VAP, and might become a useful tool for assisting ICU physicians, both for routinely daily assessment and in patients clinically suspected of having VAP. Empirical validation of its performance is now warranted.

  10. Ventilator-associated pneumonia in trauma patients with open tracheotomy: Predictive factors and prognosis impact

    Science.gov (United States)

    Chaari, Anis; Kssibi, Hichem; Zribi, Wassim; Medhioub, Fatma; Chelly, Hedi; Algia, Najla B.; Hamida, Chokri B.; Bahloul, Mabrouk; Bouaziz, Mounir

    2013-01-01

    Objective: To assess the predictive factors of ventilator associated pneumonia (VAP) occurrence following open tracheotomy in trauma patients. Materials and Methods: We conducted an observational, prospective study over 15 months, between 01/08/2010 and 30/11/2011. All trauma patients (except those with cervical spine trauma), older than 15 years, undergoing open tracheotomy during their ICU stay were included. All episode of VAP following tracheotomy were recorded. Predictive factor of VAP onset were studied. Results: We included 106 patients. Mean age was 37.9 ± 15.5 years. Mean Glasgow coma Scale (GCS) was 8.5 ± 3.7 and mean Injury Severity Score (ISS) was 53.1 ± 23.8. Tracheotomy was performed for 53 patients (50%) because of prolonged ventilation whereas 83 patients (78.3%) had tracheotomy because of projected long mechanical ventilation. Tracheotomy was performed within 8.6 ± 5.3 days. Immediate complications were bleeding events (22.6%) and barotrauma (0.9%). Late complications were stomal infection (28.3%) and VAP (52.8%). In multivariate analysis, independent factors predicting VAP onset were delayed tracheotomy (OR = 0.041; CI95% [1.02-7.87]; P = 0.041) and stomal infection (OR = 3.04; CI95% [1.02-9.93]; P = 0.045). Thirty three patients died in ICU (31.1%) without significant impact of VAP on mortality. Conclusion: Late tracheotomy and stomal infection are independent factors predicting VAP onset after open tracheotomy in trauma patients. The occurrence of VAP prolongers mechanical ventilation duration and intensive care unit (ICU) length of stay (LOS) but doesn’t increase mortality. PMID:24339656

  11. The application of human engineering interventions reduces ventilator-associated pneumonia in trauma patients.

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    Cachecho, Riad; Dobkin, Eric

    2012-10-01

    Ventilator-associated pneumonia (VAP) increases mortality and length of stay and escalates the cost of care. Our institution embarked on a project to eradicate VAP. We compared the outcome of trauma patients admitted in period 1 (P1) (January 2005 to December 2006) and period 2 (P2) (January 2006 to December 2009). Team building, culture change, and the ventilator bundle were introduced and modified during P1 and were fully implemented in P2. Outcome data were calculated for both periods. The Center for Disease Control VAP definition was used. The VAP rate was calculated as VAP/1,000 ventilator days. Chi-square and t test statistics were used as appropriate. Data were considered statistically significant if p ≤ 0.05. In total, 299 trauma patients were admitted in P1 and 655 in P2. The two groups were identical in age, Injury Severity Score, mortality, and non-VAP. There was a trend toward a shorter length of stay in P2 (p = 0.06). The days on ventilator was significantly shorter in P2 compared with P1 (p = 0.05). The VAP rate dropped significantly from 7.9/1,000 in P1 to 1.0/1,000 in P2 (p = 0.04). The Appropriate Care Measure score increased from 45% in early P1 to 91% in late P2 (p = 0.0001). The application of the VAP bundle, a checklist, and the multidisciplinary team approach resulted in significant improvement of VAP in all trauma patients admitted to the shock trauma unit and to the decrease in days on ventilator in the trauma patients. This intervention did not affect mortality or the rate of non-VAP in the trauma patients. Therapeutic study, level IV.

  12. Incidence, bacteriology, and clinical outcome of ventilator-associated pneumonia at tertiary care hospital.

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    Patil, Harsha V; Patil, Virendra C

    2017-01-01

    Ventilator-associated pneumonia (VAP) is the most frequent Intensive Care Unit acquired infection. The aim is to determine the incidence, bacteriology and factors affecting VAP and to determine the multi-drug resistant (MDR) pathogens. This was a prospective observational study conducted over a period of 1 year from April 1, 2011, to March 31, 2012. The patients fulfilling criteria of VAP were included in this study. This was performed using SPSS trial version 11.0 software (SPSS Inc., Chicago, Illinois, USA) and the values of P < 0.05 were considered statistically significant. Totally 74 (27.71%) patients were developed VAP. Of total 74 patients with VAP 53 (71.62%) were females and 21 (28.37%) were females (P < 0.0001). Total 13 (17.56%) patients had early-onset VAP and 61 (82.43%) had late-onset VAP (P < 0.0001). The overall incidence of VAP rate per 1000 ventilator days was 39.59. Total 126 bacterial isolates found in 74 patients with VAP. Predominant isolates were Gram-negative 52 (70.27%). Total 41 (55.40%) patients had polymicrobial VAP, and 33 (44.59%) had single isolate. Total 55 (43.65%) isolates were MDR organisms. Total 22 patients with VAP succumbed during treatment with overall case fatality rate of 29.72%. Of total 55 MDR isolates in VAP, 13 (26.63%) were Klebsiella spp., 11(20%) Pseudomonas aeruginosa, 14 (25.45%) Acinetobacter, 8 (14.54%) Escherichia coli, and 9 (16.36%) coagulase positive Staphylococcus aureus. Total 12 (21.41%) patients succumbed among MDR isolates. There was a high incidence of MDR pathogens in late-onset VAP. The Gram-negative organisms Klebsiella, PseudomonasE. coli and Acinetobacter were the most commonly isolated organisms with high mortality rates.

  13. Pharmacokinetic optimisation of beta-lactams for the treatment of ventilator-associated pneumonia

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    G. L. Drusano

    2007-08-01

    Full Text Available Rational therapy of ventilator-associated pneumonia requires choosing the right drug at the right dose. The choice of dose depends on the microbiological goal, the range of minimum inhibitory concentrations (MICs for likely pathogens, the extent of the drug's protein binding and, in humans, pharmacokinetics. If protein binding and the distribution of pharmacokinetic parameters are known, as well as the likely pathogens and MICs in a given setting, Monte Carlo simulations can be used to calculate the likelihood that a given dose will attain an identified microbiological goal. For beta-lactams, the antibacterial effect depends on the percentage of time (%T during the dosing interval that the free (nonprotein bound antibiotic concentration remains above the MIC (%T >MIC; the required values are smaller for carbapenems than for penicillins or cephalosporins. Data show that infusion of an i.v. beta-lactam over an extended period may greatly increase %T >MIC, and hence efficacy, at a given dose. Alternatively, it may provide the same efficacy at a lower total dose, reducing cost and potential toxicity. In a real-life setting, a 4-h infusion of 3.375 g piperacillin-tazobactam q8 h (every 8 h; 3 times daily; proved more effective for severe Pseudomonas aeruginosa infections than a 30-min infusion of 3.375 g q6 h (every 6 h; 4 times daily or q4 h (every 4 h; 6 times daily. Data for doripenem, an investigational carbapenem, suggest that its stability following reconstitution may render it particularly suitable for extended infusion.

  14. Cuci tangan sebagai faktor risiko kejadian ventilator associated pneumonia di RSUP Sanglah Denpasar tahun 2012

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    Abdul Azis

    2014-02-01

    Full Text Available Ventilator associated pneumonia (VAP is a lower respiratory tract nosocomial infection which frequently resulting from mechanical ventilation support of more than 48 hours in an intensive care unit (ICU. The incidence of VAP at Sanglah Hospital is 15.48 per 1000 days used still higher than the national standard of 10 per 1000 days used. Risk factors for VAP transmission include host condition, medical equipment hygiene and healthcare provider behaviors, including handwashing. This study aimed to analyze contributing risk factors for VAP incidence at Sanglah Hospital, specifically handwashing procedures. Study applied case control with 27 sample cases (those with VAP and 54 control subjects (non-VAP, from similar gender and age backgrounds. Case control data was obtained from medical records of 2012. Data from healthcare providers (doctors and nurses attending to the study population was obtained through interviewing using structure questionnaires and cross checking through assessment of medical records. The univariate and bivariate data was analyzed by chi square and multivariate by logistic regression. Findings indicated that the contributing factors are healthcare provider handwashing (OR=6.11; 95%CI: 1.54-24.25, length of hospital stay (OR=4.18; 95%CI: 1.36-12.81 and associated disease (OR=4.22; 95%CI: 0.98-18.25. Nurse behaviors contributed to VAP incidence (OR=4.69; 95%CI: 1.22-18.08. Doctors indicated difficulty in adhering to handwashing protocol (the 5 moment handwashing requirements particularly before aseptic procedure (45,1% in cases and 66,3% in control. Study indicates that poor handwashing behaviors contribute to VAP incidence. There is a need for health promotion initiatives that encourage adherence to official handwashing protocol.

  15. Clinical experience and incidence of ventilator-associated pneumonia using closed versus open suction-system.

    Science.gov (United States)

    Åkerman, Eva; Larsson, Catharina; Ersson, Anders

    2014-01-01

    Studies have shown a decreasing ventilator-associated pneumonia (VAP) incidence after prophylactic interventions bundles. The use of closed suction systems (CSS) has been suggested beneficial as a prophylactic measure. To investigate the effects of a CSS on VAP incidence, suction circuit contamination and adverse events (AEs) compared to an open suction system (OSS) approach in a general mixed intensive care unit (ICU). Adult patients on mechanical ventilation were consecutively included. Data were collected during four 1-month periods where CSS and OSS were used on an alternating basis. Airway cultures were obtained at intubation, after 72 h and every Monday. After changing CSS and at extubation, the catheter tip was cultured. AEs and desaturation events during suction were monitored. Descriptive analysis and differences between the groups were analysed using comparative methods. No differences in airway colonization at admission between the groups were detected (Table 2). The CSS group had a higher Simplified Acute Physiology Score (SAPS) III and also a non-significant increase in VAP incidence. Positive cultures were obtained in 50% of all the retrieved CSS catheters. There was no inter-patient contamination in either group. Six AEs versus one (CSS/OSS) related to tube-occlusion and secretion clogging was seen. Desaturations at suctioning were rare in both groups. No beneficial effects were seen on VAP incidence or inter-patient contamination compared to OSS. A high frequency of circuit contamination in the CSS group paralleled with experienced secretions clearance problems seem unfavourable and in concordance with previous studies. © 2013 The Authors. Nursing in Critical Care © 2013 British Association of Critical Care Nurses.

  16. Nursing actions for the prevention of ventilator-associated pneumonia Acciones de enfermería en la profilaxis de la pneumonía asociada a la ventilación mecánica Ações de enfermagem na profilaxia da pneumonia associada à ventilação mecânica

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    Fernanda Alves Ferreira Gonçalves

    2012-01-01

    Full Text Available OBJECTIVE: To identify prevention actions of the nursing team related to ventilator-associated pneumonia (VAP. METHOD: A cross-sectional, observational study conducted in an Intensive Care Unit of a teaching hospital in Goiania/GO. RESULTS: Hand hygiene occurred, mainly, after the procedures and most of care, such as elevating the head-of-bed, bronchial and oral hygiene, diet administration, also handlingmechanical ventilator circuits were not adequate and if experienced groups such as the one in the present study are not following the recommendations emerging from evidence, it may indicate that, for some reason, the learning is not being significant. CONCLUSION: Most recommendedmeasures to reduce VAP related to positioning the head-of-bed, bronchial and oral hygiene, administration of diet and handling mechanical ventilator circuit were not followed.OBJETIVOS: identificar las acciones del equipo de enfermería relacionadas a la profilaxis de la pneumonía asociada a la ventilación mecánica (PAV. MÉTODO: estudio transversal, observacional realizado en la Unidad de Cuidados Intensivos de un hospital docente de Goiânia/GO. RESULTADOS: La higiene de las manos ocurrió, sobre todo, después de los procedimientos y la mayoría de los cuidados como la elevación de la cabecera, higiene bronquial y bucal, administración de la dieta y también de los cuidados con los circuitos del ventilador mecánico no fueron adecuados y, si los grupos con experiencia como el del presente estudio, no están siguiendo las recomendaciones oriundas de las evidencias, puede ser indicio de que, por alguna razón, el aprendizaje no está siendo significativo. CONCLUSIÓN: La mayoría de las medidas recomendadas para reducir la PAV relacionadas a la posición de la cabecera de la cama, a la higiene bronquial y bucal, a la administración de la dieta y al manejo de los circuitos del ventilador mecânico, no fueron tomados en cuenta.OBJETIVOS: identificar as ações da

  17. Nurse-led implementation of a ventilator-associated pneumonia care bundle in a children's critical care unit.

    Science.gov (United States)

    Hill, Charlotte

    2016-05-09

    Ventilator-associated pneumonia (VAP) is the leading cause of death with hospital-acquired infections, and preventing it is one of the Saving Lives initiatives ( Department of Health 2007 ). This article discusses the implementation of a purpose-designed VAP care bundle in a children's intensive care unit and examines the unique role of nurses in the management of the change process. A nurse-led VAP education, implementation and surveillance programme was set up. Nurse education was paramount, as nursing staff acceptance and involvement was a key feature. A multi-method training strategy was implemented, providing staff with multiple training opportunities and introducing VAP project education as a routine part of staff induction. Bundle compliance was monitored regularly and graphs of the results produced quarterly; feedback proved to be useful in keeping staff informed and engaged in VAP reduction. Comparison of VAP incidence before and after introduction of the care bundle showed a reduction after its implementation. With a co-ordinated, multidisciplinary approach, VAP care bundles can result in significant and sustained reductions in VAP rates in the paediatric intensive care unit. Effective co-ordination and leadership is crucial to successful implementation of the VAP bundle, and nurses are well placed to undertake this role.

  18. The Assessment of Correlation between Blood Products Injection with Ventilator- Associated Pneumonia in Trauma Patients under Mechanical Mentilation in ICU

    Directory of Open Access Journals (Sweden)

    Homeyra Akbarzadeh

    2017-03-01

    Full Text Available Abstract Background: Ventilator-associated pneumonia (VAP is one of the most important causes of mortality in intubated traumatic patients admitted in ICU. The aim of current study was to determine correlation between blood products transfusion with incidence of VAP in traumatic patients under mechanical ventilation in ICU. Materials and Methods: This study was a prospective descriptive-analytical study. Current study was carried out on traumatic patients under mechanical ventilation admitted to Imam Khomeini hospital ICU wards of Sari city, from September 2015 to September 2016. In addition to demographic data, patients' clinical information were daily recorded. Results: Of total of 2304 patients admitted to ICU, 186 traumatic patients under mechanical ventilation longer than 48 hours were reviewed and analyzed. Among patients infected with VAP, 36 persons(87.8% had transfusion of blood products before VAP incidence. Blood products transfusion (before and / or after 48 hours had the highest adjusted risk ratio in the incidence of VAP (Odds ratio; OR=3.58. Also, amount of injected Packed Red Blood Cells and platelet were significantly higher in patients infected with VAP (p<0.005. Conclusion: Considering remarkable increase in incidence of VAP following blood products transfusion and its correlation with injected PRBC and platelet, considering these modifiable risk factors for controlling and preventing the incidence of VAP in traumatic patients under mechanical ventilation in ICU is necessary and reasonable.

  19. Analysis of overall level of evidence behind the Institute of Healthcare Improvement ventilator-associated pneumonia guidelines

    Directory of Open Access Journals (Sweden)

    Iqbal M

    2011-08-01

    Full Text Available Background Clinical practice guidelines are developed to assist in patient care but the evidence basis for many guidelines has recently been called into question. Methods We conducted a literature review using PubMed and analyzed the overall quality of evidence and made strength of recommendation behind 6 Institute of Health Care (IHI guidelines for prevention of ventilator associated pneumonia (VAP. Quality of evidence was assessed by the American Thoracic Society levels of evidence (levels I through III with addition of level IV when evidence existed that the guideline increased VAP. We also examined our own intensive care units (ICUs for evidence of a correlation between guideline compliance and the development of VAP. Results None of the guidelines could be given more than a moderate recommendation. Only one of the guidelines (head of bed elevation was graded at level II and could be given a moderate recommendation. One was graded at level IV (stress ulcer disease prophylaxis. The remainder were graded level III and given weak recommendations. In our ICUs compliance with the guidelines did not correlate with a reduction in VAP (p<0.05. Conclusions Most of the IHI guidelines are based on level III evidence. Data from our ICUs did not support guideline compliance as a method of reducing VAP. Until more data from well-designed controlled clinical trials become available, physicians should remain cautious when using current IHI VAP guidelines to direct patient care decisions or as an assessment of the quality of care.

  20. Use of ventilator associated pneumonia bundle and statistical process control chart to decrease VAP rate in Syria.

    Science.gov (United States)

    Alsadat, Reem; Al-Bardan, Hussam; Mazloum, Mona N; Shamah, Asem A; Eltayeb, Mohamed F E; Marie, Ali; Dakkak, Abdulrahman; Naes, Ola; Esber, Faten; Betelmal, Ibrahim; Kherallah, Mazen

    2012-10-01

    Implementation of ventilator associated pneumonia (VAP) bundle as a performance improvement project in the critical care units for all mechanically ventilated patients aiming to decrease the VAP rates. VAP bundle was implemented in 4 teaching hospitals after educational sessions and compliance rates along with VAP rates were monitored using statistical process control charts. VAP bundle compliance rates were steadily increasing from 33 to 80% in hospital 1, from 33 to 86% in hospital 2 and from 83 to 100% in hospital 3 during the study period. The VAP bundle was not applied in hospital 4 therefore no data was available. A target level of 95% was reached only in hospital 3. This correlated with a decrease in VAP rates from 30 to 6.4 per 1000 ventilator days in hospital 1, from 12 to 4.9 per 1000 ventilator days in hospital 3, whereas VAP rate failed to decrease in hospital 2 (despite better compliance) and it remained high around 33 per 1000 ventilator days in hospital 4 where VAP bundle was not implemented. VAP bundle has performed differently in different hospitals in our study. Prevention of VAP requires a multidimensional strategy that includes strict infection control interventions, VAP bundle implementation, process and outcome surveillance and education.

  1. Effect of probiotics on the incidence of ventilator-associated pneumonia in critically ill patients: a randomized controlled multicenter trial.

    Science.gov (United States)

    Zeng, Juan; Wang, Chun-Ting; Zhang, Fu-Shen; Qi, Feng; Wang, Shi-Fu; Ma, Shuang; Wu, Tie-Jun; Tian, Hui; Tian, Zhao-Tao; Zhang, Shu-Liu; Qu, Yan; Liu, Lu-Yi; Li, Yuan-Zhong; Cui, Song; Zhao, He-Ling; Du, Quan-Sheng; Ma, Zhuang; Li, Chun-Hua; Li, Yun; Si, Min; Chu, Yu-Feng; Meng, Mei; Ren, Hong-Sheng; Zhang, Ji-Cheng; Jiang, Jin-Jiao; Ding, Min; Wang, Yu-Ping

    2016-06-01

    To evaluate the potential preventive effect of probiotics on ventilator-associated pneumonia (VAP). This was an open-label, randomized, controlled multicenter trial involving 235 critically ill adult patients who were expected to receive mechanical ventilation for ≥48 h. The patients were randomized to receive (1) a probiotics capsule containing live Bacillus subtilis and Enterococcus faecalis (Medilac-S) 0.5 g three times daily through a nasogastric feeding tube plus standard preventive strategies or (2) standard preventive strategies alone, for a maximum of 14 days. The development of VAP was evaluated daily, and throat swabs and gastric aspirate were cultured at baseline and once or twice weekly thereafter. The incidence of microbiologically confirmed VAP in the probiotics group was significantly lower than that in the control patients (36.4 vs. 50.4 %, respectively; P = 0.031). The mean time to develop VAP was significantly longer in the probiotics group than in the control group (10.4 vs. 7.5 days, respectively; P = 0.022). The proportion of patients with acquisition of gastric colonization of potentially pathogenic microorganisms (PPMOs) was lower in the probiotics group (24 %) than the control group (44 %) (P = 0.004). However, the proportion of patients with eradication PPMO colonization on both sites of the oropharynx and stomach were not significantly different between the two groups. The administration of probiotics did not result in any improvement in the incidence of clinically suspected VAP, antimicrobial consumption, duration of mechanical ventilation, mortality and length of hospital stay. Therapy with the probiotic bacteria B. Subtilis and E. faecalis are an effective and safe means for preventing VAP and the acquisition of PPMO colonization in the stomach.

  2. Early-Onset Ventilator-Associated Pneumonia in Adults Randomized Clinical Trial: Comparison of 8 versus 15 Days of Antibiotic Treatment

    Science.gov (United States)

    Capellier, Gilles; Mockly, Hélène; Charpentier, Claire; Annane, Djillali; Blasco, Gilles; Desmettre, Thibault; Roch, Antoine; Faisy, Christophe; Cousson, Joel; Limat, Samuel; Mercier, Mariette; Papazian, Laurent

    2012-01-01

    Purpose The optimal treatment duration for ventilator-associated pneumonia is based on one study dealing with late-onset of the condition. Shortening the length of antibiotic treatment remains a major prevention factor for the emergence of multiresistant bacteria. Objective To demonstrate that 2 different antibiotic treatment durations (8 versus 15 days) are equivalent in terms of clinical cure for early-onset ventilator-associated pneumonia. Methods Randomized, prospective, open, multicenter trial carried out from 1998 to 2002. Measurements The primary endpoint was the clinical cure rate at day 21. The mortality rate was evaluated on days 21 and 90. Results 225 patients were included in 13 centers. 191 (84.9%) patients were cured: 92 out of 109 (84.4%) in the 15 day cohort and 99 out of 116 (85.3%) in the 8 day cohort (difference = 0.9%, odds ratio = 0.929). 95% two-sided confidence intervals for difference and odds ratio were [−8.4% to 10.3%] and [0.448 to 1.928] respectively. Taking into account the limits of equivalence (10% for difference and 2.25 for odds ratio), the objective of demonstrative equivalence between the 2 treatment durations was fulfilled. Although the rate of secondary infection was greater in the 8 day than the 15 day cohort, the number of days of antibiotic treatment remained lower in the 8 day cohort. There was no difference in mortality rate between the 2 groups on days 21 and 90. Conclusion Our results suggest that an 8-day course of antibiotic therapy is safe for early-onset ventilator-associated pneumonia in intubated patients. Trial Registration ClinicalTrials.gov NCT01559753 PMID:22952580

  3. Oral chlorhexidine in the prevention of ventilator- associated ...

    African Journals Online (AJOL)

    Oswell Khondowe, MSc (PT), MSc APA, BSc (PT), Dip PT (PhD candidate). Janet Bell, MCur, BCur, PGDN (PhD candidate). Division of Nursing, Stellenbosch University, Tygerberg, W Cape. Purpose. The aim of this review was to evaluate the evidence on the effectiveness of oral chlorhexidine in the prevention of.

  4. Prehospital airway technique does not influence incidence of ventilator-associated pneumonia in trauma patients.

    Science.gov (United States)

    Steuerwald, Michael Thomas; Robinson, Bryce R H; Hanseman, Dennis J; Makley, Amy; Pritts, Timothy A

    2016-02-01

    The relationship between the prehospital airway device used and later development of ventilator-associated pneumonia (VAP) is unknown. We sought to determine if the prehospital airway device choice is associated with an increased risk of VAP in risk-adjusted critically injured patients. We performed a retrospective analysis of all trauma patients requiring definitive airway placement before intensive care unit admission at a Level I trauma center from 2008 to 2012. Prehospital airway management strategies were classified as extraglottic device placement, endotracheal intubation, bag-valve mask ventilation (BVM), or lack of a prehospital airway with subsequent intubation at the trauma center. Patients were excluded if they were hospital transfers, were dead on arrival, died in the emergency department, or did not require at least 48 hours of mechanical ventilation. The primary end point was the development of VAP as determined by institutional guidelines for diagnosis. Logistic regression was used to determine risk factors for VAP. A total of 317 patients met inclusion criteria. The median age was 37 years (interquartile range, 25-51 years), 75% were male, 78% sustained a blunt injury, and the median Injury Severity Score (ISS) was 29 (interquartile range, 21-34). Ninety-seven patients (30.6%) developed VAP. Prehospital airway strategies were as follows: 17 (5.4%) had extraglottic device placement, 28 (8.8%) had BVM, 84 (26.5%) had endotracheal intubation, and 188 (59.3%) had no prehospital airway placement and were intubated after arrival. The type of prehospital airway was not statistically significant in terms of VAP development (range, 26.1-42.9%; p = 0.15). The only statistically significant predictor of VAP was length of mechanical ventilation (univariate: odds ratio, 1.14; 95% confidence interval, 1.10-1.18; p ≤ 0.01; multivariate: odds ratio, 1.15; 95% confidence interval, 1.10-1.20; p ≤ 0.01). Our data suggest that the prehospital airway device used was

  5. Investigation into the effect of closed-system suctioning on the frequency of pediatric ventilator-associated pneumonia in a developing country.

    Science.gov (United States)

    Morrow, Brenda M; Mowzer, Rukaiya; Pitcher, Richard; Argent, Andrew C

    2012-01-01

    To investigate the effect of closed-system vs. open endotracheal suctioning on the frequency of ventilator-associated pneumonia and outcome in a pediatric intensive care unit in a developing country. Prospective observational and nonrandomized controlled clinical study. A 20-bed pediatric intensive care unit in a tertiary pediatric hospital. Infants and children mechanically ventilated for >24 hrs. : Pediatric intensive care unit suctioning systems were alternated monthly. An 8-month interim analysis was planned with a priori efficacy and futility study termination boundaries set at p .52, respectively. Demographic, clinical, and laboratory data were prospectively recorded. Ventilator-associated pneumonia was diagnosed using the Clinical Pulmonary Infection Score, and the results were confirmed retrospectively using Centers for Disease Control criteria. A total of 250 patients (median [interquartile range] age of 3.8 [1.2-15.0] months) in 263 pediatric intensive care unit admissions were included. Fifty-nine admissions developed ventilator-associated pneumonia, with a calculated rate of 45.1 infections per 1000 ventilated days. There was no difference in characteristics or outcome between patients on closed-system suctioning (n = 83) and those on open endotracheal suctioning (n = 180). The frequencies of ventilator-associated pneumonia for patients on closed-system suctioning and open endotracheal suctioning were 20.5% and 23.3%, respectively (p = .6), reaching the a priori set limit of futility. Patients who developed ventilator-associated pneumonia spent a median (interquartile range) of 22 (13-37) and 11 (8-16) days in the hospital and pediatric intensive care unit, respectively, compared to 14.5 (10-24) and 6 (4-8) days for those without ventilator-associated pneumonia (p < .001). A 22% proportion of patients who developed ventilator-associated pneumonia died compared to 11.3% of those without ventilator-associated pneumonia (p = .03). Risk factors for

  6. Effect of clarithromycin in inflammatory markers of patients with ventilator-associated pneumonia and sepsis caused by Gram-negative bacteria: results from a randomized clinical study.

    NARCIS (Netherlands)

    Spyridaki, A.; Raftogiannis, M.; Antonopoulou, A.; Tsaganos, T.; Routsi, C.; Baziaka, F.; Karagianni, V.; Mouktaroudi, M.; Koutoukas, P.; Pelekanou, A.; Kotanidou, A.; Orfanos, S.E.; Meer, J.W.M. van der; Netea, M.G.; Giamarellos-Bourboulis, E.J.

    2012-01-01

    One recent, double-blind, randomized clinical trial with 200 patients showed that clarithromycin administered intravenously for 3 days in patients with ventilator-associated pneumonia (VAP) accelerated the resolution of pneumonia and decreased the risk of death from septic shock and multiple organ

  7. Ventilator-associated pneumonia: the influence of bacterial resistance, prescription errors, and de-escalation of antimicrobial therapy on mortality rates

    Directory of Open Access Journals (Sweden)

    Ana Carolina Souza-Oliveira

    Full Text Available Abstract Ventilator-associated pneumonia is the most prevalent nosocomial infection in intensive care units and is associated with high mortality rates (14–70%. Aim This study evaluated factors influencing mortality of patients with Ventilator-associated pneumonia (VAP, including bacterial resistance, prescription errors, and de-escalation of antibiotic therapy. Methods This retrospective study included 120 cases of Ventilator-associated pneumonia admitted to the adult adult intensive care unit of the Federal University of Uberlândia. The chi-square test was used to compare qualitative variables. Student's t-test was used for quantitative variables and multiple logistic regression analysis to identify independent predictors of mortality. Findings De-escalation of antibiotic therapy and resistant bacteria did not influence mortality. Mortality was 4 times and 3 times higher, respectively, in patients who received an inappropriate antibiotic loading dose and in patients whose antibiotic dose was not adjusted for renal function. Multiple logistic regression analysis revealed the incorrect adjustment for renal function was the only independent factor associated with increased mortality. Conclusion Prescription errors influenced mortality of patients with Ventilator-associated pneumonia, underscoring the challenge of proper Ventilator-associated pneumonia treatment, which requires continuous reevaluation to ensure that clinical response to therapy meets expectations.

  8. Control of multi-resistant bacteria and ventilator-associated pneumonia: is it possible with changes in antibiotics?

    Directory of Open Access Journals (Sweden)

    Elisa M. Jukemura

    Full Text Available Potent antimicrobial agents have been developed as a response to the development of antibiotic-resistant bacteria, which especially affect patients with prolonged hospitalization in Intensive Care Units (ICU and who had been previously treated with antimicrobials, especially third-generation cephalosporins.This study was to determine how changes in the empirical treatment of infections in ICU patients affect the incidence of Gram-negative bacteria species and their susceptibility to antimicrobials, and examine the impact of these changes on nosocomial infections. A prospective interventional study was performed in a university hospital during two periods: 1 First period (September 1999 to February 2000; and 2 Second period (August 2000 to December 2000; empirical treatment was changed from ceftriaxone and/or ceftazidime in the first period to piperacillin/tazobactam in the second. ICU epidemiological and infection control rates, as well as bacterial isolates from upper airways were analyzed. Ceftazidime consumption dropped from 34.83 to 0.85 DDD/1000 patients per day (p=0.004. Piperacillin/tazobactam was originally not available; its consumption reached 157.07 DDD/1000 patients per day in the second period (p=0.0002. Eighty-seven patients and 66 patients were evaluated for upper airway colonization in the first and second periods, respectively. There was a significant decrease in the incidence of K. pneumoniae (p=0.004 and P. mirabilis (p=0.036, restoration of K. pneumoniae susceptibility to cephalosporins (p<0.0001 and reduction of ventilator-associated pneumonia rates (p<0.0001. However, there was an increase in P. aeruginosa incidence (p=0.005 and increases in ceftazidime (p=0.003 and meropenem (p<0.0001 susceptibilities. Changing antimicrobial selective pressure on multi-resistant Gram-negative bacteria helps control ventilator-associated pneumonia and decreases antimicrobial resistance.

  9. Development of an RN Champion Model to Improve the Outcomes of Ventilator-Associated Pneumonia Patients in the Intensive Care Unit.

    Science.gov (United States)

    Robinson, Carol; Hoze, Marci; Hevener, Stacy; Nichols, Amy A

    2018-02-01

    Healthcare-associated infections are costly. Methods to prevent infections must be effective and provide a return on investment to be sustainable. A funded project supported the design and implementation of a unique quality and safety model, using unit-based quality and safety RN champions. The goal was to create and sustain a hospital-wide safety culture focused on preventing ventilator-associated pneumonia (VAP) by adopting the Institute for Healthcare Improvement's VAP bundle. The program began with a pilot in 7 ICUs. Using the RN champion model resulted in the reduction of the incidence of VAP, cost avoidance, and decreased length of stay. Six years later, each adult ICU reached "zero zone."

  10. Incidence and clinical implication of nosocomial infections associated with implantable biomaterials – catheters, ventilator-associated pneumonia, urinary tract infections

    Science.gov (United States)

    Guggenbichler, Josef Peter; Assadian, Ojan; Boeswald, Michael; Kramer, Axel

    2012-01-01

    Health care associated infections, the fourth leading cause of disease in industrialised countries, are a major health issue. One part of this condition is based on the increasing insertion and implantation of prosthetic medical devices, since presence of a foreign body significantly reduces the number of bacteria required to produce infection. The most significant hospital-acquired infections, based on frequency and potential severity, are those related to procedures e.g. surgical site infections and medical devices, including urinary tract infection in catheterized patients, pneumonia in patients intubated on a ventilator and bacteraemia related to intravascular catheter use. At least half of all cases of nosocomial infections are associated with medical devices. Modern medical and surgical practices have increasingly utilized implantable medical devices of various kinds. Such devices may be utilized only short-time or intermittently, for months, years or permanently. They improve the therapeutic outcome, save human lives and greatly enhance the quality of life of these patients. However, plastic devices are easily colonized with bacteria and fungi, able to be colonized by microorganisms at a rate of up to 0.5 cm per hour. A thick biofilm is formed within 24 hours on the entire surface of these plastic devices once inoculated even with a small initial number of bacteria. The aim of the present work is to review the current literature on causes, frequency and preventive measures against infections associated with intravascular devices, catheter-related urinary tract infection, ventilator-associated infection, and infections of other implantable medical devices. Raising awareness for infection associated with implanted medical devices, teaching and training skills of staff, and establishment of surveillance systems monitoring device-related infection seem to be the principal strategies used to achieve reduction and prevention of such infections. The intelligent use

  11. Prevention and management of ventilator-associated pneumonia ...

    African Journals Online (AJOL)

    2009-11-16

    Nov 16, 2009 ... The guidelines provide targeted strategies, while additional management of VAP includes the ... Multidrug-resistant (MDR) strains of pathogens are on the increase both locally and internationally. Risk factors. Risk factors for the development of VAP ..... multidisciplinary team, the organisational climate and.

  12. [New definition of ventilator associated pneumonia might not necessarily have been a step in the right direction. Key takeaways from published studies after two years in clinical use].

    Science.gov (United States)

    Zamaro-Michalska, Aleksandra; Adamczyk, Agata; Mikaszewska-Sokolewicz, Małgorzata; Siewiera, Jacek; Łazowski, Tomasz

    2015-12-01

    Ventilator-associated pneumonia (VAP) is one of the most common hospital-acquired infections. VAP is associated with prolonged hospitalization and visibly increased mortality, which in the group of patients with VAP ranges from 25% to 47%. In January 2013 Centers of Disease Control and Prevention introduced a new definition for VAP. Subjective criteria in the previous VAP definition were the reason for difficulties in VAP surveillance and assessment of efficacy of ventilator bundles and other quality improvement initiatives. The purpose of this article is to summarise the new definition of VAP and the first researches after two years of use of the new definition. The new definition of ventilator-associated events (VAE) identifies a broader group of patients than the previous VAP definition. Surveillance of all complications of mechanical ventilation aimed to create more efficient prophylaxis bundles and to decrease the mortality in critically ill patients. The latest published studies suggest that most of the complications defined as VAE are patient-related, not modifiable risk factors and these patients had no evidence of hospital-acquired complications. The new definition failed to detect many patients with VAP and it has not resolved the ambiguities related to the diagnosis of this complication. It seems that the new surveillance program will not lead to introducing new prevention strategies that could decrease the mortality in intensive care unit patients. © 2015 MEDPRESS.

  13. Oral care with chlorhexidine seems effective for reducing the incidence of ventilator-associated pneumonia.

    Science.gov (United States)

    Veitz-Keenan, Analia; Ferraiolo, Debra M

    2017-12-22

    , low quality evidence) or duration of intensive care unit (ICU) stay (MD 0.21 days, 95% CI -1.48 to 1.89 days, P = 0.81, I2 = 9%, six RCTs, 833 participants, moderate quality evidence). There is insufficient evidence to determine the effect of CHX on duration of systemic antibiotics, oral health indices, caregivers' preferences or cost. Only two studies reported any adverse effects, and these were mild with similar frequency in CHX and control groups.The effect of toothbrushing (± antiseptics) is uncertain on the outcomes of VAP (RR 0.69, 95% CI 0.44 to 1.09, P = 0.11, I2 = 64%, five RCTs, 889 participants, very low quality evidence) and mortality (RR 0.87, 95% CI 0.70 to 1.09, P = 0.24, I2 = 0%, five RCTs, 889 participants, low quality evidence) compared to OHC without toothbrushing (± antiseptics).There is insufficient evidence to determine whether toothbrushing affects duration of mechanical ventilation, duration of ICU stay, use of systemic antibiotics, oral health indices, adverse effects, caregivers' preferences or cost.Only one trial (78 participants) compared use of a powered toothbrush with a manual toothbrush, providing insufficient evidence to determine the effect on any of the outcomes of this review.Fifteen trials compared various other oral care solutions. There is very weak evidence that povidone iodine mouthrinse is more effective than saline/placebo (RR 0.69, 95% CI 0.50 to 0.95, P = 0.02, I2 = 74%, three studies, 356 participants, high risk of bias) and that saline rinse is more effective than saline swab (RR 0.47, 95% CI 0.37 to 0.62, P <0.001, I2 = 84%, four studies, 488 participants, high risk of bias) in reducing VAP. Due to variation in comparisons and outcomes among trials, there is insufficient evidence concerning the effects of other oral care solutions.ConclusionsThe results from high quality evidence found that oral hygiene care (OHC), including chlorhexidine mouthwash or gel, reduces the risk of developing ventilator-associated pneumonia

  14. Evaluation of prevention and control measures for ventilator-associated pneumonia Evaluación de las medidas de prevención y control de neumonía asociada a ventilación mecánica Avaliação das medidas de prevenção e controle de pneumonia associada à ventilação mecânica

    Directory of Open Access Journals (Sweden)

    Leandra Terezinha Roncolato da Silva

    2011-12-01

    Full Text Available This study aimed to evaluate the quality of health care delivered in an Intensive Care Unit, concerning the use of pneumonia prevention and control measures in high-risk patients on mechanical ventilation. In this descriptive and exploratory research, 839 observations of patients under invasive ventilation care were carried out, between November 2009 and January 2010, using the Indicator of Evaluation of Adherence to Prevention and Control Measures in High-risk Patients (IRPR. Some isolated measures that compose the mentioned indicator reached rates close to 100%, but the general compliance rate with all prevention and control measures of ventilator-associated pneumonia was 26.94%. It is concluded that, although the evaluated practices are accomplished at the unit, systematic evaluations of the interventions is needed so as to permit the discussion and practice of other educational strategies by the health team.Este estudio objetivó evaluar la calidad de la asistencia a la salud prestada en una Unidad de Terapia Intensiva, en lo que se refiere al uso de medidas de prevención y control de neumonía en pacientes de alto riesgo sometidos a ventilación mecánica. Se trató de una investigación descriptiva exploratoria en la cual fueron realizadas 839 observaciones de pacientes en asistencia ventilatoria invasora, en el período de noviembre de 2009 a enero de 2010, utilizando el Indicador de Evaluación de la Adhesión a las Medidas de Prevención y Control de Neumonía en Pacientes de Alto Riesgo (IRPR. Algunas medidas aisladas que componen el Indicador alcanzaron índices próximos a 100%, sin embargo el índice de la conformidad general en todas las medidas de prevención y control de neumonía asociada a la ventilación mecánica correspondió a 26,94%. Se concluye que a pesar de que estas prácticas evaluadas estuviesen instituidas en la unidad, hay necesidad de realizar evaluaciones sistemáticas de las intervenciones para que otras

  15. An Update on Aerosolized Antibiotics for Treating Hospital-Acquired and Ventilator-Associated Pneumonia in Adults.

    Science.gov (United States)

    Wood, G Christopher; Swanson, Joseph M

    2017-12-01

    A significant percentage of patients with hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) have poor outcomes with intravenous antibiotics. It is not clear if adding aerosolized antibiotics improves treatment. This review is an update on using aerosolized antibiotics for treating HAP/VAP in adults. PubMed search using the terms "aerosolized antibiotics pneumonia," "nebulized antibiotics pneumonia," and "inhaled antibiotics pneumonia." Reference lists from identified articles were also searched. Clinical studies of aerosolized antibiotics for treating HAP/VAP in adults from July 2010 to March 2017. This article updates a previous review on this topic written in mid-2010. The size and quality of studies have improved dramatically in the recent time period compared to previous studies. However, there still are not large randomized controlled trials available. Colistin and aminoglycosides were the most commonly studied agents, and the most common pathogens were Pseudomonas and Acinetobacter. The clinical efficacy of adding aerosolized antibiotics was mixed. Approximately half of the studies showed better outcomes, and none showed worse outcomes. Aerosolized antibiotics appear to be relatively safe, though pulmonary adverse events can occur. Attention to proper administration technique in mechanically ventilated patients is required, including the use of vibrating plate nebulizers. Adding aerosolized antibiotics to intravenous antibiotics may improve the outcomes of adult patients with HAP/VAP in some settings. It seems reasonable to add aerosolized antibiotics in patients with multidrug-resistant organisms or who appear to be failing therapy. Clinicians should pay attention to potential adverse events and proper administration technique.

  16. Bayesian network models for the management of ventilator-associated pneumonia = Bayesiaanse netwerkmodellen voor de diagnose en behandeling van beademingsgerelateerde longontsteking.

    NARCIS (Netherlands)

    Visscher, S.

    2008-01-01

    The purpose of the research described in this thesis was to develop Bayesian network models for the analysis of patient data, as well as to use such a model as a clinical decision-support system for assisting clinicians in the diagnosis and treatment of ventilator-associated pneumonia (VAP) in

  17. Achieving and sustaining ventilator-associated pneumonia-free time among intensive care units (ICUs): evidence from the Keystone ICU Quality Improvement Collaborative.

    Science.gov (United States)

    Matar, Dany S; Pham, Julius C; Louis, Thomas A; Berenholtz, Sean M

    2013-07-01

    Our retrospective analysis of the Michigan Keystone intensive care unit (ICU) collaborative demonstrated that adult ICUs could achieve and sustain a zero rate of ventilator-associated pneumonia (VAP) for a considerable number of ventilator and calendar months. Moreover, the results highlight the importance of adjustment for ventilator-days before comparing VAP-free time among ICUs.

  18. [The metoclopramide effect on enteral nutrition tolerance and mechanical ventilation associated pneumonia in neuro critically ill patients].

    Science.gov (United States)

    Acosta-Escribano, Jose; Almanza López, Susana; Plumed Martín, Lidia; García Martinez, Miguel Angel; Tajadura Manjarín, Nuria

    2014-06-01

    The use of procinéticos in the critical patient with nutrition enteral, they have as aim reduce the increase of the gastric residue (RG). We evaluate his efficiency in the improvement of the intake enteral and on the reduction in the incident gastrointestinal complications (CGI) and pneumonia, in critical patients, with neurological injury Aims: To evaluate the effects in the administration metoclopramide (MCG), during the first five days with enteral nutrition, versus control (GC), on the volume of administered diet, gastrointestinal complications and the incidence of mechanical ventilation associated pneumonia (NAVM), in neuro-critically patients (NC) of traumatic and vascular aetiology. Prospective, closed-label, randomized study performed in an intensive Care Unit. Methords: 150 adult neuro-critical patients (NC) were admitted of consecutive form and 109 were randomly and two groups 58 MCG y 51 GC. The primary outcomes was the nutritional: the volume of administered diet (VAD); mean efficacious volume (MEV) measured in three consecutive periods of time; the gastrointestinal complications (GIC), and the rate of partial and definitive suspension of the diet. Infecction: incidence of ventilator associated pneumonia NAVM; and of secondary outcomes were: the duration of mechanical ventilation, length of ICU and hospital stay, and incidence the serious sequelae, and 30 days mortality. Differences were not observed in the severity variables between groups on admission. A significant increase was observed in the global values and in the first five days of (p < 0.03) of the VEM in the group of MCG. The values of the global VDA and during three phases of study, the number CGI, the rate of partial and definitive suspensions of the diet, and number of NAVM, were similar in both not significant groups. Neither differences were observed in the overall analysis secondary variables. The metoclopramida in the NC, it is not effective in the decrease of the CGI, in the doses and

  19. Tracheotomy tubes with suction above the cuff reduce the rate of ventilator-associated pneumonia in intensive care unit patients.

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    Ledgerwood, Levi G; Salgado, Moses D; Black, Hugh; Yoneda, Ken; Sievers, Ann; Belafsky, Peter C

    2013-01-01

    We evaluated the effect of tracheotomy tubes that enable suction immediately above the cuff on the development of ventilator-associated pneumonia (VAP). Patients without preexisting pneumonia who required tracheotomy were randomly assigned to receive a tracheotomy tube with or without above-the-cuff suction. The suction tube provided 10 mm Hg of continuous wall suction while the tracheotomy tube cuff was inflated. Data regarding the development of VAP, time on the ventilator, and length of stay in the intensive care unit (ICU) were recorded and compared between groups. Eighteen patients were randomized and prospectively evaluated. Nine patients received standard tracheotomy tubes, and 9 received suction-above-the-cuff tracheotomy tubes. The prevalences of VAP were 56% in the control group and 11% in the suction tracheotomy group (p = 0.02). The mean times on the ventilator were 18 +/- 14 days in the control group and 11 +/- 11 days in the suction group (p = 0.12). The mean lengths of ICU stay were 26 +/- 15 days in the control group and 18 +/- 15 days in the suction group (p = 0.14). Use of suction-above-the-cuff tracheotomy tubes significantly decreases the incidence of VAP in ICU patients. There were trends toward decreased time on the ventilator and decreased length of stay in the ICU.

  20. Eficácia de estratégias educativas para ações preventivas da pneumonia associada à ventilação mecânica Eficacia de las estrategias educativas para la acción preventiva de neumonía asociada a ventilación mecánica Efficacy of health education strategies for preventive interventions of ventilator-associated pneumonia

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    Fernanda Alves Ferreira Gonçalves

    2012-12-01

    presión del manguito y la instalación de la alimentación enteral. Cada procedimiento se utilizó como unidad de análisis y de resultados. La intervención fue efectiva para la limpieza de la lengua (51%, la instalación del ventilador (43% y la correcta secuencia de succión tubo-nariz-boca, en la higiene bronquial (13%. Estudios en diferentes escenarios podrían confirmar la eficacia de la estrategia educativa (workshop, así como identificar otras estrategias educativas para prevenir la neumonía asociada a la ventilación mecánica.The objective of the study was to determine the efficacy of educational strategy to improve the performance of nursing staff in performing preventive procedures of ventilator-associated pneumonia. This randomized controlled clinical trial was conducted during 2011 in an intensive care unit in Goiânia, Brazil, with the nursing staff allocated in the intervention group (n=24 and comparison group (n=11. Thirty days after workshops (intervention, the groups was systematically observed using a checklist including ventilator setting-up, angle for bed head elevation, patient decubitus position changing, use of personal protective equipment, bronchial and oral hygiene, verification of the cuff pressure and installation of enteral feeding. Each procedure was used as a unit of analysis and outcome. The intervention was effective for cleaning the tongue (51%, for the ventilator setting-up (43% and for the correct order tube-nose-mouth during bronchial hygiene (13%. Studies in different scenarios should confirm the efficacy of studied strategy (workshop, as well as identify additional educational strategies to prevent ventilator-associated pneumonia.

  1. A case-control study on the clinical impact of ventilator associated tracheobronchitis in adult patients who did not develop ventilator associated pneumonia.

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    Cantón-Bulnes, María Luisa; González-García, María Ascensión; García-Sánchez, Manuela; Arenzana-Seisdedos, Ángel; Garnacho-Montero, José

    2018-02-05

    The main objective was to determine whether ventilator-associated tracheobronchitis (VAT) is related to increased length of ICU stay. Secondary endpoints included prolongation of hospital stay, as well as, ICU and hospital mortality. A retrospective matched case-control study. Each case was matched with a control for duration of ventilation (± 2 days until development of ventilator-associated tracheobronchitis), disease severity (Acute Physiology and Chronic Health Evaluation II) at admission ± 3, diagnostic category and age ±10 years. Critically ill adults admitted to a polyvalent 30-beds ICU with the diagnosis of VAT in the period 2013-2016. We identified 76 cases of VAT admitted to our ICU during the study period. No adequate controls were found for 3 patients with VAT. There were no significant differences in demographic characteristics, reasons for admission and comorbidities. Patients with VAT had a longer ICU length of stay, median 22 days (14-35), compared to controls, median 15 days (8-27), p=.02. Ventilator days were also significantly increased in VAT patients, median 18 (9-28) versus 9 days (5-16), p=.03. There was no significant difference in total hospital length of stay 40 (28-61) vs. 35days (23-54), p=.32; ICU mortality (20.5 vs. 31.5% p=.13) and hospital mortality (30.1 vs. 43.8% p=.09). We performed a subanalysis of patients with microbiologically proven VAT receiving adequate antimicrobial treatment and did not observe significant differences between cases and the corresponding controls. VAT is associated with increased length of intensive care unit stay and longer duration of mechanical ventilation. This effect disappears when patients receive appropriate empirical treatment. Copyright © 2018 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  2. Inadequate treatment of ventilator-associated and hospital-acquired pneumonia: Risk factors and impact on outcomes

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    Piskin Nihal

    2012-10-01

    Full Text Available Abstract Background Initial antimicrobial therapy (AB is an important determinant of clinical outcome in patients with severe infections as pneumonia, however well-conducted studies regarding prognostic impact of inadequate initial AB in patients who are not undergoing mechanical ventilation (MV are lacking. In this study we aimed to identify the risk factors for inadequate initial AB and to determine its subsequent impact on outcomes in both ventilator associated pneumonia (VAP and hospital acquired pneumonia (HAP. Methods We retrospectively studied the accuracy of initial AB in patients with pneumonia in a university hospital in Turkey. A total of 218 patients with HAP and 130 patients with VAP were included. For each patient clinical, radiological and microbiological data were collected. Stepwise multivariate logistic regression analysis was used for risk factor analysis. Survival analysis was performed by using Kaplan-Meier method with Log-rank test. Results Sixty six percent of patients in VAP group and 41.3% of patients in HAP group received inadequate initial AB. Multiple logistic regression analysis revealed that the risk factors for inadequate initial AB in HAP patients were; late-onset HAP (OR = 2.35 (95% CI, 1.05-5.22; p = 0.037 and APACHE II score at onset of HAP (OR = 1.06 (95% CI, 1.01-1.12; p = 0.018. In VAP patients; antibiotic usage in the previous three months (OR = 3.16 (95% CI, 1.27-7.81; p = 0.013 and admission to a surgical unit (OR = 2.9 (95% CI, 1.17-7.19; p = 0.022 were found to be independent risk factors for inadequate initial AB. No statistically significant difference in crude hospital mortality and 28-day mortality was observed between the treatment groups in both VAP and HAP. However we showed a significant increase in length of hospital stay, duration of mechanical ventilation and a prolonged clinical resolution in the inadequate AB group in both VAP and HAP. Conclusion Our data

  3. Randomized controlled trial of toothbrushing to reduce ventilator-associated pneumonia pathogens and dental plaque in a critical care unit.

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    Needleman, Ian G; Hirsch, Nicholas P; Leemans, Michele; Moles, David R; Wilson, Michael; Ready, Derren R; Ismail, Salim; Ciric, Lena; Shaw, Michael J; Smith, Martin; Garner, Anne; Wilson, Sally

    2011-03-01

    To investigate the effect of a powered toothbrush on colonization of dental plaque by ventilator-associated pneumonia (VAP)-associated organisms and dental plaque removal. Parallel-arm, single-centre, examiner- and analyst-masked randomized controlled trial. Forty-six adults were recruited within 48 h of admission. Test intervention: powered toothbrush, control intervention: sponge toothette, both used four times per day for 2 min. Groups received 20 ml, 0.2% chlorhexidine mouthwash at each time point. The results showed a low prevalence of respiratory pathogens throughout with no statistically significant differences between groups. A highly statistically significantly greater reduction in dental plaque was produced by the powered toothbrush compared with the control treatment; mean plaque index at day 5, powered toothbrush 0.75 [95% confidence interval (CI) 0.53, 1.00], sponge toothette 1.35 (95% CI 0.95, 1.74), p=0.006. Total bacterial viable count was also highly statistically significantly lower in the test group at day 5; Log(10) mean total bacterial counts: powered toothbrush 5.12 (95% CI 4.60, 5.63), sponge toothette 6.61 (95% CI 5.93, 7.28), p=0.002. Powered toothbrushes are highly effective for plaque removal in intubated patients in a critical unit and should be tested for their potential to reduce VAP incidence and health complications. © 2011 John Wiley & Sons A/S.

  4. Superbugs causing ventilator associated pneumonia in a tertiary care hospital and the return of pre-antibiotic era!

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    S Qureshi

    2015-01-01

    Full Text Available The rise in super bugs causing Ventilator-Associated Pneumonia (VAP is a major cause of mortality and morbidity despite recent advances in management owing to the looming ′antibiotic apocalypse′. The aetiology and susceptibility pattern of the VAP isolates varies with patient population, type of intensive care unit (ICU and is an urgent diagnostic challenge. The present study carried out for a period of one year in a tertiary care hospital, enrolled patients on mechanical ventilation (MV for ≥48 hrs. Endotracheal aspirates (ETA from suspected VAP patients were processed by semi quantitative method. Staphylococus aureus, members of Enterobacteriaceae were more common in early onset VAP (EOVAP, while Nonfermenting Gram negative bacilli (NFGNB were significantly associated with late onset VAP (LOVAP. Most of the isolates were multi drug resistant (MDR super bugs. With limited treatment options left for this crisis situation like the pre-antibiotic era; it is an alarm for rational antibiotic therapy usage and intensive education programs.

  5. The study of vitamin D administration effect on CRP and Interleukin-6 as prognostic biomarkers of ventilator associated pneumonia.

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    Miroliaee, Amir Ebrahim; Salamzadeh, Jamshid; Shokouhi, Shervin; Sahraei, Zahra

    2018-04-01

    In regard with the effect of immune-stimulants in the treatment of infectious diseases, the effect of vitamin D administration on the outcome of patients with Ventilator-Associated Pneumonia (VAP) with a high rate of mortality, was studied. In this trial, 46 adult patients suffering from VAP and vitamin D deficiency were enrolled. The first group of patients received single intramuscular injection of vitamin D (300000Unit), while the other group were given the placebo. Administration of vitamin D significantly enhanced its levels (P<0.0001) in the treated patients (12.28±8.26) in comparison with placebo group (1.15±1.50). Serum Interleukin-6 levels were significantly reduced in the treated group compared to placebo (P=0.01). Although C-Reactive protein (CRP) levels showed an improving trend in the vitamin D group, no significant difference between groups (P=0.12) was found. Interestingly, the mortality rate of patients that treated with vitamin D (5/24) was significantly lower (p=0.04) than that of the placebo group (11/22). Our results indicate that vitamin D administration can significantly reduce the IL-6 as prognostic marker in VAP patients, and must be considered as adjunct option in the treatment of VAP patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Incidence and risk factors for ventilator-associated pneumonia in a developing country: where is the difference?

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    Jaimes, Fabian; De La Rosa, Gisela; Gómez, Emiliano; Múnera, Paola; Ramírez, Jaime; Castrillón, Sebastián

    2007-04-01

    Latin America exhibits a wide range of differences, compared to developed nations, in genetic background, health services, and clinical research development. It is valid to hypothesize that the incidence and risk factors for ventilator-associated pneumonia (VAP) in our setting may be substantially different of those reported elsewhere. We conducted a study to determine the incidence and risk factors for VAP in a University Hospital from Medellin, Colombia. Prospective cohort study in three intensive care units (ICU) (surgical/trauma, medical, cardiovascular) in a 550-bed University Hospital. Critically ill patients (n=270) who required at least 48 h of mechanical ventilation (MV) between June 2002 and October 2003 were followed until ICU discharge, VAP diagnosis or death. Sixty patients (22.2%) developed VAP 5.9+/-3.6 days after admission. The overall incidence of VAP was 29 cases per 1000 ventilator-days. The daily hazard for developing VAP increased until day 8, and then decreased over the duration of stay in the ICU. The only statistically significant factor after multivariable analysis was gender, with being female reducing 57% the risk of pneumonia (hazard ratios (HR): 0.43; 95% confidence intervals (CI): 0.19-0.96). The epidemiologic profile of VAP in terms of incidence, length of stay and clinical course resembles the general pattern described everywhere. Surprisingly, we could not identify any potentially modifiable risk factor for VAP. A comprehensive multicenter study is warranted. It should provide deep insight about the specific microbiological, genetic and clinic features of VAP in our setting.

  7. Ventilator-associated pneumonia in a paediatric intensive care unit in a developing country with high HIV prevalence.

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    Morrow, Brenda M; Argent, Andrew C

    2009-03-01

    To obtain preliminary prevalence, aetiological and outcome data on South African paediatric patients with ventilator-associated pneumonia (VAP). Non-bronchoscopic bronchoalveolar lavage (BAL) specimens taken between January 2004 and September 2005 were prospectively recorded and related clinical data were retrospectively reviewed. VAP was defined as a new isolate on BAL and a modified Clinical Pulmonary Infection Score > or =5. A total of 230 patients aged 3.9 (2.2-9.1) months (median interquartile range (IQR) ) underwent 309 BALs during 244 paediatric intensive care unit (PICU) admissions. Most patients (84%) were admitted with acute infectious diseases, with a 70% incidence of comorbidity. Thirty-three patients (14.3%) were HIV-exposed but uninfected and 58 (25.2%) were HIV-infected. Of 172 BALs taken > or =48 h after intubation, 63 specimens from 55 patients fulfilled VAP criteria. Acinetobacter baumannii was the most common VAP pathogen, followed by Klebsiella pneumoniae, viruses, yeasts and Staphylococcus aureus. Patients who developed VAP had a higher proportion of comorbid conditions (76% vs. 55%, P= 0.01) and reintubations (39% vs. 12%, P < 0.0001) when compared with non-VAP patients. Median (IQR) length of PICU stay was 12.5 (5-21) days versus 8 (5-14) days (P= 0.03); and the risk adjusted PICU mortality was 1.38 versus 0.79 (P= 0.002) in VAP versus non-VAP patients, respectively. VAP is associated with significant morbidity and mortality and may relate to the high incidence of comorbid conditions in this population. Primary VAP pathogens differ from developed countries.

  8. The use of 2% chlorhexidine gel and toothbrushing for oral hygiene of patients receiving mechanical ventilation: effects on ventilator-associated pneumonia

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    Meinberg, Maria Cristina de Avila; Cheade, Maria de Fátima Meinberg; Miranda, Amanda Lucia Dias; Fachini, Marcela Mascaro; Lobo, Suzana Margareth

    2012-01-01

    Objective To evaluate the effects of oral chlorhexidine hygiene with toothbrushing on the rate of ventilator-associated pneumonia in a mixed population of critically ill patients under prolonged mechanical ventilation. Methods Prospective, randomized, and placebo-controlled pilot study. Patients who were receiving mechanical ventilation, had been admitted less than 24 hours prior, and were anticipated to require mechanical ventilation for more than 72 hours were included in the study. The patients were randomly divided into one of the following groups: chlorhexidine hygiene with toothbrushing or a placebo group (gel with the same color and consistency and toothbrushing). Results The planned interim analysis was conducted using 52 patients, and the study was terminated prematurely. In total, 28 patients were included in the chlorhexidine / toothbrushing group, and 24 patients were included in the placebo group. Ventilator-associated pneumonia occurred in 45.8% of the placebo group and in 64.3% of the chlorhexidine hygiene with toothbrushing group (RR=1.4; 95% CI=0.83-2.34; p=0.29). Conclusion Because the study was terminated due to futility, it was not possible to evaluate the impact of oral hygiene using 2% chlorhexidine and toothbrushing on the incidence of ventilator-associated pneumonia in this heterogeneous population of critical patients receiving long-term mechanical ventilation, and no beneficial effect was observed for this intervention. PMID:23917935

  9. Incidence of Ventilator-Associated Pneumonia in Critically Ill Children Undergoing Mechanical Ventilation in Pediatric Intensive Care Unit

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    Ali Amanati

    2017-07-01

    Full Text Available Background: Among hospital-acquired infections (HAIs in children, ventilator-associated pneumonia (VAP is the most common after blood stream infection (BSI. VAP can prolong length of ventilation and hospitalization, increase mortality rate, and directly change a patient’s outcome in Pediatric Intensive Care Units (PICU. Objectives: The research on VAP in children is limited, especially in Iran; therefore, the identification of VAP incidence and mortality rate will be important for both clinical and epidemiological implications. Materials and Methods: Mechanically ventilated pediatric patients were assessed for development of VAP during hospital course on the basis of clinical, laboratory and imaging criteria. We matched VAP group with control group for assessment of VAP related mortality in the critically ill ventilated children. Results: VAP developed in 22.9% of critically ill children undergoing mechanical ventilation. Early VAP and late VAP were found in 19.3% and 8.4% of VAP cases, respectively. Among the known VAP risk factors that were investigated, immunodeficiency was significantly greater in the VAP group (p = 0.014. No significant differences were found between the two groups regarding use of corticosteroids, antibiotics, PH (potential of hydrogen modifying agents (such as ranitidine or pantoprazole, presence of nasogastric tube and total or partial parenteral nutrition administration. A substantial number of patients in the VAP group had more than four risk factors for development of VAP, compared to those without VAP (p = 0.087. Mortality rate was not statistically different between the VAP and control groups (p = 0.477. Conclusion: VAP is still one of the major causes of mortality in PICUs. It is found that altered immune status is a significant risk factor for acquiring VAP. Also, occurrence of VAP was high in the first week after admission in PICU.

  10. Impact of colistin-initiation delay on mortality of ventilator-associated pneumonia caused by A. baumannii.

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    Samrah, Shaher; Bashtawi, Yazan; Hayajneh, Wail; Almomani, Basima; Momany, Suleiman; Khader, Yousef

    2016-10-31

    There has been increased incidence and high mortality in cases with ventilator-associated pneumonia (VAP) caused by colistin-only-susceptible Acinetobacter baumannii (COS-AB). Colistin has emerged as a therapeutic option for VAP caused by multidrug-resistant Gram-negative organisms including COS-AB. A retrospective study was conducted to examine the impact of early versus late initiation of colistin on 30-day mortality of critically ill patients with VAP caused by COS-AB. Critically ill patients with VAP caused by COS-AB who received colistin were enrolled. The receiver operating characteristic (ROC) curve was used to identify the temporal breakpoint that maximized the difference in 30-day mortality. A total of 56 patients (34 men and 22 women) were included in the study. About 86% of all cases were late-onset VAP. The 30-day mortality was 46.4%. The rate was higher among patients with admission Acute Physiology and Chronic Health Evaluation II (APACHE II) score > 18 and patients with a delay of more than four days in initiating colistin treatment. The mortality rate was 26.9% among patients with treatment delay of four or fewer days and 63.3% for patients with a treatment delay of more than four days. A delay of four days or more in initiating colistin in patients with VAP caused by COS-AB significantly increases mortality. Colistin should be considered in the empirical protocols in late-onset VAP cases when COS-AB is highly suspected.

  11. Study of Characteristics, risk factors and outcome for Ventilator Associated Pneumonia in Neonatal Intensive Care Unit patient

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    Mehdi Moradi

    2013-09-01

    Full Text Available Background: Ventilator Associated Pneumonia (VAP, developing in mechanically ventilated patients after 48 hours of mechanical ventilation, is the second most common nosocomial infection. Therefore, there is a vital need to study the etiology and risk factors associated with VAP in neonates.Methods: Neonates admitted to neonatal intensive care unit (NICU, over a period of one year and who required mechanical ventilation for more than 48 hours were enrolled consecutively into the study. Semi-quantitative assay of endotracheal aspirate was used for microbiological diagnoses of VAP. 105CFU/ml was taken as the cut off between evidence of pathological infection and colonization. The primary outcome measure was the development of VAP. Secondary outcome measures were length of mechanical ventilation, NICU length of stay, hospital cost, and death.Results: Thirty eight patients were enrolled (58% were boys and 42% were girls. 42% of neonates developed VAP. The most common VAP organisms identified were Acinetobacter baumanni (43%. On multiple regression analysis, duration of mechanical ventilation was associated with VAP (P=0.00. Patients with VAP had greater need for mechanical ventilation (18.7 vs 6 median days, longer NICU length of stay (39 vs 21.5 median days and higher total median hospital costs (79.5 vs 52 million rials than those without VAP. The mortality rate was not different between two groups.Conclusion: In mechanically ventilated neonates, those with VAP had a prolonged need for mechanical ventilation, a longer NICU stay, and a higher hospital costs. Longer mechanical ventilation was associated with an increased risk of developing VAP in these patients. Developing of VAP didn’t increase mortality in patients.

  12. Incidence of Ventilator-Associated Pneumonia in Critically Ill Children Undergoing Mechanical Ventilation in Pediatric Intensive Care Unit.

    Science.gov (United States)

    Amanati, Ali; Karimi, Abdollah; Fahimzad, Alireza; Shamshiri, Ahmad Reza; Fallah, Fatemeh; Mahdavi, Alireza; Talebian, Mahshid

    2017-07-03

    Among hospital-acquired infections (HAIs) in children, ventilator-associated pneumonia (VAP) is the most common after blood stream infection (BSI). VAP can prolong length of ventilation and hospitalization, increase mortality rate, and directly change a patient's outcome in Pediatric Intensive Care Units (PICU). The research on VAP in children is limited, especially in Iran; therefore, the identification of VAP incidence and mortality rate will be important for both clinical and epidemiological implications. Mechanically ventilated pediatric patients were assessed for development of VAP during hospital course on the basis of clinical, laboratory and imaging criteria. We matched VAP group with control group for assessment of VAP related mortality in the critically ill ventilated children. VAP developed in 22.9% of critically ill children undergoing mechanical ventilation. Early VAP and late VAP were found in 19.3% and 8.4% of VAP cases, respectively. Among the known VAP risk factors that were investigated, immunodeficiency was significantly greater in the VAP group (p = 0.014). No significant differences were found between the two groups regarding use of corticosteroids, antibiotics, PH (potential of hydrogen) modifying agents (such as ranitidine or pantoprazole), presence of nasogastric tube and total or partial parenteral nutrition administration. A substantial number of patients in the VAP group had more than four risk factors for development of VAP, compared to those without VAP (p = 0.087). Mortality rate was not statistically different between the VAP and control groups (p = 0.477). VAP is still one of the major causes of mortality in PICUs. It is found that altered immune status is a significant risk factor for acquiring VAP. Also, occurrence of VAP was high in the first week after admission in PICU.

  13. Comparison of prophylactic effects of polyurethane cylindrical or tapered cuff and polyvinyl chloride cuff endotracheal tubes on ventilator-associated pneumonia.

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    Ata Mahmoodpoor

    2013-07-01

    Full Text Available Because microaspiration of contaminated supraglottic secretions past the endotracheal tube cuff is considered to be central in the pathogenesis of pneumonia, improved design of tracheal tubes with new cuff material and shape have reduced the size and number of folds, which together with the addition of suction ports above the cuff to drain pooled subglottic secretions leads to reduced aspiration of oropharyngeal secretions. So we conducted a study to compare the prophylactic effects of polyurethane-cylindrical or tapered cuff and polyvinyl chloride cuff endotracheal tubes (ETT on ventilator-associated pneumonia. This randomized clinical trial was carried out in a 12 bed surgical intensive care unit. 96 patients expected to require mechanical ventilation more than 96 hours were randomly allocated to one of three following groups: Polyvinyl chloride cuff (PCV ETT, Polyurethane (PU cylindrical Sealguard ETT and PU Taperguard ETT. Cuff pressure monitored every three hours 3 days in all patients. Mean cuff pressure didn't have significant difference between three groups during 72 hours. Pneumonia was seen in 11 patients (34% in group PVC, 8 (25% in Sealguard and 7 (21% in Taperguard group. Changes in mean cuff pressure between Sealguard and PVC tubes and also between Taperguard and PVC tubes did not show any significant difference. There was no significant difference in overinflation between three groups. The use of ETT with PU material results in reducing ventilator-associated pneumonia compared to ETT with PVC cuff. In PU tubes Taperguard has less incidence of ventilator-associated pneumonia compared to Sealguard tubes.

  14. International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia: Guidelines for the management of hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) of the European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociación Latinoamericana del Tórax (ALAT).

    Science.gov (United States)

    Torres, Antoni; Niederman, Michael S; Chastre, Jean; Ewig, Santiago; Fernandez-Vandellos, Patricia; Hanberger, Hakan; Kollef, Marin; Li Bassi, Gianluigi; Luna, Carlos M; Martin-Loeches, Ignacio; Paiva, J Artur; Read, Robert C; Rigau, David; Timsit, Jean François; Welte, Tobias; Wunderink, Richard

    2017-09-01

    The most recent European guidelines and task force reports on hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) were published almost 10 years ago. Since then, further randomised clinical trials of HAP and VAP have been conducted and new information has become available. Studies of epidemiology, diagnosis, empiric treatment, response to treatment, new antibiotics or new forms of antibiotic administration and disease prevention have changed old paradigms. In addition, important differences between approaches in Europe and the USA have become apparent.The European Respiratory Society launched a project to develop new international guidelines for HAP and VAP. Other European societies, including the European Society of Intensive Care Medicine and the European Society of Clinical Microbiology and Infectious Diseases, were invited to participate and appointed their representatives. The Latin American Thoracic Association was also invited.A total of 15 experts and two methodologists made up the panel. Three experts from the USA were also invited (Michael S. Niederman, Marin Kollef and Richard Wunderink).Applying the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) methodology, the panel selected seven PICO (population-intervention-comparison-outcome) questions that generated a series of recommendations for HAP/VAP diagnosis, treatment and prevention. Copyright ©ERS 2017.

  15. National bundle care program implementation to reduce ventilator-associated pneumonia in intensive care units in Taiwan.

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    Kao, Chin-Chuan; Chiang, Hsiu-Tzy; Chen, Chih-Yu; Hung, Ching-Tzu; Chen, Ying-Chun; Su, Li-Hsiang; Shi, Zhi-Yuan; Liu, Jein-Wei; Liu, Chang-Pan; Chuang, Yin-Ching; Ko, Wen-Chien; Chen, Yen-Hsu; Tseng, Shu-Hui; Lee, Chun-Ming; Lu, Min-Chi; Hsueh, Po-Ren

    2017-12-01

    This study investigated the impact of implementing ventilator-associated pneumonia (VAP) bundle care on the rates of VAP in intensive care units (ICUs) in Taiwan. A total of 10 ICUs (bed number, 170), including surgical (SICUs) (n = 7), cardiovascular/surgical (CV/S-ICUs) (n = 1), and medical ICUs (MICUs) (n = 2) from 10 hospitals (7 medical center hospitals and 3 regional hospitals) were enrolled in this quality-improvement project. This study was divided into the pre-intervention phase (1st January, 2012-31st July, 2013) and the intervention phase (1st August, 2013-31st October, 2014). Among the 10 hospitals, the overall rates (cases per 1000 ventilator-days) of VAP declined significantly (p = 0.005; rate ratio, 0.71) from 1.9 in the pre-intervention period to 1.5 in the intervention period. Significant difference in VAP rates between these periods was found in the regional hospitals (from 1.6 to 0.7; p < 0.001) and the SICUs (from 2.1 to 1.4; p < 0.001), but not in the medical centers (2.0 vs. 1.9; p = 0.0667) or CV/S-ICUs (4.5 vs. 4.5; p = 0.5391). However, VAP rate increased significantly (cases per 1000 ventilator-days) in the MICUs between the two periods (from 0.5 to 1.0; p = 0.0489). For the VAP bundle care elements, the overall compliance rate was 87.7% with 83.6% and 97.9% in the medical centers and regional hospitals, respectively. Implementing VAP bundle care has effectively reduced VAP in Taiwanese ICUs, but differences in performance and compliance rates of VAP bundle care among the different ICUs and hospital categories did exist. Copyright © 2017. Published by Elsevier B.V.

  16. Role of soluble triggering receptor expressed on myeloid cells-1 for diagnosing ventilator-associated pneumonia after cardiac surgery: an observational study.

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    Matsuno, Alessandra K; Carlotti, Ana P C P

    2013-12-01

    The diagnosis of ventilator-associated pneumonia (VAP) is a challenge, particularly after cardiac surgery. The use of biological markers of infection has been suggested to improve the accuracy of VAP diagnosis. We aimed to evaluate the usefulness of soluble triggering receptor expressed on myeloid cells (sTREM)-1 in the diagnosis of VAP following cardiac surgery. This was a prospective observational cohort study of children with congenital heart disease admitted to the pediatric intensive care unit (PICU) after surgery and who remained intubated and mechanically ventilated for at least 24 hours postoperatively. VAP was defined by the 2007 Centers for Disease Control and Prevention criteria. Blood, modified bronchoalveolar lavage (mBAL) fluid and exhaled ventilator condensate (EVC) were collected daily, starting immediately after surgery until the fifth postoperative day or until extubation for measurement of sTREM-1. Thirty patients were included, 16 with VAP. Demographic variables, Pediatric Risk of Mortality (PRISM) and Risk Adjustment for Congenital Heart Surgery (RACHS)-1 scores, duration of surgery and length of cardiopulmonary bypass were not significantly diferent in patients with and without VAP. However, time on mechanical ventilation and length of stay in the PICU and in the hospital were significantly longer in the VAP group. Serum and mBAL fluid sTREM-1 concentrations were similar in both groups. In the VAP group, 12 of 16 patients had sTREM-1 detected in EVC, whereas it was undetectable in all but two patients in the non-VAP group over the study period (p = 0.0013) (sensitivity 0.75, specificity 0.86, positive predictive value 0.86, negative predictive value 0.75, positive likelihood ratio (LR) 5.25, negative LR 0.29). Measurement of sTREM-1 in EVC may be useful for the diagnosis of VAP after cardiac surgery.

  17. BreathDx - molecular analysis of exhaled breath as a diagnostic test for ventilator-associated pneumonia: protocol for a European multicentre observational study.

    Science.gov (United States)

    van Oort, Pouline M P; Nijsen, Tamara; Weda, Hans; Knobel, Hugo; Dark, Paul; Felton, Timothy; Rattray, Nicholas J W; Lawal, Oluwasola; Ahmed, Waqar; Portsmouth, Craig; Sterk, Peter J; Schultz, Marcus J; Zakharkina, Tetyana; Artigas, Antonio; Povoa, Pedro; Martin-Loeches, Ignacio; Fowler, Stephen J; Bos, Lieuwe D J

    2017-01-03

    The diagnosis of ventilator-associated pneumonia (VAP) remains time-consuming and costly, the clinical tools lack specificity and a bedside test to exclude infection in suspected patients is unavailable. Breath contains hundreds to thousands of volatile organic compounds (VOCs) that result from host and microbial metabolism as well as the environment. The present study aims to use breath VOC analysis to develop a model that can discriminate between patients who have positive cultures and who have negative cultures with a high sensitivity. The Molecular Analysis of Exhaled Breath as Diagnostic Test for Ventilator-Associated Pneumonia (BreathDx) study is a multicentre observational study. Breath and bronchial lavage samples will be collected from 100 and 53 intubated and ventilated patients suspected of VAP. Breath will be analysed using Thermal Desorption - Gas Chromatography - Mass Spectrometry (TD-GC-MS). The primary endpoint is the accuracy of cross-validated prediction for positive respiratory cultures in patients that are suspected of VAP, with a sensitivity of at least 99% (high negative predictive value). To our knowledge, BreathDx is the first study powered to investigate whether molecular analysis of breath can be used to classify suspected VAP patients with and without positive microbiological cultures with 99% sensitivity. UKCRN ID number 19086, registered May 2015; as well as registration at www.trialregister.nl under the acronym 'BreathDx' with trial ID number NTR 6114 (retrospectively registered on 28 October 2016).

  18. Pneumonia associada à ventilação mecânica: impacto da multirresistência bacteriana na morbidade e mortalidade Ventilator-associated pneumonia: impact of bacterial multidrug-resistance on morbidity and mortality

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    Paulo José Zimermann Teixeira

    2004-12-01

    Full Text Available INTRODUÇÃO: A pneumonia associada à ventilação mecânica é a infecção hospitalar mais comum nas unidades de terapia intensiva. OBJETIVO: Determinar o impacto da multirresistência dos microorganismos na morbidade e mortalidade dos pacientes com pneumonia associada à ventilação mecânica. MÉTODO: Estudo de coorte retrospectivo. Em 40 meses consecutivos, 91 pacientes sob ventilação mecânica tiveram o diagnóstico de pneumonia. Os casos foram divididos entre causados por microorganismo multirresistente e causados por microorganismo sensível à antibioticoterapia. RESULTADOS: Pneumonia foi causada por microorganismo multirresistente em 75 casos (82,4% e por microorganismo sensível 16 (17,6% deles. As características clínicas e epidemiológicas não foram estatisticamente diferentes entre os grupos. O Staphylococcus aureus foi responsável por 27,5% dos episódios de pneumonia associada à ventilação mecânica e a Pseudomonas aeruginosa por 17,6%. A doença foi de início recente em 33 pacientes (36,3% e de início tardio em 58 deles (63,7%. Os tempos de ventilação mecânica, de internação em unidade de terapia intensiva e de internação hospitalar total não diferiram. O tratamento empírico foi considerado inadequado em 42 pacientes com pneumonia por microorganismo multirresistente (56% e em 4 com pneumonia por microorganismo sensível (25% (p = 0,02. Óbito ocorreu em 46 pacientes com a pneumonia por microorganismo multirresistente (61,3%, e em 4 daqueles com pneumonia por microorganismo sensível (25% (p = 0,008. CONCLUSÃO: A multirresistência bacteriana não determinou nenhum impacto na morbidade, mas esteve associada à maior mortalidade.BACKGROUND: Ventilator-associated pneumonia is the most common nosocomial infection occurring in intensive care units. OBJECTIVE: To determinate the impact of multidrug-resistant bacteria on morbidity and mortality in patients with ventilator-associated pneumonia. METHOD

  19. Clinical pulmonary infection score and C-reactive protein in the prediction of early ventilator associated pneumonia

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    Enas Elsayed Mohamed

    2013-07-01

    Conclusion: When the CPIS exceeded 6, there was an association with the presence of pneumonia which was confirmed by microbiological culture furthermore serum CRP is an easy, available and cheap test so daily serum CRP measurements to ICU patients enabled the early diagnosis of pneumonia and enhanced the value of the CPIS. Further studies of CPIS are needed with particular attention to how its variability might affect therapeutic choices.

  20. Costs and risk factors for ventilator-associated pneumonia in a Turkish University Hospital's Intensive Care Unit: A case-control study

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    Serin Simay

    2004-04-01

    Full Text Available Abstract Background Ventilator-associated pneumonia (VAP which is an important part of all nosocomial infections in intensive care unit (ICU is a serious illness with substantial morbidity and mortality, and increases costs of hospital care. We aimed to evaluate costs and risk factors for VAP in adult ICU. Methods This is a-three year retrospective case-control study. The data were collected between 01 January 2000 and 31 December 2002. During the study period, 132 patients were diagnosed as nosocomial pneumonia of 731 adult medical-surgical ICU patients. Of these only 37 VAP patients were assessed, and multiple nosocomially infected patients were excluded from the study. Sixty non-infected ICU patients were chosen as control patients. Results Median length of stay in ICU in patients with VAP and without were 8.0 (IQR: 6.5 and 2.5 (IQR: 2.0 days respectively (P Conclusion Respiratory failure, coma, depressed consciousness, enteral feeding and length of stay are independent risk factors for developing VAP. The cost of VAP is approximately five-fold higher than non-infected patients.

  1. Gastropulmonary Route of Infection and the Prevalence of Microaspiration in the Elderly Patients with Ventilator-Associated Pneumonia Verified by Molecular Microbiology-GM-PFGE.

    Science.gov (United States)

    Liu, Qing-hua; Zhang, Jing; Lin, Dian-jie; Mou, Xiao-yan; He, Li-xian; Qu, Jie-ming; Li, Hua-yin; Hu, Bi-jie; Zhu, Ying-min; Zhu, Du-ming; Gao, Xiao-dong

    2015-04-01

    Gastropulmonary route of infection was considered to be an important mechanism of ventilator-associated pneumonia (VAP). However there is little evidence to support this assumption. Moreover, the prevalence of microaspiration in elderly ventilated patients was not well understood. To confirm gastropulmonary infection route and investigate the prevalence of microaspiration in elderly ventilated patients using genome macrorestriction-pulsed field gel electrophoresis (GM-PFGE). Patients over 60 years old, expected to receive mechanical ventilation longer than 48 h, were prospectively enrolled from October 2009 to January 2012. Clinical data were collected and recorded until they died, developed pneumonia, or were extubated. Samples from gastric fluid, subglottic secretion and lower respiratory tract (LRT) were collected during the follow-up for microbiological examination. To evaluate the homogeneity, GM-PFGE was performed on strains responsible for VAP that had the same biochemical phenotype as those isolated from gastric juice and subglottic secretions sequentially. Among 44 VAP patients, 76 strains were isolated from LRT and considered responsible for VAP. Twenty-two isolates had the same biochemical phenotype with the corresponding gastric isolates. The homology was further confirmed using GM-PFGE in 12 episodes of VAP. Nearly 30% of VAPs were caused by microaspiration based on the analysis of bacterial phenotype or GM-PFGE. In addition, 58.3% patients with gastric colonization developed VAP, especially late-onset VAP (LOP). Gastropulmonary infection route exists in VAP especially LOP in elderly ventilated patients. It is one of the important mechanisms in the development of VAP.

  2. Sphingosine Prevents Bacterial Adherence to Endotracheal Tubes: A Novel Mechanism to Prevent Ventilator-Associated Pneumonia

    Science.gov (United States)

    2016-06-21

    Sphingosine Kinase Assay ............................. 5  3.9  Statistical Methods...bacterial adherence of AB, PA, and MRSA to vehicle (ethanol)-coated (A, C, E) compared to phytosphingosine-coated (B, D, F) plastic coverslips...Electron Microscopy Sciences (Hatfield, PA). Three different bacterial strains were used: methicillin-resistant Staphylococcus aureus ( MRSA ) (USA 300

  3. Incidence, temporal trend and factors associated with ventilator-associated pneumonia in mainland China: a systematic review and meta-analysis.

    Science.gov (United States)

    Ding, Chengyi; Zhang, Yuelun; Yang, Zhirong; Wang, Jing; Jin, Aoming; Wang, Weiwei; Chen, Ru; Zhan, Siyan

    2017-07-04

    Data to date is far from sufficient to describe the recent epidemiology of ventilator-associated pneumonia (VAP) in mainland China. This study aimed to estimate the overall incidence of VAP, with a special focus on its temporal trend and associated factors. Meta-analyses of 195 studies published from 2010 to 2015 were conducted, followed by subgroup analyses by methodological quality, pre-defined setting characteristics and attributes of populations. The overall cumulative VAP incidence in mainland China was 23.8% (95% confidence interval (CI) 20.6-27.2%), with the results showing high heterogeneity. The pooled incidence densities were 24.14 (95% CI 21.19-27.51) episodes and 22.83 (95% CI 19.88-26.23) patients per 1000 ventilator-days. A decline in the cumulative incidence was observed from 2006 (49.5%, 95% CI 40.0-59.0%) to 2014 (19.6%, 95% CI 10.4-31.0%); differences in the incidence rates were also documented according to Chinese provinces and diagnostic criteria (p China but has decreased since 2006. The reported rates vary considerably across individual studies, probably due to variations in diagnosis and geographical region. More studies using standard definitions and cut-off points are needed to better clarify the epidemiology of VAP across the country.

  4. A comparison of APACHE II and CPIS scores for the prediction of 30-day mortality in patients with ventilator-associated pneumonia.

    Science.gov (United States)

    Zhou, Xiao-Yu; Ben, Su-Qin; Chen, Hong-Lin; Ni, Song-Shi

    2015-01-01

    The aim of this study was to compare the Acute Physiology and Chronic Health Evaluation II (APACHE II) score and the Clinical Pulmonary Infection Score (CPIS) for the prediction of 30-day mortality in patients with ventilator-associated pneumonia (VAP). A single-center, prospective cohort study design was employed between January 1, 2010 and January 1, 2014. APACHE II and CPIS scores were determined on the day of VAP diagnosis. Discrimination was tested using receiver-operating characteristic (ROC) curves and the areas under the curve (AUC). Calibration was tested using the Hosmer-Lemeshow statistic. Of 135 patients with VAP, 39 died; the 30-day mortality was 28.9%. APACHE II and CPIS scores were significantly higher in non-survivors compared to survivors (23.1±4.8 vs. 16.7±4.6, pAPACHE II had excellent discrimination for predicting 30-day mortality in patients with VAP, with AUC 0.808 (95% confidence interval (CI) 0.704-0.912, pAPACHE II expected mortality (Chi-square=1.099, p=0.785). However, CPIS expected 30-day mortality did not fit the observed mortality (Chi-square=6.72, p=0.004). These data suggest that APACHE II is useful for predicting 30-day mortality in patients with VAP, but that the CPIS does not have good discrimination and calibration for predicting mortality. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

  5. The concomitant development of poly(vinyl chloride)-related biofilm and antimicrobial resistance in relation to ventilator-associated pneumonia.

    Science.gov (United States)

    Gorman, S P; McGovern, J G; Woolfson, A D; Adair, C G; Jones, D S

    2001-10-01

    Ventilator-associated pneumonia is a major cause of death in intensive care patients and the endotracheal tube, commonly fabricated from poly(vinyl chloride) (PVC), is acknowledged as a significant factor in this. Bacteria colonise the biomaterial, thereby adopting a sessile mode of growth that progresses to the establishment of an antibiotic-resistant biofilm by the accretion of a protective glycocalyx. This study examined the sequential steps involved in the formation of biofilm on PVC by atomic force microscopy and the concomitant development of resistance to an antibiotic (ceftazidime) and to a non-antibiotic antimicrobial agent (hexetidine). Staphylococcus aureus and Pseudomonas aeruginosa isolated from ET tube biofilm were employed. The surface microrugosity of bacteria growing in sessile mode on PVC decreased significantly (p or = 24 h) significantly more resistant (p < 0.05) than early sessile populations (< or = 4 h). Importantly, for practice, even newly colonised bacteria (1 h) were significantly more resistant to antibiotic than planktonic bacteria. Hexetidine was significantly more active (p < 0.05) than ceftazidime on biofilms of both isolates, irrespective of age, with total kill within 24 h treatment. Hexetidine may offer promise in the resolution of infection associated with PVC endotracheal tubes.

  6. Acinetobacter baumannii Infection in Prior ICU Bed Occupants Is an Independent Risk Factor for Subsequent Cases of Ventilator-Associated Pneumonia

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    Eirini Tsakiridou

    2014-01-01

    Full Text Available Objective. We aimed to evaluate risk factors for ventilator-associated pneumonia (VAP due to Acinetobacter baumannii (AbVAP in critically ill patients. Methods. This was a prospective observational study conducted in an intensive care unit (ICU of a district hospital (6 beds. Consecutive patients were eligible for enrolment if they required mechanical ventilation for >48 hours and hospitalization for >72 hours. Clinical, microbiological, and laboratory parameters were assessed as risk factors for AbVAP by univariate and multivariate analysis. Results. 193 patients were included in the study. Overall, VAP incidence was 23.8% and AbVAP, 11.4%. Previous hospitalization of another patient with Acinetobacter baumannii infection was the only independent risk factor for AbVAP (OR (95% CI 12.016 (2.282–19.521 P<0.001. ICU stay (25±17 versus 12±9   P<0.001, the incidence of other infections (OR (95% CI 9.485 (1.640–10.466 P=0.002 (urinary tract infection, catheter related infection, and bacteremia, or sepsis (OR (95% CI 10.400 (3.749–10.466 P<0.001 were significantly increased in patients with AbVAP compared to patients without VAP; no difference was found with respect to ICU mortality. Conclusion. ICU admission or the hospitalization of patients infected by Acinetobacter baumannii increases the risk of AbVAP by subsequent patients.

  7. Novel Pharmacotherapy for the Treatment of Hospital-Acquired and Ventilator-Associated Pneumonia Caused by Resistant Gram-Negative Bacteria.

    Science.gov (United States)

    Kidd, James M; Kuti, Joseph L; Nicolau, David P

    2018-02-07

    Introduction Hospital-acquired and ventilator-associated bacterial pneumonia (HABP/VABP) are among the most prevalent infections in hospitalized patients, particularly those in the intensive care unit. Importantly, the frequency of multidrug resistant (MDR) Gram-negative (GN) bacteria as the bacteriologic cause of HABP/VABP is increasing. These include MDR Pseudomonas aeruginosa, Acinetobacter baumannii, and carbapenem resistant Enterobactericeae (CRE). Few antibiotics are currently available when such MDR Gram-negatives are encountered and older agents such as polymyxin B, colistin (polymyxin E), and tigecycline have typically performed poorly in HABP/VABP. Areas Covered In this review, the authors summarize novel antibiotics which have reached phase 3 clinical trials including patients with HABP/VABP. For each agent, the spectrum of activity, pertinent pharmacological characteristics, clinical trial data, and potential utility in the treatment of MDR-GN HABP/VABP is discussed. Expert opinion Novel antibiotics currently available, and those soon to be, will expand opportunities to treat HABP/VABP caused by MDR-GN organisms and minimize the use of more toxic, less effective drugs. However, with sparse clinical data available, defining the appropriate role for each of the new agents is challenging. In order to maximize the utility of these antibiotics, combination therapy and the role of therapeutic drug monitoring should be investigated.

  8. Protective effect of early low-dose hydrocortisone on ventilator-associated pneumonia in the cancer patients: a propensity score analysis.

    Science.gov (United States)

    Lagier, David; Platon, Laura; Lambert, Jérome; Chow-Chine, Laurent; Sannini, Antoine; Bisbal, Magali; Brun, Jean-Paul; Asehnoune, Karim; Leone, Marc; Faucher, Marion; Mokart, Djamel

    2017-10-23

    Ventilator-associated pneumonia (VAP) is a care-related event that could be promoted by immune suppression caused by critical diseases, malignancies and cancer treatments. Low dose of hydrocortisone was proposed for modulation of immune response in the critically ill population. In this monocentric observational study, all cancer patients mechanically ventilated for more than 48 h were included. Effect of low-dose hydrocortisone administered during the first 48 h of mechanical ventilation was evaluated applying inverse probability weighting analysis after propensity score assessment. VAP impact on 1-year mortality, ICU length of stay and mechanical ventilation duration was secondarily determined. Within this cohort, 190 cancer patients were followed. VAP was confirmed in 22.1% of cases in the early hydrocortisone group and confirmed in 42.6% of cases in the no or late hydrocortisone group. Early hydrocortisone exhibited a protective effect on the risk of VAP (OR 0.23; 95% CI 0.12-0.44; P < 0.0001). VAP was associated with 1-year mortality (HR 1.60; 95% CI 1.10-2.34; P = 0.017) and increased ICU length of stay (mean extra length of stay: 4.2 days; 95% CI 0.6-7.8). Immune modulation with low-dose hydrocortisone administered in the first days of mechanical ventilation could protect from VAP occurrence in cancer patients.

  9. Comparing the APACHE II score and IBM-10 score for predicting mortality in patients with ventilator-associated pneumonia.

    Science.gov (United States)

    Naeini, Alireza Emami; Abbasi, Saeid; Haghighipour, Somayeh; Shirani, Kiana

    2015-01-01

    VAP is defined as pneumonia in patients who use ventilators. The acute physiology and chronic health evaluation (APACHE II) scoring system was originally developed for predicting mortality in patients who were admitted to the intensive care unit. Due to the complexity, a simpler score called IBMP-10 was developed. We designed the study to confirm and further investigate these two methods. This cross-sectional and analysis-descriptive study was done at the moment of VAP diagnosis on 60 patients in intensive care units. APACHE II and the IBMP-10 scores were calculated. ROC curves were generated to compare the new prediction rule with the APACHE II score. Results were reported as adjusted odds ratios with 95% confidence intervals (CIs). Analyses were performed using SPSS, version 20 and P values of 0.05 were considered to be statistically significant. APACHE II Score means (P < 0.001) and IBMP-10 score (P < 0.001) means had significant increase in Non-survivor patient than in patients who survived. APACHE II can be used as a good prediction measure for mortality rate. In IBMP-10 method, specificity and PPV were greater than APACHE II, but in mc-nemar test, there was no significant difference between the two methods (P = 0.55). Both prediction rules had high NPV. In our study, survivors' prediction value in APACHE II was 46.7%, and in IBMP-10, it was 46.7%. IBMP-10, compared to APACHE II, has greater sensitivity, specificity, and AUC to predict mortality. So the consequence of the use of IBMP-10 was better than APACHE II.

  10. Value of CT in the diagnosis of ventilator-associated pneumonia; Stellenwert der CT bei der Diagnose der Ventilator-assoziierten Pneumonie

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    Hahn, U.; Pereira, P.; Laniado, M.; Claussen, C.D. [Tuebingen Univ. (Germany). Abt. fuer Radiologische Diagnostik; Heininger, A. [Tuebingen Univ. (Germany). Klinik fuer Anaesthesiologie

    1999-02-01

    Purpose: To analyse the diagnostic accuracy of computed tomography (CT) in ventilator-associated pneumonia (VAP). Materials and methods: 23 patients on mechanical ventilation with a new pulmonary abnormality on chest X-ray were examined with both spiral-CT and high-resolution CT. The diagnosis VAP was made according to prospectively defined criteria. Bronchoscopic specimen asservation with protected specimen brushing (PSB) served as gold standard. Results: With PSB, 11 of 23 patients were found to have VAP. CT showed a sensitivity and specificity of 53% and 63%, respectively. Ground glass infiltrates appeared to have a 100% specificity but were found in only 5/11 patients. Conclusions: CT is not the method of choice for diagnosing VAP. Groundglass infiltrates seeming to be highly specific are only inconstantly found. (orig.) [Deutsch] Ziel: Der diagnostische Stellenwert der Computertomographie (CT) bei der Ventilator-assoziierten Pneumonie (VAP) sollte prospektiv analysiert werden. Material und Methoden: 23 beatmete Patienten mit neu aufgetretener pneumoniesuspekter Verschattung wurden mittels Spiral-CT und High-Resolution-CT untersucht. Die Diagnose der VAP erfolgte mittels prospektiv definierter Kriterien. Als Goldstandard diente die bronchoskopische Keimgewinnung mittels Protected-Specimen-Brushing (PSB), wobei als Pneumonienachweis ein Schwellenwert von >10{sup 3} colony forming units (cfu)/ml angenommen wurde. Ergebnisse: Bei 11/23 Patienten wurde mittels PSB die Diagnose VAP gestellt. Die CT zeigte eine Sensitivitaet von 53% und ein Spezifitaet von 63%. Milchglasartige Infiltrate zeigten eine Spezifitaet von 100%, wurden jedoch nur bei 5/11 Patienten mit VAP gefunden. Schlussfolgerungen: Die CT ist zur Diagnosefindung VAP nur bedingt geeignet. Milchglasartigen Infiltraten scheint bei der VAP ein hoher diagnostischer Stellenwert zuzukommen, sie werden jedoch nur inkonstant gefunden. (orig.)

  11. Prevalence of Gram-negative bacteria in ventilator-associated pneumonia in neonatal intensive care units: a systematic review and meta-analysis protocol.

    Science.gov (United States)

    Erfani, Yousef; Rasti, Arezoo; Janani, Leila

    2016-10-11

    Ventilator-associated pneumonia (VAP) is a common and potentially lethal problem among mechanically ventilated neonates in neonatal intensive care units (NICUs). The main pathogenic bacteria of VAP in NICUs are Gram-negative pathogens, which show a general decline in sensitivities to commonly used antibiotics, but their true prevalence is not known. We aim to provide a systematic review of studies measuring the prevalence of Gram-negative bacteria in VAP in NICUs. We will search PubMed, SCOPUS, EMBASE and the ISI Web of Science, as well as the Google Scholar search engine with no restriction on language. Full copies of articles will be identified by a defined search strategy and will be considered for inclusion against predefined criteria. Study selection and data extraction will be performed by 2 independent reviewers. Statistical analysis will include the identification of data sources and documentation of estimates, as well as the application of the random-effects and fixed-effects meta-analysis models. This will allow us to aggregate prevalence estimates and account for between-study variability in calculating the overall pooled estimates and 95% CI for the prevalence of Gram-negative bacteria in VAP in NICUs. Heterogeneity will be evaluated using the I2 and χ2 statistical tests to determine the extent of variation in effect estimates due to heterogeneity rather than chance. Publication bias and data synthesis will be assessed by funnel plots and Begg's and Egger's tests using STATA software V.13. This systematic review protocol was prepared according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses Protocols (PRISMA-P) 2015 Statement. No ethical issues are predicted. These findings will be published in a peer-reviewed journal and presented at national and international conferences. CRD42016036048. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  12. The value of antibody-coated bacteria in tracheal aspirates for the diagnosis of ventilator-associated pneumonia: a case-control study.

    Science.gov (United States)

    Ranzani, Otavio Tavares; Forte, Daniel Neves; Forte, Antonio Carlos; Mimica, Igor; Forte, Wilma Carvalho Neves

    2016-01-01

    Ventilator-associated pneumonia (VAP) is the leading type of hospital-acquired infection in ICU patients. The diagnosis of VAP is challenging, mostly due to limitations of the diagnostic methods available. The aim of this study was to determine whether antibody-coated bacteria (ACB) evaluation can improve the specificity of endotracheal aspirate (EA) culture in VAP diagnosis. We conducted a diagnostic case-control study, enrolling 45 patients undergoing mechanical ventilation. Samples of EA were obtained from patients with and without VAP (cases and controls, respectively), and we assessed the number of bacteria coated with FITC-conjugated monoclonal antibodies (IgA, IgM, or IgG) or an FITC-conjugated polyvalent antibody. Using immunofluorescence microscopy, we determined the proportion of ACB among a fixed number of 80 bacteria. The median proportions of ACB were significantly higher among the cases (n = 22) than among the controls (n = 23)-IgA (60.6% vs. 22.5%), IgM (42.5% vs. 12.5%), IgG (50.6% vs. 17.5%), and polyvalent (75.6% vs. 33.8%)-p 95,0% e > 93,3%, respectivamente. O número de BRA em amostras de AT foi maior nos casos que nos controles. Nossos achados indicam que a avaliação de BRA no AT é uma ferramenta promissora para aumentar a especificidade do diagnóstico de PAVM. A técnica pode ser custo-efetiva e, portanto, útil em locais com poucos recursos, com as vantagens de minimizar resultados falso-positivos e evitar o tratamento excessivo.

  13. Management of ventilator associated pneumonia with a new antibiotic adjuvant entity (ceftriaxone+sulbactam+disodium edetate) - A novel approach to spare carbapenems.

    Science.gov (United States)

    Sathe, Prachee; Maddani, Sagar; Kulkarni, Shilpa; Munshi, Nita

    2017-10-01

    Ventilator associated pneumonia (VAP) is one of the most serious nosocomial infections in Intensive Care Unit (ICU). The aim of this study was to evaluate a new approach to spare the carbapenems for the management of patients diagnosed with VAP due to Acinetobacter baumannii (A. baumannii). This retrospective study was conducted on VAP patients presenting for treatment at tertiary care centre between May 2014 and March 2016. The case sheets of patients who have been treated for VAP with meropenem, antibiotic adjuvant entity (AAE) and colistin were analysed. Out of 113 patients analysed, 24 (21.3%) patients were having VAP due to MDR A. baumannii. Microbial sensitivity has shown that 87.5% of patients were sensitive to AAE and colistin whereas all of them were resistant to meropenem, imipenem and gentamycin. The mean treatment durations were 12.4±2.1, 13.2±2.4 and 14.3±2.1days for AAE, meropenem+colistin and AAE+colistin treatment groups. In AAE susceptible patients, the mean treatment duration and cost could be reduced by 23-24% and 43-53% if AAE is used empirically. In AAE-resistant patients, the mean treatment duration and cost could be reduced by 21% and 26% if AAE+colistin regime is used empirically instead of meropenem followed by AAE+colistin. Clinical assessment with microbial eradication and pharmaco-economic evaluation clearly shows benefits in using AAE empirically in the management of A. baumannii infected VAP cases. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Microbial investigations in throat swab and tracheal aspirate specimens are beneficial to predict the corresponding endotracheal tube biofilm flora among intubated neonates with ventilator-associated pneumonia.

    Science.gov (United States)

    Pan, Yun; Du, Lizhong; Ai, Qing; Song, Sijie; Tang, Xiaoli; Zhu, Danping; Yu, Jialin

    2017-08-01

    Ventilator-associated pneumonia (VAP) is a common nosocomial infection in neonatal intensive care units with high morbidity and mortality. Bacterial biofilm in the endotracheal tube (ET) provides a notable and persistent source of pathogens that may cause VAP, and thus is important for VAP detection. However, during intubation microbial investigations in ET, samples are unavailable due to the infeasibility of collecting ET samples during intubation of neonates. It is therefore of great importance to find alternative sources of samples that can help identify the ET biofilm flora. In the present study, the microbial signatures of throat swabs and tracheal aspirates were compared with ET biofilm samples from VAP neonates using 16S ribosomal RNA gene polymerase chain reaction, denaturing gradient gel electrophoresis (DGGE), cloning and sequencing. Sequences were assigned to phylogenetic species using BLAST. Microbial diversity and richness among the three types of specimens were compared based on their DGGE fingerprints, and taxonomic characteristics based on the BLAST results. The microbial richness and diversity of ET biofilms were similar to tracheal aspirate yet significantly different from throat swab samples (P<0.05). Compared with ET biofilms, the overall constituent ratio of microflora was significantly different in throat swab and tracheal aspirate samples (P<0.05). However tracheal aspirate samples were useful for predicting Staphylococcus sp. in ET biofilms with a sensitivity of 85.7% and a specificity of 83.3%. The sensitivity for the combination of tracheal aspirate and throat swab samples to detect Staphylococcus sp. in ET biofilms was 100%. The detection of Pseudomonas sp. in throat swabs assisted its identification in ET biofilms (sensitivity 33.3% and specificity 100%). The results of the present study suggest that microbial investigations in throat swab and tracheal aspirate samples are beneficial for identifying the ET biofilm flora. There may

  15. Detection of AdeABC efflux pump genes in tetracycline-resistant Acinetobacter baumannii isolates from burn and ventilator-associated pneumonia patients

    Directory of Open Access Journals (Sweden)

    Maryam Beheshti

    2014-01-01

    Full Text Available Purpose: Acinetobacter baumannii is the most prevalent nosocomial pathogen which have been emerged in the past three decades worldwide. The aim of this study was to assess the distribution of the AdeABC efflux pump genes, associated with tetracycline resistance in Acinetobacter baumannii isolates collected from burn infection and Ventilator Associated Pneumonia (VAP. Materials and Methods: Ninety-eight A. baumannii isolates were collected from two different hospitals in Tehran, Iran. Tetracycline susceptibility testing was performed by disk diffusion and agar dilution methods according to the CLSI guidelines. The presence of adeSR, adeB, drug efflux system genes in resistant isolates was assessed by polymerase chain reaction (PCR. Carbonyl cyanide 3-chlorophenylhydrazone (CCCP was used as a chemical inhibitor agent to assess the contribution of AdeABC efflux pump in tetracycline resistance isolates. Results: Approximately 48% (47 out of 98 of isolates showed resistance to tetracycline which 14 (14.2% isolates were corresponded to burn infection and the remaining 33 (33.8% strains were isolated from VAP. All tetracycline resistant isolates have AdeABC in PCR assay. The reduction of tetracycline MICs by using 50 μg/ml CCCP were as follows: in 18 isolates 2-4 fold reduction in MICs, 26 isolates showed 8 fold reduction,1 isolate showed 16 fold, 1 isolate showed 32 fold and the remaining 1 isolate showed 128 fold reduction in MICs. Conclusion: The results showed significant correlation between tetracycline resistance and AdeABC efflux pump genes in resistant A. baumannii isolates.

  16. Case fatality rate related to nosocomial and ventilator-associated pneumonia in an ICU: a single-centre retrospective cohort study.

    Science.gov (United States)

    Yalçınsoy, Murat; Salturk, Cuneyt; Takır, Hurıye Berk; Kutlu, Semra Batı; Oguz, Ayşegul; Aksoy, Emine; Balcı, Merih; Kargın, Feyza; Mocin, Ozlem Yazıcıoglu; Adıguzel, Nalan; Gungor, Gokay; Karakurt, Zuhal

    2016-02-01

    Nosocomial pneumonia (NP) and ventilator associated pneumonia (VAP) have been associated with financially significant economic burden and increased case fatality rate in adult intensive care units (ICUs). This study was designed to evaluate case fatality rate among patients with NP and VAP in a respiratory ICU. In 2008-2013, VAP and NP in the ICUs were included in this retrospective single-centre cohort study. Data on demographics, co-morbidities, severity of illness, mechanical ventilation, empirical treatment, length of hospital stay and laboratory findings were recorded in each group, as were case fatality rate during ICU admission and after discharge including short-term (28-day) and long-term (a year) case fatality rate. A total of 108 patients with VAP (n = 64, median (IQR) age: 70 (61-75) years, 67.2% were men) or NP (n = 44, median (IQR) age: 68 (62-74) years, 68.2% were men) were found. Appropriate empirical antibiotic therapy was identified only in 45.2 and 42.9% of patients with VAP and NP, respectively. Overall case fatality rate in VAP and NP (81.3 vs 84.1), ICU case fatality rate (42.2 vs 45.5%), short-term case fatality rate (15.6 vs 27.3%) and long-term case fatality rate (23.4 vs 11.4%) were similar between VAP and NP groups along with occurrence 50% of case fatality rate cases in the first 2 months and 90% within the first year of discharge. Multivariate analysis showed that chronic obstructive pulmonary disease (COPD) (HR: 3.15, 95% CI: 1.06-9.38; p = 0.039) and presence of septic shock (HR: 3.83, 95% CI: 1.26-11.60; p = 0.018) were independently associated with lower survival. In conclusion, our findings in a retrospective cohort of respiratory ICU patients with VAP or NP revealed high ICU, short- and long-term case fatality rates within 1 year of diagnosis, regardless of the diagnosis of NP after 48 h of initial admission or after induction of ventilator support. COPD and presence of septic shock are associated with high

  17. Guideline-adherent initial intravenous antibiotic therapy for hospital-acquired/ventilator-associated pneumonia is clinically superior, saves lives and is cheaper than non guideline adherent therapy

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    Wilke MH

    2011-07-01

    Full Text Available Abstract Introduction Hospital-acquired pneumonia (HAP often occurring as ventilator-associated pneumonia (VAP is the most frequent hospital infection in intensive care units (ICU. Early adequate antimicrobial therapy is an essential determinant of clinical outcome. Organisations like the German PEG or ATS/IDSA provide guidelines for the initial calculated treatment in the absence of pathogen identification. We conducted a retrospective chart review for patients with HAP/VAP and assessed whether the initial intravenous antibiotic therapy (IIAT was adequate according to the PEG guidelines Materials and methods We collected data from 5 tertiary care hospitals. Electronic data filtering identified 895 patients with potential HAP/VAP. After chart review we finally identified 221 patients meeting the definition of HAP/VAP. Primary study endpoints were clinical improvement, survival and length of stay. Secondary endpoints included duration of mechanical ventilation, total costs, costs incurred on the intensive care unit (ICU, costs incurred on general wards and drug costs. Results We found that 107 patients received adequate initial intravenous antibiotic therapy (IIAT vs. 114 with inadequate IIAT according to the PEG guidelines. Baseline characteristics of both groups revealed no significant differences and good comparability. Clinical improvement was 64% over all patients and 82% (85/104 in the subpopulation with adequate IIAT while only 47% (48/103 inadequately treated patients improved (p Drug costs for the hospital stay were also lower (EUR 4,069 vs. EUR 4,833 yet not significant. The most frequent types of inadequate therapy were monotherapy instead of combination therapy, wrong type of penicillin and wrong type of cephalosporin. Discussion These findings are consistent with those from other studies analyzing the impact of guideline adherence on survival rates, clinical success, LOS and costs. However, inadequately treated patients had a higher

  18. Positive bronchoalveolar lavage and quantitative cultures results in suspected late-onset ventilator associated pneumonia evaluation – retrospective study

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    A.P. Vaz

    Full Text Available Introduction: Bronchoalveolar lavage (BAL with quantitative cultures has been used in order to increase ventilator associated pneumonia (VAP diagnosis specificity, although the accurate technique for this entity diagnosis remains controversial. Objectives: To evaluate the influence of using positive BAL and quantitative cultures results in microbiologic diagnosis and treatment of patients with suspected late VAP and prior antibiotherapy. Material and methods: Retrospective analysis of intensive care unit (UCI patients, during a one year period, with clinical suspicion of late VAP and prior use of antibiotics that presented a growth in BAL cultures. Results: Of 243 BAL performed, there were 71 (29.2 % positive cultures (60 patients, 76.7 % male, 54 ± 19 years. BAL was done after 13 days (median of invasive mechanical ventilation, 11 days of ICU antibiotherapy and in the day in which a new antibiotic for VAP suspicion was started. Colony forming units (CFU/ml count was performed in 71.8 % and endotracheal aspirate (ETA simultaneously collected for qualitative analysis in 85.9 %. Therapeutic approach was changed in 38.0 %: correction (16.9 %, de-escalation (12.7 % and directed antibiotherapy start (8.4 %. Therapeutic changes were made in the presence of CFU > 104 in 84.2 % and in agreement with ETA in 70.8 %. In cases in which antibiotherapy was maintained (62.0 %, quantitative cultures would have allowed de-escalation in 9.1 %. Changes in prescription were more frequent when CFU was > 104 (48.5 %, comparing with situations in which counts were lower and BAL analysis was only qualitative (28.9 %, p = 0.091. There were no significant differences between patients submitted to different therapeutic approaches concerning to ICU mortality or length of stay. Conclusion: In late onset VAP, positive BAL and quantitative cultures allowed therapeutic changes, leading to antibiotic adequacy and consumption reduction, which can

  19. Multicentre randomised controlled trial to investigate the usefulness of continuous pneumatic regulation of tracheal cuff pressure for reducing ventilator-associated pneumonia in mechanically ventilated severe trauma patients: the AGATE study protocol.

    Science.gov (United States)

    Marjanovic, Nicolas; Frasca, Denis; Asehnoune, Karim; Paugam, Catherine; Lasocki, Sigismond; Ichai, Carole; Lefrant, Jean-Yves; Leone, Marc; Dahyot-Fizelier, Claire; Pottecher, Julien; Falcon, Dominique; Veber, Benoit; Constantin, Jean-Michel; Seguin, Sabrina; Guénézan, Jérémy; Mimoz, Olivier

    2017-08-07

    Severe trauma represents the leading cause of mortality worldwide. While 80% of deaths occur within the first 24 hours after trauma, 20% occur later and are mainly due to healthcare-associated infections, including ventilator-associated pneumonia (VAP). Preventing underinflation of the tracheal cuff is recommended to reduce microaspiration, which plays a major role in the pathogenesis of VAP. Automatic devices facilitate the regulation of tracheal cuff pressure, and their implementation has the potential to reduce VAP. The objective of this work is to determine whether continuous regulation of tracheal cuff pressure using a pneumatic device reduces the incidence of VAP compared with intermittent control in severe trauma patients. This multicentre randomised controlled and open-label trial will include patients suffering from severe trauma who are admitted within the first 24 hours, who require invasive mechanical ventilation to longer than 48 hours. Their tracheal cuff pressure will be monitored either once every 8 hours (control group) or continuously using a pneumatic device (intervention group). The primary end point is the proportion of patients that develop VAP in the intensive care unit (ICU) at day 28. The secondary end points include the proportion of patients that develop VAP in the ICU, early (≤7 days) or late (>7 days) VAP, time until the first VAP diagnosis, the number of ventilator-free days and antibiotic-free days, the length of stay in the ICU, the proportion of patients with ventilator-associated events and that die during their ICU stay. This protocol has been approved by the ethics committee of Poitiers University Hospital, and will be carried out according to the principles of the Declaration of Helsinki and the Good Clinical Practice guidelines. The results of this study will be disseminated through presentation at scientific conferences and publication in peer-reviewed journals. Clinical Trials NCT02534974. © Article author(s) (or

  20. A biomarker panel (Bioscore incorporating monocytic surface and soluble TREM-1 has high discriminative value for ventilator-associated pneumonia: a prospective observational study.

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    Vimal Grover

    Full Text Available Ventilator-associated pneumonia (VAP increases mortality in critical illness. However, clinical diagnostic uncertainty persists. We hypothesised that measuring cell-surface and soluble inflammatory markers, incorporating Triggering Receptor Expressed by Myeloid cells (TREM-1, would improve diagnostic accuracy.A single centre prospective observational study, set in a University Hospital medical-surgical intensive Care unit, recruited 91 patients into 3 groups: 27 patients with VAP, 33 ventilated controls without evidence of pulmonary sepsis (non-VAP, and 31 non-ventilated controls (NVC, without clinical infection, attending for bronchoscopy. Paired samples of Bronchiolo-alveolar lavage fluid (BALF and blood from each subject were analysed for putative biomarkers of infection: Cellular (TREM-1, CD11b and CD62L and soluble (IL-1β, IL-6, IL-8, sTREM-1, Procalcitonin. Expression of cellular markers on monocytes and neutrophils were measured by flow cytometry. Soluble inflammatory markers were determined by ELISA. A biomarker panel ('Bioscore', was constructed, tested and validated, using Fisher's discriminant function analysis, to assess its value in distinguishing VAP from non VAP.The expression of TREM-1 on monocytes (mTREM-1 and neutrophils (nTREM-1 and concentrations of IL-1β, IL-8, and sTREM-1 in BALF were significantly higher in VAP compared with non-VAP and NVC (p<0.001. The BALF/blood mTREM-1 was significantly higher in VAP patients compared to non-VAP and NVC (0.8 v 0.4 v 0.3 p<0.001. A seven marker Bioscore (BALF/blood ratio mTREM-1 and mCD11b, BALF sTREM-1, IL-8 and IL-1β, and serum CRP and IL-6 correctly identified 88.9% of VAP cases and 100% of non-VAP cases.A 7-marker bioscore, incorporating cellular and soluble TREM-1, accurately discriminates VAP from non-pulmonary infection.

  1. High-throughput sequencing of 16S rDNA amplicons characterizes bacterial composition in bronchoalveolar lavage fluid in patients with ventilator-associated pneumonia

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    Yang XJ

    2015-08-01

    Full Text Available Xiao-Jun Yang,1,* Yan-Bo Wang,2,3,* Zhi-Wei Zhou,4,* Guo-Wei Wang,2 Xiao-Hong Wang,1 Qing-Fu Liu,1 Shu-Feng Zhou,4 Zhen-Hai Wang2,3 1Department of Intensive Care Unit, 2Neurology Center, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, People’s Republic of China; 3Key Laboratory of Brain Diseases of Ningxia, Yinchuan, Ningxia, People’s Republic of China; 4Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, Tampa, FL, USA *These authors contributed equally to this work Abstract: Ventilator-associated pneumonia (VAP is a life-threatening disease that is associated with high rates of morbidity and likely mortality, placing a heavy burden on an individual and society. Currently available diagnostic and therapeutic approaches for VAP treatment are limited, and the prognosis of VAP is poor. The present study aimed to reveal and discriminate the identification of the full spectrum of the pathogens in patients with VAP using high-throughput sequencing approach and analyze the species richness and complexity via alpha and beta diversity analysis. The bronchoalveolar lavage fluid samples were collected from 27 patients with VAP in intensive care unit. The polymerase chain reaction products of the hypervariable regions of 16S rDNA gene in these 27 samples of VAP were sequenced using the 454 GS FLX system. A total of 103,856 pyrosequencing reads and 638 operational taxonomic units were obtained from these 27 samples. There were four dominant phyla, including Proteobacteria, Firmicutes, Actinobacteria, and Bacteroidetes. There were 90 different genera, of which 12 genera occurred in over ten different samples. The top five dominant genera were Streptococcus, Acinetobacter, Limnohabitans, Neisseria, and Corynebacterium, and the most widely distributed genera were Streptococcus, Limnohabitans, and Acinetobacter in these 27 samples. Of note, the mixed profile of causative pathogens was observed. Taken

  2. Improving Conduct and Feasibility of Clinical Trials to Evaluate Antibacterial Drugs to Treat Hospital-Acquired Bacterial Pneumonia and Ventilator-Associated Bacterial Pneumonia: Recommendations of the Clinical Trials Transformation Initiative Antibacterial Drug Development Project Team.

    Science.gov (United States)

    Knirsch, Charles; Alemayehu, Demissie; Botgros, Radu; Comic-Savic, Sabrina; Friedland, David; Holland, Thomas L; Merchant, Kunal; Noel, Gary J; Pelfrene, Eric; Reith, Christina; Santiago, Jonas; Tiernan, Rosemary; Tenearts, Pamela; Goldsack, Jennifer C; Fowler, Vance G

    2016-08-15

    The etiology of hospital-acquired or ventilator-associated bacterial pneumonia (HABP/VABP) is often multidrug-resistant infections. The evaluation of new antibacterial drugs for efficacy in this population is important, as many antibacterial drugs have demonstrated limitations when studied in this population. HABP/VABP trials are expensive and challenging to conduct due to protocol complexity and low patient enrollment, among other factors. The Clinical Trials Transformation Initiative (CTTI) seeks to advance antibacterial drug development by streamlining HABP/VABP clinical trials to improve efficiency and feasibility while maintaining ethical rigor, patient safety, information value, and scientific validity. In 2013, CTTI engaged a multidisciplinary group of experts to discuss challenges impeding the conduct of HABP/VABP trials. Separate workstreams identified challenges associated with HABP/VABP protocol complexity. The Project Team developed potential solutions to streamline HABP/VABP trials using a Quality by Design approach. CTTI recommendations focus on 4 key areas to improve HABP/VABP trials: informed consent processes/practices, protocol design, choice of an institutional review board (IRB), and trial outcomes. Informed consent processes should include legally authorized representatives. Protocol design decisions should focus on eligibility criteria, prestudy antibacterial therapy considerations, use of new diagnostics, and sample size. CTTI recommends that sponsors use a central IRB and discuss trial endpoints with regulators, including defining a clinical failure and evaluating the impact of concomitant antibacterial drugs. Streamlining HABP/VABP trials by addressing key protocol elements can improve trial startup and patient recruitment/retention, reduce trial complexity and costs, and ensure patient safety while advancing antibacterial drug development. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of

  3. Streamlining Safety Data Collection in Hospital-Acquired Bacterial Pneumonia and Ventilator-Associated Bacterial Pneumonia Trials: Recommendations of the Clinical Trials Transformation Initiative Antibacterial Drug Development Project Team.

    Science.gov (United States)

    Donnelly, Helen; Alemayehu, Demissie; Botgros, Radu; Comic-Savic, Sabrina; Eisenstein, Barry; Lorenz, Benjamin; Merchant, Kunal; Pelfrene, Eric; Reith, Christina; Santiago, Jonas; Tiernan, Rosemary; Wunderink, Richard; Tenaerts, Pamela; Knirsch, Charles

    2016-08-15

    Resistant bacteria are one of the leading causes of hospital-acquired/ventilator-associated bacterial pneumonia (HABP/VABP). HABP/VABP trials are complex and difficult to conduct due to the large number of medical procedures, adverse events, and concomitant medications involved. Differences in the legislative frameworks between different regions of the world may also lead to excessive data collection. The Clinical Trials Transformation Initiative (CTTI) seeks to advance antibacterial drug development (ABDD) by streamlining clinical trials to improve efficiency and feasibility while maintaining ethical rigor, patient safety, information value, and scientific validity. In 2013, CTTI engaged a multidisciplinary group of experts to discuss challenges impeding the conduct of HABP/VABP trials. Separate workstreams identified challenges associated with current data collection processes. Experts defined "data collection" as the act of capturing and reporting certain data on the case report form as opposed to recording of data as part of routine clinical care. The ABDD Project Team developed strategies for streamlining safety data collection in HABP/VABP trials using a Quality by Design approach. Current safety data collection processes in HABP/VABP trials often include extraneous information. More targeted strategies for safety data collection in HABP/VABP trials will rely on optimal protocol design and prespecification of which safety data are essential to satisfy regulatory reporting requirements. A consensus and a cultural change in clinical trial design and conduct, which involve recognition of the need for more efficient data collection, are urgently needed to advance ABDD and to improve HABP/VABP trials in particular. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

  4. A comparison of Listerine® and sodium bicarbonate oral cleansing solutions on dental plaque colonisation and incidence of ventilator associated pneumonia in mechanically ventilated patients: a randomised control trial.

    Science.gov (United States)

    Berry, A M

    2013-10-01

    Effective oral hygiene has been proposed as a key factor in the reduction of dental plaque colonisation and subsequent development of ventilator associated pneumonia (VAP). Listerine(®) oral rinse, while used extensively in dental practice has rarely been tested in mechanically ventilated patients. Sodium bicarbonate as an oral rinse has been more commonly utilised in oral hygiene regimens in intensive care patients. To test the efficacies of the essential oil mouth rinse, Listerine(®) (Pfizer) and sodium bicarbonate in the reduction of dental plaque colonisation with respiratory pathogens and the subsequent development of VAP. The study design was a prospective, single blind randomised comparative study of adult patients mechanically ventilated for at least 4 days. Patients were randomised to Listerine(®) (Pfizer) oral rinse twice daily, sodium bicarbonate oral rinse 2/24 or sterile water 2/24 (control group). All groups received tooth brushing 3 times a day. Dental plaque colonisation (primary outcome) and incidence of ventilator associated pneumonia (secondary outcome) were studied. Three hundred and ninety-eight patients were randomised to either the Listerine group (127), sodium bicarbonate group (133) or the control group (138). Baseline characteristics were similar for all groups. There were no significant differences between the control and study groups in colonisation of dental plaque at Day 4 (p=0.243). Ventilator associated pneumonia was diagnosed in 18 patients. The incidence was, Listerine(®) group 4.7%, sodium bicarbonate group 4.5% and control 4.3% [OR, 0.99; 95% CI, 0.31 to 3.16; p=0.92]. Compared to the control group, Listerine(®) or sodium bicarbonate oral rinses were not more effective in the reduction of colonisation of dental plaque or the incidence of VAP. Given the low incidence of VAP, the common factor of a small, soft toothbrush as part of an oral hygiene regimen suggests possible benefit in mechanically ventilated patients. Crown

  5. How Can Pneumonia Be Prevented?

    Science.gov (United States)

    ... can occur if pneumonia is not treated. The pleura is a membrane that consists of two large, ... Pleurisy is when the two layers of the pleura become irritated and inflamed, causing sharp pain each ...

  6. Vaccines in the Prevention of Viral Pneumonia.

    Science.gov (United States)

    Fraser, Clementine S; Jha, Akhilesh; Openshaw, Peter J M

    2017-03-01

    Pneumonia is of great global public health importance. Viral infections play both direct and indirect parts in its cause across the globe. Influenza is a leading cause of viral pneumonia in both children and adults, and respiratory syncytial virus is increasingly recognized as causing disease at both extremes of age. Vaccination offers the best prospect for prevention but current influenza vaccines do not provide universal and durable protection, and require yearly reformulation. In the future, it is hoped that influenza vaccines will give better and universal protection, and that new vaccines can be found for other causes of viral pneumonia. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Differences in hospital- and ventilator-associated pneumonia due to Staphylococcus aureus (methicillin-susceptible and methicillin-resistant) between Europe and Latin America: a comparison of the EUVAP and LATINVAP study cohorts.

    Science.gov (United States)

    Rello, J; Molano, D; Villabon, M; Reina, R; Rita-Quispe, R; Previgliano, I; Afonso, E; Restrepo, M I

    2013-05-01

    A comparison is made of epidemiological variables (demographic and clinical characteristics) and outcomes in patients with hospital-acquired pneumonia (HAP) or ventilator-associated pneumonia (VAP) caused by methicillin-susceptible and methicillin-resistant Staphylococcus aureus (MSSA and MRSA) in the Latin American VAP (LATINVAP) vs. the European Union VAP (EUVAP) cohorts of patients admitted to intensive care units (ICUs). The EUVAP project was a prospective, multicenter observational study reporting 827 patients with HAP/VAP in 27 ICUs from 9 European countries. The LATINVAP project was a multicenter prospective observational study, with an identical design, performed in 17 ICUs from 4 Latin American countries involving 99 patients who developed HAP/VAP. Episodes of VAP/HAP caused by S. aureus, MSSA, and MRSA were compared in both cohorts. Forty-five patients had S. aureus HAP/VAP in the EUVAP cohort vs. 11 patients in the LATINVAP cohort. More patients had MRSA in the LATINVAP study than in the EUVAP (45% vs. 33%). ICU mortality among patients with MSSA HAP/VAP in EUVAP was 10% vs. 50% for LATINVAP (OR=9.75, p=0.01). Fifteen patients in the EUVAP cohort developed MRSA HAP/VAP as opposed to 5 in LATINVAP. In the EUVAP study there was an ICU mortality rate of 33.3%. In the LATINVAP cohort, the ICU mortality rate was 60% (OR for death=3.0; 95%CI 0.24-44.7). MRSA pneumonia was associated with poorer outcomes in comparison with MSSA. Our study suggests significant variability among European and Latin American ICU practices that may influence clinical outcomes. Furthermore, patients with pneumonia in Latin America have different outcomes. Copyright © 2012 Elsevier España, S.L. and SEMICYUC. All rights reserved.

  8. [Pneumonia: Regional experience with prevention programs].

    Science.gov (United States)

    Chuchalin, A G; Onishchenko, G G; Kolosov, V P; Kurganova, O P; Tezikov, N L; Manakov, L G; Gulevich, M P; Perelman, Yu M

    to generalize the regional experience in implementing a package of organizational and methodical and antiepidemic measures for preventing pneumococcal infections. How the prevention programs were implemented using the materials and methods of the epidemiological and statistical monitoring of the incidence of pneumonia in the Amur Region was analyzed. Pneumococcal conjugate vaccine (Prevenar-13) and influenza vaccines were used for immunoprophylaxis against acute respiratory viral and pneumococcal infections. Information on the incidence of acute respiratory viral infections and pneumonia over time in the period 2010 to 2015 must be taken into account. Indicators and special criteria are used to evaluate the efficiency of vaccination. The comparative statistical analysis revealed the high efficiency of regional programs using the methods for immunoprophylaxis against pneumococcal infections: the vaccination prophylactic efficiency index in terms of the incidence of pneumonia might be as high as 75-100%. Pneumonia morbidity rates became 2.3 times lower in the vaccinated population of the region. The results of the investigation suggest that the Program for the clinical and epidemiological monitoring and prevention of community-acquired pneumonias, by using the vaccine against pneumococcal infection in the Amur Region, has a high medical and socioeconomic efficiency.

  9. The Combination of SAT and SBT Protocols May Help Reduce the Incidence of Ventilator-Associated Pneumonia in the Burn Intensive Care Unit.

    Science.gov (United States)

    Lee, Yann-Leei Larry; Sims, Kaci D; Butts, Charles C; Frotan, M Amin; Kahn, Steven; Brevard, Sidney B; Simmons, Jon D

    There are few published reports on the unique nature of burn patients using a paired spontaneous awakening and spontaneous breathing protocol. A combined protocol was implemented in our burn intensive care unit (ICU) on January 1, 2012. This study evaluates the impact of this protocol on patient outcomes in a burn ICU. We performed a retrospective review of our burn registry over 4 years, including all patients placed on mechanical ventilation. In the latter 2 years, patients meeting criteria underwent daily spontaneous awakening trial; if successful, spontaneous breathing trial was performed. Patient data included age, burn size, percent full-thickness burn, tracheostomy, and inhalation injury. Outcome measures included ventilator days, ICU and hospital lengths of stay, pneumonia, and disposition. Data were analyzed using Graphpad Prism and IBM SPSS software, with statistical significance defined as P < .05. There were 171 admissions in the preprotocol period and 136 after protocol implementation. Protocol patients had greater percent full-thickness burns, but did not differ in other characteristics. The protocol group had significantly shorter ICU length of stay, fewer ventilator days, and lower pneumonia incidence. Hospital length of stay, disposition, and mortality were not significantly different. Among patients with inhalation injuries, the protocol group exhibited fewer ventilator and ICU days. Protocol implementation in a burn ICU was accompanied by decreased ventilator days and a reduced incidence of pneumonia. A combined spontaneous awakening and breathing protocol is safe and may improve clinical practice in the burn ICU.

  10. Pneumonia associada à ventilação mecânica em Unidade de Terapia Intensiva cirúrgica Ventilator-associated pneumonia in surgical Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Claudia Maria Dantas de Maio Carrilho

    2006-03-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A pneumonia associada à ventilação mecânica (PAV é uma infecção grave que apresenta múltiplas causas, podendo variar dependendo do tipo de UTI e da população de pacientes. Tais características desta doença enfatizam a necessidade de medidas de vigilância com coleta de dados locais. O objetivo deste estudo foi descrever a incidência, os fatores de risco e a mortalidade de pacientes com pneumonia associada à ventilação mecânica (PAV, internados em UTI cirúrgica. MÉTODO: Foi realizada uma coorte prospectiva, no período de janeiro de 2004 a janeiro de 2005. Foram incluídos todos os pacientes internados, sendo que destes 68% em pós-operatório, em suporte ventilatório e acompanhados diariamente para coleta de dados demográficos, diagnósticos, escores APACHE II e TISS 28, tempo de VM e de internação, freqüência de PAV e mortalidade. RESULTADOS: Foram analisados 462 pacientes com idade média de 57,2 ± 16,6 anos, sendo 55% do sexo masculino. O APACHE II médio foi 18,3 e a incidência de PAV 18,8%. O TISS na admissão OR = 1,050 (IC 95%: 1,003-1,050 e o uso de nutrição enteral OR = 5,609 (IC 3,351-9,388 foram fatores associados à PAV e o uso profilático de antibióticos foi fator de proteção OR = 0,399 (IC 95%: 0,177-0,902. Os pacientes com PAV tiveram maior tempo de internação na UTI (10,3 ± 10,7 versus 4,9 ± 3,3 dias, maior mediana de tempo de VM (4 versus 1 dia, média maior de TISS 28 (24,4 ± 4,6 versus 22,8 ± 4,5 e maior mortalidade bruta (46 versus 28,8%, quando comparados aos pacientes sem PAV. CONCLUSÕES: A PAV foi infecção freqüente nos pacientes cirúrgicos em VM. A nutrição enteral e TISS na admissão foram fatores de risco e o uso profilático de antibiótico fator de proteção. Na amostra estudada, os resultados demonstraram que a PAV está associada a maior duração da VM, do tempo de internação e da mortalidade.BACKGROUND AND OBJECTIVES: The ventilator-associated

  11. Pneumonia Can Be Prevented -- Vaccines Can Help

    Science.gov (United States)

    ... this? Submit What's this? Submit Button Past Emails Pneumonia Can Be Prevented—Vaccines Can Help Language: English ( ... with pneumonia. World Pneumonia Day is November 12th. Pneumonia Affects the Young and Old Pneumonia is an ...

  12. Impacto do sistema de aspiração traqueal aberto e fechado na incidência de pneumonia associada à ventilação mecânica: revisão de literatura Impact of the open and closed tracheal suctioning system on the incidence of mechanical ventilation associated pneumonia: literature review

    Directory of Open Access Journals (Sweden)

    Fernanda Maia Lopes

    2009-03-01

    systems on the incidence of ventilation-associated pneumonia. A search in the Pubmed database was performed to identify randomized controlled trials, published from 1990 to November 2008. Nine studies were included. Of the studies reviewed, seven did not disclose any significant advantages of using the closed system when compared to th e open, whereas two reported that use of the closed system increased colonization rates but not incidence of ventilation-associated pneumonia and one observed that use of the closed system did not increase colonization of the respiratory tract but reduced the spread of infection resulting in decreased sepsis rates. Only two studies found a reduction in the incidence of ventilation-associated pneumonia with use of the closed system, and one revealed a 3.5 times greater risk of developing this infection with the open system. Results suggest that the impact of the open and closed tracheal suction system is similar on development of ventilation-associated pneumonia, choice of the suction system should therefore be based on other parameters. While the closed system increases risk of colonization of the respiratory tract, but has the advantages of continuing mechanical ventilation and lessening hemodynamic impairment.

  13. Comparação da acurácia de preditores de mortalidade na pneumonia associada à ventilação mecânica Comparing the accuracy of predictors of mortality in ventilator-associated pneumonia

    Directory of Open Access Journals (Sweden)

    Renato Seligman

    2011-08-01

    -terminal provasopressin (copeptin, and C-reactive protein (CRP, as well as Sequential Organ Failure Assessment (SOFA scores, are associated with severity and described as predictors of outcome in ventilator-associated pneumonia (VAP. This study sought to compare the predictive value of these biomarkers for mortality in VAP. METHODS: An observational study of 71 patients with VAP. Levels of procalcitonin, MR-proANP, copeptin, and CRP, together with SOFA scores, were determined at VAP onset, designated day 0 (D0, and on day 4 of treatment (D4. Patients received empirical antimicrobial therapy, with modifications based on culture results. Patients who died before D28 were classified as nonsurvivors. RESULTS: Of the 71 patients evaluated, 45 were classified as survivors. Of the 45 survivors, 35 (77.8% received appropriate antimicrobial therapy, compared with 18 (69.2% of the 26 nonsurvivors (p = 0.57. On D0 and D4, the levels of all biomarkers (except CRP, as well as SOFA scores, were lower in eventual survivors than in eventual nonsurvivors. For D0 and D4, the area under the ROC curve was largest for procalcitonin. On D0, MR-proANP had the highest positive likelihood ratio (2.71 and positive predictive value (0.60, but procalcitonin had the highest negative predictive value (0.87. On D4, procalcitonin had the highest positive likelihood ratio (3.46, the highest positive predictive value (0.66, and the highest negative predictive value (0.93. CONCLUSIONS: The biomarkers procalcitonin, MR-proANP, and copeptin can predict mortality in VAP, as can the SOFA score. Procalcitonin alone has the greatest predictive power for such mortality.

  14. Prehospital oral chlorhexidine does not reduce the rate of ventilator-associated pneumonia among critically ill trauma patients: A prospective concurrent-control study.

    Science.gov (United States)

    Mohr, Nicholas M; Pelaez Gil, Carlos A; Harland, Karisa K; Faine, Brett; Stoltze, Andrew; Pearson, Kent; Ahmed, Azeemuddin

    2015-08-01

    The purpose of the study was to test the hypothesis that prehospital oral chlorhexidine administered to intubated trauma patients will decrease the Clinical Pulmonary Infection Score (CPIS) during the first 2 days of hospitalization. Prospective interventional concurrent-control study of all intubated adult trauma patients transported by air ambulance to a 711-bed Midwestern academic trauma center over a 1-year period. Patients transported by 2 university-based helicopters were treated with oral chlorhexidine after intubation, and the control group was patients transported by other air transport services. Sixty-seven patients were enrolled, of which 23 received chlorhexidine (9 patients allocated to the intervention were not treated). The change in CPIS score was no different between the intervention and control groups by intention to treat (1.06- vs 1.40-point reduction, P = .520), and no difference was observed in tracheal colonization (29.0% vs 36.7%, P = .586). No differences were observed in the rate of clinical pneumonia (8.7% vs 8.6%, P = .987) or mortality (P = .196) in the per-protocol chlorhexidine group. The prehospital administration of oral chlorhexidine does not reduce the CPIS score over the first 48 hours of admission for intubated trauma patients. Further study should explore other prehospital strategies of reducing complications of critical illness. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Prevalência e prognóstico dos pacientes com pneumonia associada à ventilação mecânica em um hospital universitário Prevalence of ventilator-associated pneumonia in a university hospital and prognosis for the patients affected

    Directory of Open Access Journals (Sweden)

    Márcio Martins de Queiroz Guimarães

    2006-08-01

    Full Text Available OBJETIVO: Determinar prevalência de pneumonia associada à ventilação mecânica em unidade de terapia intensiva, fatores associados e evolução. MÉTODOS: Foram avaliados 278 pacientes sob ventilação mecânica por mais de 24 horas prospectivamente em hospital universitário. RESULTADOS: Desenvolveram a doença 38,1% dos pacientes, 35,7 casos/1.000 dias de ventilação mecânica: 45,3% por bacilos gram negativos, Pseudomonas aeruginosa (22% o mais comum e 43,4% por germes multi-resistentes. O grupo com pneumonia associada à ventilação mecânica teve maiores tempos de ventilação mecânica, desmame, permanência no hospital e na unidade de terapia intensiva (p 10 dias (7,7; 4,1 - 14,2, imunodepressão (4,3; 1,3 - 14,3, síndrome do desconforto respiratório agudo (3,5; 1,4 - 9,0, atelectasia (3,0; 1,2 - 7,3, parada cardiorrespiratória (0,18; 0,05 - 0,66 e hemorragia digestiva alta (0,07; 0,009 - 0,62]. Fatores associados ao óbito hospitalar: insuficiência renal crônica (26,1; 1,9 - 350,7, admissão prévia na unidade de terapia intensiva (15,6; 1,6 - 152,0, simplified acute physiologic score II > 50 pontos (11,9; 3,4 - 42,0 e idade > 55 anos (4,4; 1,6 - 12,3. CONCLUSÃO: A pneumonia associada à ventilação mecânica aumentou tempos de ventilação mecânica, permanência na unidade de terapia intensiva e no hospital, número de complicações, mas não a letalidade.OBJECTIVE: To determine the prevalence of ventilator-associated pneumonia in an intensive care unit, as well as to identify related factors and characterize patient evolution. METHODS: This study evaluated 278 patients on mechanical ventilation for more than 24 hours in a university hospital. RESULTS: Ventilator-associated pneumonia developed in 38.1% of the patients, translating to 35.7 cases/1000 ventilator-days: 45.3% were caused by gram-negative agents (Pseudomonas aeruginosa accounting for 22%; and multidrug resistant organisms were identified in 43.4%. In the

  16. Prevention of hospital-acquired pneumonia in non-ventilated adult patients: a narrative review

    Directory of Open Access Journals (Sweden)

    Leonor Pássaro

    2016-11-01

    Full Text Available Abstract Background Pneumonia is one of the leading hospital-acquired infections worldwide and has an important impact. Although preventive measures for ventilator-associated pneumonia (VAP are well known, less is known about appropriate measures for prevention of hospital-acquired pneumonia (HAP. Aim The purpose of this narrative review is to provide an overview of the current standards for preventing HAP in non-ventilated adult patients. Methods A search of the literature up to May 2015 was conducted using Medline for guidelines published by national professional societies or professional medical associations. In addition, a comprehensive search for the following preventive measures was performed: hand hygiene, oral care, bed position, mobilization, diagnosis and treatment of dysphagia, aspiration prevention, viral infections and stress bleeding prophylaxis. Findings Regarding international guidelines, several measures were recommended for VAP, whilst no specific recommendations for HAP prevention in non-ventilated patients are available. There is reasonable evidence available that oral care is associated with a reduction in HAP. Early mobilization interventions, swift diagnosis and treatment of dysphagia, and multimodal programmes for the prevention of nosocomial influenza cross-infection, have a positive impact on HAP reduction. The impact of bed position and stress bleeding prophylaxis remains uncertain. Systematic antibiotic prophylaxis for HAP prevention should be avoided. Conclusion Scant literature and little guidance is available for the prevention of HAP among non-ventilated adult patients. In addition, the criteria used for the diagnosis of HAP and the populations targeted in the studies selected are heterogeneous. Oral care was the most studied measure and was commonly associated with a decrease in HAP rate, although a broad range of interventions are proposed. No robust evidence is available for other measures. Further high

  17. Uso de clorexidina 2% gel e escovação mecânica na higiene bucal de pacientes sob ventilação mecânica: efeitos na pneumonia associada a ventilador The use of 2% chlorhexidine gel and toothbrushing for oral hygiene of patients receiving mechanical ventilation: effects on ventilator-associated pneumonia

    Directory of Open Access Journals (Sweden)

    Maria Cristina de Avila Meinberg

    2012-12-01

    Full Text Available OBJETIVO: Avaliar os efeitos da higiene bucal com clorexidina 2% e escovação mecânica sobre a taxa de pneumonia associada a ventilador em uma população mista de pacientes sob ventilação mecânica prolongada. MÉTODOS: Estudo piloto prospectivo, aleatório e placebo-controlado. Foram incluídos pacientes sob ventilação mecânica, com menos de 24 horas de internação e cuja perspectiva de duração da ventilação mecânica era a de um período >72 horas. Os pacientes foram randomizados para o grupo clorexidina (gel com clorexidina a 2% e escovação mecânica ou grupo placebo (gel da mesma coloração e consistência e escovação mecânica na higiene bucal. RESULTADOS: A análise interina planejada foi realizada quando 52 pacientes foram incluídos, e o estudo foi interrompido precocemente. Um total de 28 pacientes foi incluído no grupo clorexidina/escovação mecânica e 24 no grupo placebo. As taxas de pneumonia associada a ventilador foram de 45,8% no grupo placebo e de 64,3% no grupo clorexidine/escovação mecânica (RR=1,4; IC95%=0,83-2,34;p=0,29. CONCLUSÃO: Devido a interrupção precoce por futilidade, não foi possível avaliar o impacto do uso de clorexidina a 2% e escovação mecânica na higiene bucal na incidência de pneumonia associada a ventilador nessa população heterogênea de pacientes críticos sob ventilação mecânica prolongada, não tendo sido evidenciado nenhum efeito benéfico dessa intervenção.OBJECTIVE: To evaluate the effects of oral chlorhexidine hygiene with toothbrushing on the rate of ventilator-associated pneumonia in a mixed population of critically ill patients under prolonged mechanical ventilation. METHODS: Prospective, randomized, and placebo-controlled pilot study. Patients who were receiving mechanical ventilation, had been admitted less than 24 hours prior, and were anticipated to require mechanical ventilation for more than 72 hours were included in the study. The patients were randomly

  18. CDC releases ventilator-associated events criteria

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    Robbins RA

    2017-01-01

    Full Text Available No abstract available. Article truncated at 150 words. A new term has been coined by the CDC, ventilator-associated events (VAEs (1. In 2011, the CDC convened a working group composed of members of several stakeholder organizations to address the limitations of the definition of ventilator-associated pneumonia (VAP definition (2. The organizations represented in the Working Group include: the Critical Care Societies Collaborative (the American Association of Critical-Care Nurses, the American College of Chest Physicians, the American Thoracic Society, and the Society for Critical Care Medicine; the American Association for Respiratory Care; the Association of Professionals in Infection Control and Epidemiology; the Council of State and Territorial Epidemiologists; the Healthcare Infection Control Practices Advisory Committee’s Surveillance Working Group; the Infectious Diseases Society of America; and the Society for Healthcare Epidemiology of America. VAEs are defined by an increase oxygen (>0.2 in FiO2 or positive end-expiratory pressure (PEEP (≥3 cm H2O, after a previous stable baseline of at least 2 …

  19. The Impact of Ventilator-Associated Events in Critically Ill Subjects With Prolonged Mechanical Ventilation.

    Science.gov (United States)

    Kobayashi, Hidetsugu; Uchino, Shigehiko; Takinami, Masanori; Uezono, Shoichi

    2017-11-01

    The Centers for Disease Control and Prevention recently released a surveillance definition for respiratory complications in ventilated patients, ventilator-associated events (VAEs), to replace ventilator-associated pneumonia (VAP). VAEs consist of ventilator-associated conditions (VAC), infection-related ventilator-associated complications (IVAC), and possible VAP. A duration of mechanical ventilation of at least 4 d is required to diagnose VAE. However, the observed duration of mechanical ventilation was mechanical ventilation for ≥ 4 d. This single-center retrospective cohort study was conducted in the general ICU of an academic hospital. We included 407 adult subjects who were admitted to the ICU and required mechanical ventilation for at least 4 d. VAC and IVAC were identified from the electronic medical records. VAP was defined according to the Centers for Disease Control and Prevention 2008 criteria and was identified from the surveillance data of the infection control team of our hospital. Clinical outcomes were studied in the VAC, IVAC, and VAP groups. Possible VAP was not investigated. Higher mortality was seen in VAC and IVAC subjects, but not in VAP subjects, compared with those without VAEs and VAP. By multivariable hazard analysis for hospital mortality, IVAC was independently associated with hospital mortality (hazard ratio 2.42, 95% CI 1.39-4.20, P = .002). VAC also tended to show a similar association with hospital mortality (hazard ratio 1.45, 95% CI 0.97-2.18, P = .07). On the other hand, VAP did not increase a hazard of hospital death (hazard ratio 1.08, 95% CI 0.44-2.66, P = .87). We found that a VAE was related to hospital mortality in critically ill subjects with prolonged mechanical ventilation, and that VAP was not. Copyright © 2017 by Daedalus Enterprises.

  20. Preventing Pneumonia (A Cup of Health with CDC)

    Centers for Disease Control (CDC) Podcasts

    2017-11-09

    Pneumonia is a lung infection that can result in severe illness and even death. Common symptoms include cough, fever, and difficulty breathing. In this podcast, Dr. Jennifer Farrar discusses ways to prevent pneumonia.  Created: 11/9/2017 by MMWR.   Date Released: 11/9/2017.

  1. Incidence and prognosis of ventilator-associated tracheobronchitis (TAVeM): a multicentre, prospective, observational study.

    Science.gov (United States)

    Martin-Loeches, Ignacio; Povoa, Pedro; Rodríguez, Alejandro; Curcio, Daniel; Suarez, David; Mira, Jean-Paul; Cordero, Maria Lourdes; Lepecq, Raphaël; Girault, Christophe; Candeias, Carlos; Seguin, Philippe; Paulino, Carolina; Messika, Jonathan; Castro, Alejandro G; Valles, Jordi; Coelho, Luis; Rabello, Ligia; Lisboa, Thiago; Collins, Daniel; Torres, Antonio; Salluh, Jorge; Nseir, Saad

    2015-11-01

    Ventilator-associated tracheobronchitis has been suggested as an intermediate process between tracheobronchial colonisation and ventilator-associated pneumonia in patients receiving mechanical ventilation. We aimed to establish the incidence and effect of ventilator-associated tracheobronchitis in a large, international patient cohort. We did a multicentre, prospective, observational study in 114 intensive care units (ICU) in Spain, France, Portugal, Brazil, Argentina, Ecuador, Bolivia, and Colombia over a preplanned time of 10 months. All patients older than 18 years admitted to an ICU who received invasive mechanical ventilation for more than 48 h were eligible. We prospectively obtained data for incidence of ventilator-associated lower respiratory tract infections, defined as ventilator-associated tracheobronchitis or ventilator-associated pneumonia. We grouped patients according to the presence or absence of such infections, and obtained data for the effect of appropriate antibiotics on progression of tracheobronchitis to pneumonia. Patients were followed up until death or discharge from hospital. To account for centre effects with a binary outcome, we fitted a generalised estimating equation model with a logit link, exchangeable correlation structure, and non-robust standard errors. This trial is registered with ClinicalTrials.gov, number NCT01791530. Between Sept 1, 2013, and July 31, 2014, we obtained data for 2960 eligible patients, of whom 689 (23%) developed ventilator-associated lower respiratory tract infections. The incidence of ventilator-associated tracheobronchitis and that of ventilator-associated pneumonia at baseline were similar (320 [11%; 10·2 of 1000 mechanically ventilated days] vs 369 [12%; 8·8 of 1000 mechanically ventilated days], p=0·48). Of the 320 patients with tracheobronchitis, 250 received appropriate antibiotic treatment and 70 received inappropriate antibiotics. 39 patients with tracheobronchitis progressed to pneumonia; however

  2. CHARACTERIZATION OF THE VENTILATOR-ASSOCIATED RESPIRATORY INFECTIONS IN AN INTENSIVE CARE UNIT

    OpenAIRE

    Cogollo-González Marysabel; Julio-Narváez Luis Carlos; Alvarado-Cueto Daniel Enrique

    2015-01-01

    Introduction: the ventilator-associated respiratory infections (VARI), pneumonia or tracheobronchitis, are important complications in intensive care units (ICU). Objective: To characterize the epidemiological, clinical and microbiological aspects of VARI. Methods: retrospective study of all patients who were admitted to the ICU of the Clínica San Juan de Dios, during the period of one year, with diagnosis of Ventilator-Associated tracheobronchitis (VAT) or Ventilator-associa...

  3. Pneumonia associada à ventilação mecânica: análise de fatores epidemiológicos na confecção de estratégias de profilaxia e terapêutica Ventilator associated pneumonia: confection of a strategy of prophylaxis and management based on the analysis of epidemiology

    Directory of Open Access Journals (Sweden)

    Edgard do Carmo Neto

    2006-12-01

    . Assim, é necessário conhecer o perfil de sensibilidade da unidade para traçar estratégia terapêutica inicial adequada.BACKGROUND AND OBJECTIVES: Variable magnitude of impact on the outcomes of the critically ill patients has been credited to ventilation-associated pneumonia, in terms of mortality, length of hospital stay and mechanic ventilation days. Three objectives have been defined in this study: mortality and incidence of ventilation-associated pneumonia before and after the implantation of a prophylaxis protocol (primary objectives; microbiologic mapping (secondary objective as an instrument to optimize therapy. METHODS: A historical cohort was followed during the period of August 2001 to January 2004, fragmented in two segments, pre (until January 2003, n = 52 and post-implantation of the mentioned protocol, the analysis of mortality and microbiologic mapping been performed in the second segment (control group n = 39 and case group n = 14. RESULTS: The incidence rates from 2001 to 2003 were respectively 28.05‰ ± 12.92‰, 22.45‰ ± 10.18‰ and 10.75‰ ± 7.61‰. The decrease in this rate after the intervention did not reach statistical significance (p > 0.4. Mortality rates were 49% in the control group (CI 95 = 33% to 65% and 43% in the case group (CI 95 = 14% to 72%, OR = 0.88 (CI 95 = 0.26 to 2.94, without statistical significance either (p = 0.65. Eight bronco-alveolar lavage were obtained (57%, 50% with multiple flora. Pseudomonas aeruginosa was isolated in six patients (75%, Acinetobacter sp in one case (12.5 % and methicilin-resistent Staphylococcus aureus (MRSA in one (12.5%. Other Gram negative bacilli producers of extended spectrum betalactamase (ESBL were isolated in two cases (25% and Stenotrophomonas maltophilia in another (12.5%. CONCLUSIONS: The incidence rate of ventilation-associated pneumonia revealed a tendency to considerable reduction after the utilization of the prophylaxis protocol, while the results suggest no impact on

  4. Vaccines to prevent pneumonia in children - a developing country perspective.

    Science.gov (United States)

    Oliwa, Jacquie N; Marais, Ben J

    2017-03-01

    Pneumonia accounted for 15% of the 6.3 million deaths among children younger than five years in 2013, a total of approximately 935,000 deaths worldwide. Routine vaccination against common childhood illnesses has been identified as one of the most cost-effective strategies to prevent death from pneumonia. Vaccine-preventable or potentially preventable diseases commonly linked with respiratory tract infections include Streptococcus pneumoniae, Haemophilus influenza type-b (Hib), pertussis, influenza, measles, and tuberculosis. Although here have been great strides in the development and administration of effective vaccines, the countries that carry the largest disease burdens still struggle to vaccinate their children and newer conjugated vaccines remain out of reach for many. The Global Vaccine Action Plan (GVAP) has identified priority areas for innovation in research in all aspects of immunisation development and delivery to ensure equitable access to vaccines for all. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. Clinical Features and Antimicrobial Resistance of Bacterial Agents of Ventilator-Associated Tracheobronchitis in Hamedan, Iran

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    Seyyed Hamid Hashemi

    2017-09-01

    Full Text Available Objectives: Ventilator-associated tracheobronchitis (VAT is a common cause of mortality and morbidity in patients admitted to intensive care units (ICUs. This study was conducted to evaluate the clinical course, etiology, and antimicrobial resistance of bacterial agents of VAT in ICUs in Hamedan, Iran. Methods: During a 12-month period, all patients with VAT in a medical and a surgical ICU were included. The criteria for the diagnosis of VAT were fever, mucus production, a positive culture of tracheal secretions, and the absence of lung infiltration. Clinical course, including changes in temperature and tracheal secretions, and outcomes were followed. The endotracheal aspirates were cultured on blood agar and chocolate agar, and antimicrobial susceptibility testing of isolates were performed using the disk diffusion method. Results: Of the 1 070 ICU patients, 69 (6.4% were diagnosed with VAT. The mean interval between the patient’s intubation and the onset of symptoms was 4.7±8.5 days. The mean duration of response to treatment was 4.9±4.7 days. A total of 23 patients (33.3% progressed to ventilator-associated pneumonia (VAP, and 38 patients (55.0% died. The most prevalent bacterial isolates included Acinetobacter baumannii (24.6%, Pseudomonas aeruginosa (20.2%, and Enterobacter(13.0%. P. aeruginosa and Enterobacter were the most prevalent bacteria in surgical ICU, and A. baumannii and K. pneumoniae were the most common in the medical ICU. All A. baumannii and Citrobacter species were multidrug-resistant (MDR. MDR pathogens were more prevalent in medical ICU compared to surgical ICU (p < 0.001. Conclusions: VAT increases the rates of progression to VAP, the need for tracheostomy, and the incidence of mortality in ICUs. Most bacterial agents of VAT are MDR. Preventive policies for VAP, including the use of ventilator care bundle, and appropriate empirical antibiotic therapy for VAT may reduce the incidence of VAP.

  6. Investigation of Class I, II and III Integrons among Acinetobacter Strains Isolated from Ventilator-Associated Pneumonia Patients in Intensive Care Unit of Rasoul Akram Hospital in Tehran, Iran

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    Hajar Mohammadi-Barzelighi

    2015-10-01

    Full Text Available Background: Multi-drug resistant strains of Acinetobacter spp. have created therapeutic problems worldwide. The objective of this study was to detect integrons  in Acinetobacter  spp. isolates  from Ventilator-Associated  Pneu- monia patients using PCR method.Methods: A total 51 Bronchoalveolar lavage samples were obtained from pa-tients in ICU and examined for Acinetobacter spp. infection by biochemical and PCR methods using blaOXA51-like primers. Antimicrobial susceptibility testing was performed using disk diffusion and MIC methods.Results: Among 51 patients with VAP (62.7% males, 35.2% females, mean age 53 year, 50 (98% were positive, with a high prevalence of gram-nega- tive bacteria, mainly Acinetobacter spp. (70%, from which A. baumani was detected in 34 (68% and A. lwoffii in 1 (2% of isolates. More than 90% of isolates were resistant to imipenem,  piperacillin+tazobactam,  third genera- tion cephalosporins and gentamicin, while the most effective antibiotic was colistin (100%. The correlation coefficient between disk diffusion and MIC was 0.808 (p = 0.001. Three Acinetobacter isolates (8% harbored integrase I gene but none of isolates contained Class II or III integrons.Conclusion: The results showed that colistin was an effective antibiotic andcan be used for treatment  of patients in ICU. Due to the high number of MDR isolates lacking Integrons it can be concluded that although class I in- tegrons are important among clinical isolates of A. baumannii, they have no significant  role  in  dissemination  of  antibiotic  resistance  genes  in  Rasoul Akram  Hospital in Tehran, Iran. The presence of IntI in A. lwoffii may be related to transfer of integron to A. baumannii which can be considered as an important threat for hospitalized patients.

  7. Pneumonia

    Science.gov (United States)

    ... such as hospitals is called hospital-acquired pneumonia . Causes Pneumonia is a common illness that affects millions of ... States. Germs called bacteria, viruses, and fungi may cause pneumonia. In adults, bacteria are the most common cause ...

  8. Randomized intubation with polyurethane or conical cuffs to prevent pneumonia in ventilated patients.

    Science.gov (United States)

    Philippart, François; Gaudry, Stéphane; Quinquis, Laurent; Lau, Nicolas; Ouanes, Islem; Touati, Samia; Nguyen, Jean Claude; Branger, Catherine; Faibis, Frédéric; Mastouri, Maha; Forceville, Xavier; Abroug, Fekri; Ricard, Jean Damien; Grabar, Sophie; Misset, Benoît

    2015-03-15

    The occurrence of ventilator-associated pneumonia (VAP) is linked to the aspiration of contaminated pharyngeal secretions around the endotracheal tube. Tubes with cuffs made of polyurethane rather than polyvinyl chloride or with a conical rather than a cylindrical shape increase tracheal sealing. To test whether using polyurethane and/or conical cuffs reduces tracheal colonization and VAP in patients with acute respiratory failure. We conducted a multicenter, prospective, open-label, randomized study in four parallel groups in four intensive care units between 2010 and 2012. A cohort of 621 patients with expected ventilation longer than 2 days was included at intubation with a cuff composed of cylindrical polyvinyl chloride (n = 148), cylindrical polyurethane (n = 143), conical polyvinyl chloride (n = 150), or conical polyurethane (n = 162). We used Kaplan-Meier estimates and log-rank tests to compare times to events. After excluding 17 patients who secondarily refused participation or had met an exclusion criterion, 604 were included in the intention-to-treat analysis. Cumulative tracheal colonization greater than 10(3) cfu/ml at Day 2 was as follows (median [interquartile range]): cylindrical polyvinyl chloride, 0.66 (0.58-0.74); cylindrical polyurethane, 0.61 (0.53-0.70); conical polyvinyl chloride, 0.67 (0.60-0.76); and conical polyurethane, 0.62 (0.55-0.70) (P = 0.55). VAP developed in 77 patients (14.4%), and postextubational stridor developed in 28 patients (6.4%) (P = 0.20 and 0.28 between groups, respectively). Among patients requiring mechanical ventilation, polyurethane and/or conically shaped cuffs were not superior to conventional cuffs in preventing tracheal colonization and VAP. Clinical trial registered with clinicaltrials.gov (NCT01114022).

  9. Respiratory Review of 2012: Pneumonia

    OpenAIRE

    Yoon, Young-Soon

    2012-01-01

    Pneumonia is the cause of significant morbidity and mortality, despite advances in diagnosis and antibacterial treatment. Pneumonia is often misdiagnosed and mistreated up until recently. Recent classification of pneumonia consists of community-acquired pneumonia, health care-associated pneumonia, hospital-acquired pneumonia, and ventilator-associated pneumonia. The etiology, risk factors, and treatment are different among them. This article briefly introduces new concepts and ideas in biomar...

  10. Pneumonia

    OpenAIRE

    Coelho, Liana Sousa [UNESP; Do Vale, Simone Alves [UNESP; Godoy, Irma de [UNESP; Tanni, Suzana Erico [UNESP

    2012-01-01

    Pneumonia is an infectious disease with great morbidity and mortality worldwide. According to the current guidelines recommendations the authors reviewed the treatment of community-acquired pneumonia (CAP) and health care-associated pneumonia (HCAP). In this paper will be also presented data about etiology, clinics and diagnostic tools. © Copyright Moreira Jr. Editora.

  11. Pneumonia

    OpenAIRE

    Coelho, Liana Sousa [UNESP; Tanni, Suzana Erico; Godoy, Irma de [UNESP

    2009-01-01

    Pneumonia is an infectious disease with great morbidity and mortality worldwide. According to the current guidelines recommendations the authors reviewed the treatment of community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP). In this paper will be presented data about etiology, clinics and diagnostic tools. © Copyright Moreira Jr. Editora.

  12. Development and validation of an automated ventilator-associated event electronic surveillance system: A report of a successful implementation.

    Science.gov (United States)

    Hebert, Courtney; Flaherty, Jennifer; Smyer, Justin; Ding, Jing; Mangino, Julie E

    2017-11-10

    Surveillance is an important tool for infection control; however, this task can often be time-consuming and take away from infection prevention activities. With the increasing availability of comprehensive electronic health records, there is an opportunity to automate these surveillance activities. The objective of this article is to describe the implementation of an electronic algorithm for ventilator-associated events (VAEs) at a large academic medical center METHODS: This article reports on a 6-month manual validation of a dashboard for VAEs. We developed a computerized algorithm for automatically detecting VAEs and compared the output of this algorithm to the traditional, manual method of VAE surveillance. Manual surveillance by the infection preventionists identified 13 possible and 11 probable ventilator-associated pneumonias (VAPs), and the VAE dashboard identified 16 possible and 13 probable VAPs. The dashboard had 100% sensitivity and 100% accuracy when compared with manual surveillance for possible and probable VAP. We report on the successfully implemented VAE dashboard. Workflow of the infection preventionists was simplified after implementation of the dashboard with subjective time-savings reported. Implementing a computerized dashboard for VAE surveillance at a medical center with a comprehensive electronic health record is feasible; however, this required significant initial and ongoing work on the part of data analysts and infection preventionists. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  13. Early vs late tracheotomy for prevention of pneumonia in mechanically ventilated adult ICU patients: a randomized controlled trial.

    Science.gov (United States)

    Terragni, Pier Paolo; Antonelli, Massimo; Fumagalli, Roberto; Faggiano, Chiara; Berardino, Maurizio; Pallavicini, Franco Bobbio; Miletto, Antonio; Mangione, Salvatore; Sinardi, Angelo U; Pastorelli, Mauro; Vivaldi, Nicoletta; Pasetto, Alberto; Della Rocca, Giorgio; Urbino, Rosario; Filippini, Claudia; Pagano, Eva; Evangelista, Andrea; Ciccone, Gianni; Mascia, Luciana; Ranieri, V Marco

    2010-04-21

    Tracheotomy is used to replace endotracheal intubation in patients requiring prolonged ventilation; however, there is considerable variability in the time considered optimal for performing tracheotomy. This is of clinical importance because timing is a key criterion for performing a tracheotomy and patients who receive one require a large amount of health care resources. To determine the effectiveness of early tracheotomy (after 6-8 days of laryngeal intubation) compared with late tracheotomy (after 13-15 days of laryngeal intubation) in reducing the incidence of pneumonia and increasing the number of ventilator-free and intensive care unit (ICU)-free days. Randomized controlled trial performed in 12 Italian ICUs from June 2004 to June 2008 of 600 adult patients enrolled without lung infection, who had been ventilated for 24 hours, had a Simplified Acute Physiology Score II between 35 and 65, and had a sequential organ failure assessment score of 5 or greater. Patients who had worsening of respiratory conditions, unchanged or worse sequential organ failure assessment score, and no pneumonia 48 hours after inclusion were randomized to early tracheotomy (n = 209; 145 received tracheotomy) or late tracheotomy (n = 210; 119 received tracheotomy). The primary endpoint was incidence of ventilator-associated pneumonia; secondary endpoints during the 28 days immediately following randomization were number of ventilator-free days, number of ICU-free days, and number of patients in each group who were still alive. Ventilator-associated pneumonia was observed in 30 patients in the early tracheotomy group (14%; 95% confidence interval [CI], 10%-19%) and in 44 patients in the late tracheotomy group (21%; 95% CI, 15%-26%) (P = .07). During the 28 days immediately following randomization, the hazard ratio of developing ventilator-associated pneumonia was 0.66 (95% CI, 0.42-1.04), remaining connected to the ventilator was 0.70 (95% CI, 0.56-0.87), remaining in the ICU was 0.73 (95

  14. [Community acquired pneumonia in children: Outpatient treatment and prevention].

    Science.gov (United States)

    Moreno-Pérez, D; Andrés Martín, A; Tagarro García, A; Escribano Montaner, A; Figuerola Mulet, J; García García, J J; Moreno-Galdó, A; Rodrigo Gonzalo de Lliria, C; Ruiz Contreras, J; Saavedra Lozano, J

    2015-12-01

    There have been significant changes in community acquired pneumonia (CAP) in children in the last decade. These changes relate to epidemiology and clinical presentation. Resistance to antibiotics is also a changing issue. These all have to be considered when treating CAP. In this document, two of the main Spanish pediatric societies involved in the treatment of CAP in children, propose a consensus concerning therapeutic approach. These societies are the Spanish Society of Paediatric Infectious Diseases and the Spanish Society of Paediatric Chest Diseases. The Advisory Committee on Vaccines of the Spanish Association of Paediatrics (CAV-AEP) has also been involved in the prevention of CAP. An attempt is made to provide up-to-date guidelines to all paediatricians. The first part of the statement presents the approach to ambulatory, previously healthy children. We also review the prevention with currently available vaccines. In a next second part, special situations and complicated forms will be addressed. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

  15. Safety and efficacy of colistin versus meropenem in the empirical treatment of ventilator-associated pneumonia as part of a macro-project funded by the Seventh Framework Program of the European Commission studying off-patent antibiotics: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Rosso-Fernández, Clara; Garnacho-Montero, José; Antonelli, Massimo; Dimopoulos, George; Cisneros, José Miguel

    2015-03-20

    Ventilator-associated pneumonia (VAP) is one of the most common and severe hospital-adquired infections, and multidrugresistant gram-negative bacilli (MDR-GNB) constitute the main etiology in many countries. Inappropriate empiric antimicrobial treatment is associated with increased mortality. In this context, the empirical treatment of choice for VAP is unknown. Colistin, is now the antimicrobial with greatest in vitro activity against MDR-GNB. The MagicBullet clinical trial is an investigator-driven clinical study, funded by the Seventh Framework Program of the European Commission. This is designed as a phase IV, randomized, controlled, open label, non-inferiority and international trial to assess the safety and efficacy of colistin versus meropenem in late onset VAP. The study is conducted in a total of 32 centers in three European countries (Spain, Italy and Greece) with specific high incidences of infections caused by MDR-GNB. Patients older than 18 years who develop VAP with both clinical and radiological signs, and are on mechanical ventilation for more than 96 hours, or less than 96 hours but with previous antibiotic treatment plus one week of hospitalization, are candidates for inclusion in the study. A total sample size of 496 patients will be randomized according to a severity clinical score (at the time of VAP diagnosis in a 1:1 ratio to receive either colistin 4.5 MU as a loading dose, followed by 3 MU every eight hours (experimental arm), or meropenem 2 g every eight hours (control arm), both combined with levofloxacin. Mortality from any cause at 28 days will be considered as the main outcome. Clinical and microbiological cure will be evaluated at 72 hours, eight days, the finalization of antibiotic treatment, and 28 days of follow-up. The efficacy evaluation will be performed in every patient who receives at least one study treatment drug, and with etiologic diagnosis of VAP, intention-to-treat population and per protocol analysis will be performed

  16. Management of Pneumonia in Kidney Transplantation to Prevent Further Outbreak

    Directory of Open Access Journals (Sweden)

    Norihiko Goto

    2015-01-01

    Full Text Available The outbreak of Pneumocystis jirovecii pneumonia (PJP among kidney transplant recipients is emerging worldwide. It is important to control nosocomial PJP infection. A delay in diagnosis and treatment increases the number of reservoir patients and the number of cases of respiratory failure and death. Owing to the large number of kidney transplant recipients compared to other types of organ transplantation, there are greater opportunities for them to share the same time and space. Although the use of trimethoprim-sulfamethoxazole (TMP-SMX as first choice in PJP prophylaxis is valuable for PJP that develops from infections by trophic forms, it cannot prevent or clear colonization, in which cysts are dominant. Colonization of P. jirovecii is cleared by macrophages. While recent immunosuppressive therapies have decreased the rate of rejection, over-suppressed macrophages caused by the higher levels of immunosuppression may decrease the eradication rate of colonization. Once a PJP cluster enters these populations, which are gathered in one place and uniformly undergoing immunosuppressive therapy for kidney transplantation, an outbreak can occur easily. Quick actions for PJP patients, other recipients, and medical staff of transplant centers are required. In future, lifelong prophylaxis may be required even in kidney transplant recipients.

  17. Ceftobiprole medocaril in the treatment of hospital-acquired pneumonia

    NARCIS (Netherlands)

    Scheeren, Thomas W. L.

    2015-01-01

    Ceftobiprole medocaril is a fifth-generation cephalosporin approved in Europe as single-agent therapy for hospital-acquired pneumonia (HAP), excluding ventilator-associated pneumonia (VAP). It is rapidly converted to the active metabolite ceftobiprole following intravenous administration.

  18. pneumoniae

    African Journals Online (AJOL)

    similar design has recently been published.9 This study reports the causes, risk factors and prognostic indicators in a population from the Kenya coast with similar characteristics to that in southern Malawi and allows us to predict the likely significance of pneumococcal disease in pneumonia patients in Blantyre.

  19. Toward improved surveillance: the impact of ventilator-associated complications on length of stay and antibiotic use in patients in intensive care units.

    Science.gov (United States)

    Hayashi, Yoshiro; Morisawa, Kenichiro; Klompas, Michael; Jones, Mark; Bandeshe, Hiran; Boots, Robert; Lipman, Jeffrey; Paterson, David L

    2013-02-01

    Hospitals and quality improvement agencies are vigorously focusing on reducing rates of hospital-acquired infection. Ventilator-associated pneumonia (VAP) is notoriously difficult to diagnose and surveillance is thwarted by the subjectivity of many components of the surveillance definition. Alternative surveillance strategies are needed. Ventilator-associated complications (VAC) is a simple, objective measure of respiratory deterioration. VAC is defined by increases in fraction of inspired oxygen (FiO(2)) by ≥ 15% or positive end-expiratory pressure (PEEP) by ≥ 2.5 cm H(2)O lasting ≥ 2 days after stable or decreasing FiO(2) or PEEP lasting ≥ 2 days. We retrospectively assessed patients on mechanical ventilation for ≥ 48 hours in our study intensive care unit (ICU) using electronic medical record data. We analyzed the association between VAC and clinical diagnoses, ICU length of stay, duration of mechanical ventilation, antibiotic use, and mortality. We assessed 153 patients with VAC and 390 without VAC. VAC events were associated with significantly increased ICU length of stay, duration of mechanical ventilation, and consumption of broad-spectrum antibiotics but not with longer hospital stays or ICU mortality. Surveillance for VAP is subjective and labor intensive. VAC is an objective measure which can be readily obtained from electronic records. It is associated with adverse outcomes and increased broad-spectrum antibiotic usage. VAC may be a useful surveillance tool. The utility of VAC prevention bundles merits assessment.

  20. Preventing aspiration pneumonia in older people: do we have the 'know-how'?

    Science.gov (United States)

    Luk, James K H; Chan, Daniel K Y

    2014-10-01

    Aspiration pneumonia is common in older people. To reduce the risk of aspiration pneumonia, maintenance of good oral hygiene is important and medications affecting salivary flow or causing sedation are best avoided, if possible. The use of H2 blockers and proton-pump inhibitors should be minimised. Different compensatory and facilitation techniques can be applied during oral feeding. Hand feeding should be tried before consideration of tube feeding. The use of tube feeding is the last resort and is mainly for improving nutrition and hydration. Prevention of aspiration pneumonia and increasing survival rates should not be the rationales for tube feeding. Feeding via both gastrostomy and nasogastric tube has similar risks for aspiration pneumonia, and continuous pump feeding is not better than intermittent feeding. Jejunal feeding might decrease the chance of aspiration pneumonia in selected high-risk patients. If older patients are on angiotensin-converting enzyme inhibitors without intolerable cough, continuing the drug may be beneficial. Folate deficiency, if present, needs to be promptly corrected. Further better-designed studies are warranted to find the best ways for prevention of aspiration pneumonia.

  1. Delivering vaccines for the prevention of pneumonia - programmatic and financial issues

    Directory of Open Access Journals (Sweden)

    Diana C Otczyk

    2013-01-01

    Full Text Available Pneumonia is the leading cause of morbidity and mortality in children younger than 5 years. Vaccines are available against the main bacterial pathogens Haemophilus influenzae type b and Streptococcus pneumoniae. There are also vaccines against measles and pertussis; diseases that can predispose a child to pneumonia. Partners such as the Global Alliance for Vaccines and Immunisation (GAVI, the Hib Initiative, the Accelerated Development and Introduction Plan for pneumococcal vaccines and the Measles Initiative, have accelerated the introduction of vaccines into developing countries. Whilst significant improvements in vaccine coverage have occurred globally over the past decade, there still remains an urgent need to scale-up key pneumonia protection and treatment interventions as identified in the Global Action Plan for the Prevention and Control of Pneumonia (GAPP. There is promise that global immunisation will continue to improve child survival. However, there are several challenges to vaccine implementation that must first be addressed, including: a lack of access to under-served and marginalised populations; inadequate planning and management; a lack of political commitment; weak monitoring and surveillance programmes and assured sustainable finance and supply of quality vaccines. There is an urgent need to increase global awareness of the devastation that pneumonia brings to the worlds poorest communities.

  2. Preventative effect of massage on gastric volvulus in infants with gastroesophageal reflux-induced pneumonia.

    Science.gov (United States)

    Yan, Suqi; Xiong, Xiaoli; Wan, Qi; Liu, Fan; Tang, Jianqiao; Jiang, Zhixia; Zhou, Lishan; Yuan, Kai; Xie, Dong

    2015-10-01

    To study the preventative effects of massage on gastric volvulus (GV) in infants with gastroesophageal reflux (GER)-induced pneumonia. One-hundred and eighty GV with GER-induced pneumonia inpatients were divided randomly into four groups: basic treatment 1 (n = 60), basic treatment 2 (n = 30), massage treatment 1 (n = 60) and massage treatment 2 (n = 30). Clinical examinations selected between groups 1 and 2 were different. Radiography of the upper gastrointestinal tract using iodine-containing contrast was assessed in group 1 before and after treatment, whereas 24-h pH monitoring of the distal esophagus was assessed in group 2 before and after treatment. Symptom scores and chest radiography were assessed in all groups upon hospital admission and after procedures. Clinical effects were estimated after procedures in all groups. The prevalence of severe pneumonia among the four groups was compared. Massage treatment groups showed a significantly higher percentage of cure and total effect (P 0.05) than basic treatment groups. Furthermore, massage treatment groups had remarkably lower scores for symptoms and signs (P massage treatment groups compared with those in basic treatment groups. Finally, massage treatment groups demonstrated a lower prevalence of severe pneumonia than basic treatment groups (P Massage treatment can prevent GV with GER-induced pneumonia in infants by timely correction of stomach rotation and subsequent attenuation of GER.

  3. Development of a new trend conjugate vaccine for the prevention of Klebsiella pneumoniae

    Directory of Open Access Journals (Sweden)

    Tarek A. Ahmad

    2012-07-01

    Full Text Available Klebsiella pneumoniae is a major cause of nosocomial pneumonia, septicemia and urinary tract infections, especially in newborns, blood cancer patients, and other immunocompromised candidates. The control of K. pneumoniae is a complicated issue due to its tight pathogenesis. Immuno-prophylactic preparations, especially those directed toward the bacterium O-antigen, showed to be the most successful way to prevent the infection incidence. However, all previously proposed preparations were either of limited spectrum or non-maternal, and hence not targeting the main Klebsiella patients. Moreover, all preparations were directed only to prevent the respiratory diseases due to that pathogen. This article addresses the development of a method originally used to purify the non-capsular bacterial- endotoxins, as a new and easy method for vaccine production against K. pneumoniae. The application of this method was preceded by a biotechnological control of capsular polysaccharide production in K. pneumoniae. The new produced natural conjugate between the bacterial O-antigen and its outer membrane proteins was evaluated by physicochemical and immunological methods to investigate its purity, integrity, safety and immunogenicity. It showed to be pure, stable, safe for use, and able to elicit a protective immunoglobulin titer against different Klebsiella infections. This immune-response proved to be transferable to the offspring of the vaccinated experimental rabbits via placenta.

  4. Continuous Positive Airway Pressure (CPAP for prevention of recurrent pneumonia in the Neuromyelitis Optica patient

    Directory of Open Access Journals (Sweden)

    James A. Welker

    2014-01-01

    Conclusions: Patients with Neuromyelitis Optica differ from those with traumatic spinal cord injury as they have a chronic progressive systemic illness that causes continued deterioration of their nervous system resulting in the need for routine monitoring that ensures the timely addition of CPAP for the prevention of pneumonia and its associated medical expenses.

  5. pneumoniae

    African Journals Online (AJOL)

    vaccine-preventable cause of death in children and adults. The management of pneumococcal infections is complicated by the development of resistance to antimicrobials. Risk factors for increased resistance include young age, isolation from the upper respiratory tract, hospitalisation, residence in an urban area, day care ...

  6. Epidemiologic characteristics of Klebsiella pneumoniae isolates in ...

    African Journals Online (AJOL)

    Klebsiella pneumoniae is a common pathogen that causes ventilator associated pneumonia (VAP) in intensive care units (ICUs). Strain typing is a useful tool in tracking the spread of these infections. Primary objective was to study different strains causing VAP in Anesthesia ICUs. Secondary objective was to determine role ...

  7. Mutant prevention concentration of tigecycline for clinical isolates of Streptococcus pneumoniae and Staphylococcus aureus.

    Science.gov (United States)

    Hesje, C K; Drlica, K; Blondeau, J M

    2015-02-01

    The mutant prevention concentration (MPC) reflects the antimicrobial susceptibility of the resistant mutant subpopulations present in large bacterial populations. In principle, combining the MPC with pharmacokinetic measurements can guide treatment to restrict the enrichment of resistant subpopulations, just as the MIC is used with pharmacokinetics to restrict the growth of bulk, susceptible populations. Little is known about the MPC of tigecycline, one of the more recently approved antimicrobials. Tigecycline is particularly interesting because it shows good activity against Gram-positive pathogens. MPCs were determined using tigecycline-containing agar plates for clinical isolates of Streptococcus pneumoniae (n=47), MRSA (n=50) and MSSA (n=50). Trypticase soy agar containing sheep red blood cells, commonly used for the growth of S. pneumoniae, gave tigecycline MPC90 values that were two orders of magnitude higher than expected. The addition of agar to Todd-Hewitt broth (solidified Todd-Hewitt broth) allowed the high-density growth of S. pneumoniae in the absence of red blood cells and lowered the MPC90 of tigecycline by 100-fold to 0.5 mg/L. The addition of red blood cells to solidified Todd-Hewitt broth raised the MPC90 by 100-fold. Thus, red blood cells reduce the efficacy of tigecycline against S. pneumoniae. The growth of Staphylococcus aureus was not sensitive to red blood cells; values of MPC90 were 2 and 4 mg/L for MSSA and MRSA, respectively. Values of MPC constitute a concentration threshold for restricting the emergence of tigecycline resistance that can now be used in animal studies to determine pharmacodynamic thresholds. The off-label treatment of S. pneumoniae blood infections with tigecycline may require caution due to blood-cell-mediated interference with the antimicrobial. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e

  8. Hospitalizations for vaccine preventable pneumonias in patients with inflammatory bowel disease: a 6-year analysis of the Nationwide Inpatient Sample

    Directory of Open Access Journals (Sweden)

    Stobaugh DJ

    2013-05-01

    Full Text Available Derrick J Stobaugh,1,2 Parakkal Deepak,1,2 Eli D Ehrenpreis1,21Center for the Study of Complex Diseases, Research Institute, NorthShore University HealthSystem, Evanston, IL, USA; 2Gastroenterology Department, NorthShore University HealthSystem, Highland Park, IL, USABackground: Pneumonias are among the most common causes of hospitalization among inflammatory bowel disease (IBD patients. Guidelines published in 2004 advocate vaccination against Streptococcus pneumoniae and influenza virus. We sought to examine trends in hospitalizations for vaccine preventable pneumonias among IBD patients since the availability of published guidelines, and to identify whether Haemophilus influenzae is a causative organism for pneumonia hospitalizations among IBD patients.Methods: This cross-sectional study on the Nationwide Inpatient Sample was used to identify admissions for pneumonias in patients with IBD between 2004 and 2009. A multivariate logistic regression analysis was performed comparing IBD patients to controls, accounting for potential confounders.Results: There were more admissions for S. pneumoniae pneumonia than influenza virus or H. influenzae (787, 393, and 183 respectively. Crohn’s disease (CD as well as ulcerative colitis (UC patients did not demonstrate increased adjusted odds of hospitalization for S. pneumoniae pneumonia (1.08; confidence interval [CI] 0.99–1.17 compared to 0.93; CI 0.82–1.06 respectively. Increased adjusted odds for hospitalization for pneumonias due to influenza virus were seen among UC patients in the bottom quartile of income (1.86; CI 1.46–2.37. Adjusted odds for H. influenzae pneumonia admission in patients with UC and CD patients were increased compared to controls (1.42; CI 1.13–1.79 and 1.28; CI 1.06–1.54, respectively.Conclusion: The study identified lowest income UC patients as having higher adjusted odds, and these patients should be targeted for influenza virus vaccination. Additionally, H

  9. Cost-effectiveness analysis of pneumococcal conjugate vaccines in preventing pneumonia in Peruvian children.

    Science.gov (United States)

    Mezones-Holguín, Edward; Bolaños-Díaz, Rafael; Fiestas, Víctor; Sanabria, César; Gutiérrez-Aguado, Alfonso; Fiestas, Fabián; Suárez, Víctor J; Rodriguez-Morales, Alfonso J; Hernández, Adrián V

    2014-12-15

    Pneumococcal pneumonia (PP) has a high burden of morbimortality in children. Use of pneumococcal conjugate vaccines (PCVs) is an effective preventive measure. After PCV 7-valent (PCV7) withdrawal, PCV 10-valent (PCV10) and PCV 13-valent (PCV13) are the alternatives in Peru. This study aimed to evaluate cost effectiveness of these vaccines in preventing PP in Peruvian children <5 years-old. A cost-effectiveness analysis was developed in three phases: a systematic evidence search for calculating effectiveness; a cost analysis for vaccine strategies and outcome management; and an economic model based on decision tree analysis, including deterministic and probabilistic sensitivity analysis using acceptability curves, tornado diagram, and Monte Carlo simulation. A hypothetic 100 vaccinated children/vaccine cohort was built. An incremental cost-effectiveness ratio (ICER) was calculated. The isolation probability for all serotypes in each vaccine was estimated: 38% for PCV7, 41% PCV10, and 17% PCV13. Avoided hospitalization was found to be the best effectiveness model measure. Estimated costs for PCV7, PCV10, and PCV13 cohorts were USD13,761, 11,895, and 12,499, respectively. Costs per avoided hospitalization were USD718 for PCV7, USD333 for PCV10, and USD 162 for PCV13. At ICER, PCV7 was dominated by the other PCVs. Eliminating PCV7, PCV13 was more cost effective than PCV10 (confirmed in sensitivity analysis). PCV10 and PCV13 are more cost effective than PCV7 in prevention of pneumonia in children <5 years-old in Peru. PCV13 prevents more hospitalizations and is more cost-effective than PCV10. These results should be considered when making decisions about the Peruvian National Inmunizations Schedule.

  10. Gastrojejunostomy inserted through PEG (PEG-J) in prevention of aspiration pneumonia. Clinical nutrition complication in dysphagic patients.

    Science.gov (United States)

    Ławiński, Michał; Gradowski, Łukasz; Bzikowska, Agnieszka; Goszczyńska, Adriana; Jachnis, Aneta; Forysiński, Karol

    2014-05-01

    Percutaneous endoscopic gastrostomy (PEG) is the most commonly used method of access to the gastrointestinal tract in long‑term home enteral nutrition (HEN) in patients with neurogenic deglutition and stenosis of the upper gastrointestinal tract caused by tumour. One of the most common complications of HEN is pneumonia resulting from aspiration of saliva or food. The risk of aspiration and the potential consequent sudden death is further increased by concomitant delayed gastric emptying and gastroesophageal reflux disease. The aim of the study was to evaluate the efficacy of changing percutaneous endoscopic gastrostomy to a gastrojejunostomy inserted through the PEG (PEG-J) in the prevention of aspiration pneumonia. MATERIAŁ AND METHODS: The study involved 158 patients receiving HEN by percutaneous endoscopic gastrostomy (PEG), aged 19 to 90 years. Indications for enteral nutrition in the study subjects included: neurogenic dysphagia--95 patients (60%), and obstruction of the upper gastrointestinal tract due to cancer--63 patients (40%). The pulmonary and gastrointestinal complications were observed in 28 patients receiving gastric nutrition through PEG within one to nine months following the start of the feeding. In 20 patients, because of the symptoms of aspiration pneumonia with accompanying gastroesophageal reflux and delayed gastric emptying, PEG was changed to PEG-J as an alternative. There were no reports on food reflux and aspiration pneumonia in patients whose PEG has been replaced by PEG-J. The use of PEG-J appears to prevent the occurrence of aspiration pneumonia in patients receiving home enteral nutrition in the long-term.

  11. Twice-weekly pyrimethamine-sulfadoxine effectively prevents Pneumocystis carinii pneumonia relapse and toxoplasmic encephalitis in patients with AIDS

    NARCIS (Netherlands)

    Schürmann, D.; Bergmann, F.; Albrecht, H.; Padberg, J.; Grünewald, T.; Behnsch, M.; Grobusch, M.; Vallée, M.; Wünsche, T.; Ruf, B.; Suttorp, N.

    2001-01-01

    OBJECTIVE: To evaluate the safety and efficacy of a fixed 25mg pyrimethamine--500mg sulfadoxine combination plus 15mg folinic acid given twice weekly for the prevention of relapses of Pneumocystis carinii pneumonia (PCP) and primary episodes of toxoplasmic encephalitis. METHODS: Ninety-five

  12. Spatial Analysis of Potentially Preventable Pneumonia and Asthma Hospitalizations for Children in the Texas Coastal Bend Area

    Science.gov (United States)

    Lin, Na

    Pneumonia and asthma, two common Ambulatory Care Sensitive Conditions (ACSCs), were two top reasons for the admission of children to the hospitals and emergency rooms in the United States in 2011. Pneumonia and asthma are potentially preventable if the child's environment is properly managed. Underlying vulnerabilities such as low socioeconomic status (SES) and proximity to air pollution play an important role in ACSCs hospitalization. Pneumonia and asthma are two common reasons for hospitalizations among children and missed school days in Texas Coastal Bend Area. This thesis examines the relationships between neighborhood socioeconomic characteristics, meteorological conditions and children ACSCs hospitalization, including pneumonia and asthma among children age 0-17 in this area. Hospital discharge data from 2007 to 2009 based on Zip Code Tabulation Area (ZCTA) were examined along with American Community Survey (ACS) data, air pollution data from Environmental Protection Agency (EPA) and temperature data from National Climatic Data Center (NCDC). Hotspot and Local Moran's I analyses were applied to identify the concentrations of the illnesses. Two regressions (OLS and GWR) were applied to identify factors that contribute the most to ACSCs hospitalization. Pearson's correlation was calculated to examine the relationship between meteorological condition and child hospitalization for asthma and pneumonia. A human subject survey was conducted to examine the relationships between neighborhood environment and children asthma cases. The main finding was that children from families with health insurance, children from single father families and children from poor families were more likely to visit hospital for ACSCs and pneumonia care. "Hispanic families" and especially "Hispanic families with father but no mother" also contributed most to child hospitalization for ACSCs and pneumonia, suggesting that family preventative health care education is needed for Hispanic

  13. Atypical pneumonia

    Science.gov (United States)

    Walking pneumonia; Community-acquired pneumonia - atypical ... Bacteria that cause atypical pneumonia include: Mycoplasma pneumonia is caused by the bacteria Mycoplasma pneumoniae . It often affects people younger than age 40. Pneumonia due ...

  14. Understanding Pneumonia

    Science.gov (United States)

    ... and Diseases > Lung Disease Lookup > Pneumonia Learn About Pneumonia 5 Facts You Should Know about Pneumonia Pneumonia ... vaccinated and practicing good health habits What Is Pneumonia? Pneumonia is an infection in one or both ...

  15. Frequency of Ventilator-associated Pneumonia With 3-day Versus 7-day Ventilator Circuit Changes

    Directory of Open Access Journals (Sweden)

    Ting-Chang Hsieh

    2010-02-01

    Conclusion: Weekly circuit change does not contribute to increased rates of VAP in pediatric patients. Long-term studies evaluating risk factors in larger pediatric patient populations are warranted for further conclusive recommendations.

  16. Ventilator associated pneumonia caused by extensive-drug resistant Acinetobacter species: Colistin is the remaining choice

    Directory of Open Access Journals (Sweden)

    Ahmed Hasanin

    2016-07-01

    Conclusions: XDR AB-VAP is endemic in our ICU without a definite factor associated with increased risk of infection. Given that almost half of the strains are also resistant to tigecycline, colistin appears to be an appropriate first-line antimicrobial drug in critically ill patients developing VAP based on invitro results.

  17. Corynebacterium macginleyi: A cause of ventilator associated pneumonia in an immunocompromised patient

    Directory of Open Access Journals (Sweden)

    Jad Kebbe

    2015-01-01

    Conclusion and relevance: Non-diphtheria Corynebacteria usually form normal flora. If isolated, they are often dismissed as contaminants. C. macginleyi has emerged as a life-threatening nosocomial infection. Prompt identification and treatment are required. It is resistant to quinolones. Thus far, vancomycin is the preferred treatment.

  18. Antibiotic resistance & pathogen profile in ventilator-associated pneumonia in a tertiary care hospital in India

    Directory of Open Access Journals (Sweden)

    Abhijit Chaudhury

    2016-01-01

    Results: VAP rates of 44.1, 43.8 and 26.3 were seen in 2011, 2012 and 2013, respectively. In all the three years, non-fermentative Gram-negative bacilli were the predominant organisms, followed by Pseudomonas spp. and Klebsiella spp. Staphylococcus aureus exhibited a downwards trend in prevalence from 50.0 per cent in 2011 to 34.9 per cent in 2013. An increase in vancomycin-resistant enterococci was seen from 4.3 per cent in 2012 to 8.3 per cent in 2013, while methicillin resistance amongst the S. aureus crossed the 50 per cent mark in 2013. An increasing trend in resistance was shown by Pseudomonas spp. for piperacillin-tazobactam (PTZ, amikacin and imipenem (IPM. For the non-fermenters, resistance frequency remained very high except for IPM (33.1% and polymyxin-B (2.4%. Interpretation & conclusions: Our findings show VAP as an important problem in the ICU setting. The incidence of multidrug-resistant pathogens was on the rise. The resistance pattern of these pathogens can help an institution to formulate effective antimicrobial policy. To have a comprehensive pan-India picture, multicentric studies are needed.

  19. Pola Kuman Penyebab Ventilator Associated Pneumonia(VAP dan Sensitivitas Terhadap Antibiotik di RSAB Harapan Kita

    Directory of Open Access Journals (Sweden)

    Retno Widyaningsih

    2016-11-01

    Kesimpulan. Basil gram negatif aerob (79,5% merupakan mikroorganisme penyebab yang paling dominan. Ceftazidime, diikuti terhadap amikacin serta netilmicin masih mempunyai sensitivitas yang tinggi sehingga dapat dipakai sebagai terapi awal VAP.

  20. Effect of perioperative oral care on prevention of postoperative pneumonia associated with esophageal cancer surgery: A multicenter case-control study with propensity score matching analysis.

    Science.gov (United States)

    Soutome, Sakiko; Yanamoto, Souichi; Funahara, Madoka; Hasegawa, Takumi; Komori, Takahide; Yamada, Shin-Ichi; Kurita, Hiroshi; Yamauchi, Chika; Shibuya, Yasuyuki; Kojima, Yuka; Nakahara, Hirokazu; Oho, Takahiko; Umeda, Masahiro

    2017-08-01

    The aim of this study was to investigate the effectiveness of oral care in prevention of postoperative pneumonia associated with esophageal cancer surgery.Postoperative pneumonia is a severe adverse event associated with esophageal cancer surgery. It is thought to be caused by aspiration of oropharyngeal fluid containing pathogens. However, the relationship between oral health status and postoperative pneumonia has not been well investigated.This study included 539 patients with esophageal cancer undergoing surgery at 1 of 7 university hospitals. While 306 patients received perioperative oral care, 233 did not. Various clinical factors as well as occurrence of postoperative pneumonia were retrospectively evaluated. Propensity-score matching was performed to minimize selection biases associated with comparison of retrospective data between the oral care and control groups. Factors related to postoperative pneumonia were analyzed by logistic regression analysis.Of the original 539 patients, 103 (19.1%) experienced postoperative pneumonia. The results of multivariate analysis of the 420 propensity score-matched patients revealed longer operation time, postoperative dysphagia, and lack of oral care intervention to be significantly correlated with postoperative pneumonia.The present findings demonstrate that perioperative oral care can reduce the risk of postoperative pneumonia in patients undergoing esophageal cancer surgery.

  1. The dynamics of the pulmonary microbiome during mechanical ventilation in the intensive care unit and the association with occurrence of pneumonia

    NARCIS (Netherlands)

    Zakharkina, Tetyana; Martin-Loeches, Ignacio; Matamoros, Sébastien; Povoa, Pedro; Torres, Antoni; Kastelijn, Janine B.; Hofstra, Jorrit J.; de Wever, B.; de Jong, Menno; Schultz, Marcus J.; Sterk, Peter J.; Artigas, Antonio; Bos, Lieuwe D. J.

    2017-01-01

    Ventilator-associated pneumonia (VAP) is the most common nosocomial infections in patients admitted to the ICU. The adapted island model predicts several changes in the respiratory microbiome during intubation and mechanical ventilation. We hypothesised that mechanical ventilation and antibiotic

  2. Long-term survival and healthcare utilization outcomes attributable to sepsis and pneumonia

    Directory of Open Access Journals (Sweden)

    Dick Andrew

    2012-11-01

    Full Text Available Abstract Background Hospital associated infections are major problems, which are increasing in incidence and very costly. However, most research has focused only on measuring consequences associated with the initial hospitalization. We explored the long-term consequences of infections in elderly Medicare patients admitted to an intensive care unit (ICU and discharged alive, focusing on: sepsis, pneumonia, central-line-associated bloodstream infections (CLABSI, and ventilator-associated pneumonia (VAP; the relationships between the infections and long-term survival and resource utilization; and how resource utilization was related to impending death during the follow up period. Methods Clinical data and one year pre- and five years post-index hospitalization Medicare records were examined. Hazard ratios (HR and healthcare utilization incidence ratios (IR were estimated from state of the art econometric models. Patient demographics (i.e., age, gender, race and health status and Medicaid status (i.e., dual eligibility were controlled for in these models. Results In 17,537 patients, there were 1,062 sepsis, 1,802 pneumonia, 42 CLABSI and 52 VAP cases. These subjects accounted for 62,554 person-years post discharge. The sepsis and CLABSI cohorts were similar as were the pneumonia and VAP cohorts. Infection was associated with increased mortality (sepsis HR = 1.39, P  Conclusions The infections had significant and lasting adverse consequences among the elderly. Yet, many of these infections may be preventable. Investments in infection prevention interventions are needed in both community and hospitals settings.

  3. Advances in the prevention, management, and treatment of community-acquired pneumonia [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Mathias W. Pletz

    2016-03-01

    Full Text Available Community-acquired pneumonia (CAP is the infectious disease with the highest number of deaths worldwide. Nevertheless, its importance is often underestimated. Large cohorts of patients with CAP have been established worldwide and improved our knowledge about CAP by far. Therefore, current guidelines are much more evidence-based than ever before. This article discusses recent major studies and concepts on CAP such as the role of biomarkers, appropriate risk stratification to identify patients in need of hospitalisation or intensive care, appropriate empiric antibiotic therapy (including the impact of macrolide combination therapy and antibiotic stewardship, and CAP prevention with novel influenza and pneumococcal vaccines.

  4. Aspiration pneumonia

    Science.gov (United States)

    Anaerobic pneumonia; Aspiration of vomitus; Necrotizing pneumonia; Aspiration pneumonitis ... The type of bacteria that caused the pneumonia depends on: Your ... facility, for example) Whether you were recently hospitalized ...

  5. Incidence and risk factors for health care-associated pneumonia in a pediatric intensive care unit.

    Science.gov (United States)

    Casado, Roberto J A; de Mello, Maria Júlia G; de Aragão, Rosana C F; de Albuquerque, Maria de Fátima P M; Correia, Jailson B

    2011-08-01

    To determine the incidence and risk factors for health care-associated pneumonia in a pediatric intensive care unit. Prospective cohort study. Pediatric intensive care unit with 16 medical and surgical beds in a tertiary teaching hospital in Recife, northeast Brazil. Patients aged health care-associated infections. Newborns and patients admitted for surveillance and those staying for health care-associated pneumonia, defined as pneumonia that occurs >48 hrs after admission but that was not incubating at the time of admission, as the primary outcome. Intrinsic and extrinsic variables were prospectively recorded into a standardized form. Statistical analyses, including multivariable logistic regression, were performed in Stata version 9.1. There were 765 eligible admissions. Health care-associated pneumonia occurred in 51 (6.7%) patients with an incidence density of 13.1 episodes/1,000 patient-days. There were 366 (47.8%) patients on mechanical ventilation, of whom 39 (10.7%) presented with ventilator-associated pneumonia with an incidence density of 27.1/1,000 days on ventilation. Longer stay on ventilation (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.01-1.08), use of gastric tube (OR, 2.88; 95% CI, 1.41-5.87), and of sedatives/analgesics (OR, 2.45; 95% CI, 1.27-4.72) were identified as independent risk factors for healthcare-associated pneumonia. Identification of independent predictors of health care-associated pneumonia may inform preventive measures. Strategies to optimize use of sedatives/analgesics, reduce the use of gastric tubes, and reduce the time on ventilation should be considered for inclusion in future intervention studies.

  6. Pilot Testing of Intervention Protocols to Prevent Pneumonia among Nursing Home Residents

    Science.gov (United States)

    Quagliarello, Vincent; Juthani-Mehta, Manisha; Ginter, Sandra; Towle, Virginia; Allore, Heather; Tinetti, Mary

    2009-01-01

    Objectives To test intervention protocols for feasibility, staff adherence and effectiveness in reducing pneumonia risk factors (i.e., impaired oral hygiene, swallowing difficulty) in nursing home residents. Design Prospective study. Setting Two nursing homes. Participants Fifty-two nursing home residents. Interventions Thirty residents with impaired oral hygiene were randomly assigned to manual oral brushing + 0.12% chlorhexidine oral rinse at different frequencies daily. Twenty-two residents with swallowing difficulty were randomly assigned to upright feeding positioning, teaching swallowing techniques, or manual oral brushing. All protocols were administered over 3 months. Measurements Feasibility was assessed monthly and defined as high if the protocol took 75% of assessments. Effectiveness for improved oral hygiene (i.e., reduction in oral plaque score) and swallowing (i.e., reduction in cough during swallowing) was assessed at 3 months compared to baseline. Results Daily manual oral brushing + 0.12% chlorhexidine rinse demonstrated high feasibility, high staff adherence and effectiveness in improving oral hygiene (ptesting for its ability to reduce pneumonia among nursing home residents. PMID:19558483

  7. Pilot testing of intervention protocols to prevent pneumonia in nursing home residents.

    Science.gov (United States)

    Quagliarello, Vincent; Juthani-Mehta, Manisha; Ginter, Sandra; Towle, Virginia; Allore, Heather; Tinetti, Mary

    2009-07-01

    To test intervention protocols for feasibility, staff adherence, and effectiveness in reducing pneumonia risk factors (impaired oral hygiene, swallowing difficulty) in nursing home residents. Prospective study. Two nursing homes. Fifty-two nursing home residents. Thirty residents with impaired oral hygiene were randomly assigned to manual oral brushing plus 0.12% chlorhexidine oral rinse at different frequencies daily. Twenty-two residents with swallowing difficulty were randomly assigned to upright feeding positioning, teaching swallowing techniques, or manual oral brushing. All protocols were administered over 3 months. Feasibility was assessed monthly and defined as high if the protocol took less than 10 minutes to administer. Adherence was assessed weekly and defined as high if full staff adherence was demonstrated in more than 75% of assessments. Effectiveness for improved oral hygiene (reduction in oral plaque score) and swallowing (reduction in cough during swallowing) was compared at baseline and 3 months. Daily manual oral brushing plus 0.12% chlorhexidine rinse demonstrated high feasibility, high staff adherence, and effectiveness in improving oral hygiene (Ptesting for its ability to reduce pneumonia in nursing home residents.

  8. Postoperative Prevention of Nosocomial Pneumonias, by Using Airway Filters under Artificial Ventilation

    Directory of Open Access Journals (Sweden)

    A. A. Yeremenko

    2007-01-01

    Full Text Available Objective: to determine the duration of exposition of filters and their most optimum position in different types of respiratory circuits. Subjects and methods. Group 1 comprised patients receiving not more than 12-hour artificial ventilation (AV through a coaxial respiratory-circuit, without a humidifier, moisture accumulators, and a nebulizer. The filters were set between the intubation tube and the circuit. Group 2 included patients having more than 12-hour AV through the disposal respiratory circuits including a nebulizer, a humidifier, and inspiratory and expiratory moisture accumulators. The filters were set in front of the inspiratory circuit and behind the expiratory one on an AV apparatuses. Before regularly replacing a filter and/or a circuit, samples were taken for bacteriological tests from different portions of the circuit at various intervals: 4, 12, 24, 48, 96, 120, and 144 hours after initiation of AV, as well as before tracheal extubation in a patient. Results. The data obtained during the study have indicated that the breathing circuit filters afford a reliable protection from the entry of environmental microorganisms into the patient’s respiratory tract. In Group 1, AV did not result in the occurrence of pneumonia or tracheobronchitis. The moisture accumulators and the Y-shaped connector are the most infection-susceptible parts of a respiratory circuit. Mechanical circuit contamination and a larger number of pathogenic microbial strains were observed after 4—5-day AV. Conclusion. All procedures associated with circuit seal failure should be performed, by observing the aseptic rules. The recommended time of using a respiratory circuit during prolonged AV is 96—120 hours. Key words: intensive care unit, artificial ventilation, nosocomial pneumonia, antibacterial respiratory circuit filter.

  9. Candida Pneumonia in Intensive Care Unit?

    Science.gov (United States)

    Schnabel, Ronny M.; Linssen, Catharina F.; Guion, Nele; van Mook, Walther N.; Bergmans, Dennis C.

    2014-01-01

    It has been questioned if Candida pneumonia exists as a clinical entity. Only histopathology can establish the definite diagnosis. Less invasive diagnostic strategies lack specificity and have been insufficiently validated. Scarcity of this pathomechanism and nonspecific clinical presentation make validation and the development of a clinical algorithm difficult. In the present study, we analyze whether Candida pneumonia exists in our critical care population. We used a bronchoalveolar lavage (BAL) specimen database that we have built in a structural diagnostic approach to ventilator-associated pneumonia for more than a decade consisting of 832 samples. Microbiological data were linked to clinical information and available autopsy data. We searched for critically ill patients with respiratory failure with no other microbiological or clinical explanation than exclusive presence of Candida species in BAL fluid. Five cases could be identified with Candida as the likely cause of pneumonia. PMID:25734099

  10. Animal models of hospital-acquired pneumonia: current practices and future perspectives.

    Science.gov (United States)

    Bielen, Kenny; 's Jongers, Bart; Malhotra-Kumar, Surbhi; Jorens, Philippe G; Goossens, Herman; Kumar-Singh, Samir

    2017-03-01

    Lower respiratory tract infections are amongst the leading causes of mortality and morbidity worldwide. Especially in hospital settings and more particularly in critically ill ventilated patients, nosocomial pneumonia is one of the most serious infectious complications frequently caused by opportunistic pathogens. Pseudomonas aeruginosa is one of the most important causes of ventilator-associated pneumonia as well as the major cause of chronic pneumonia in cystic fibrosis patients. Animal models of pneumonia allow us to investigate distinct types of pneumonia at various disease stages, studies that are not possible in patients. Different animal models of pneumonia such as one-hit acute pneumonia models, ventilator-associated pneumonia models and biofilm pneumonia models associated with cystic fibrosis have been extensively studied and have considerably aided our understanding of disease pathogenesis and testing and developing new treatment strategies. The present review aims to guide investigators in choosing appropriate animal pneumonia models by describing and comparing the relevant characteristics of each model using P. aeruginosa as a model etiology for hospital-acquired pneumonia. Key to establishing and studying these animal models of infection are well-defined end-points that allow precise monitoring and characterization of disease development that could ultimately aid in translating these findings to patient populations in order to guide therapy. In this respect, and discussed here, is the development of humanized animal models of bacterial pneumonia that could offer unique advantages to study bacterial virulence factor expression and host cytokine production for translational purposes.

  11. Rhodococcus equi foal pneumonia.

    Science.gov (United States)

    Cohen, Noah D

    2014-12-01

    Pneumonia caused by Rhodococcus equi is an important cause of disease and death in foals. This article reviews current knowledge of the epidemiology, clinical signs, diagnosis, treatment, prevention, and control of R equi pneumonia in foals. Copyright © 2014 Elsevier Inc. All rights reserved.

  12. Pneumococcal pneumonia prevention among adults: is the herd effect of pneumococcal conjugate vaccination in children as good a way as the active immunization of the elderly?

    Science.gov (United States)

    Prato, Rosa; Fortunato, Francesca; Martinelli, Domenico

    2016-01-01

    The indirect protection of adults as a result of pneumococcal conjugate vaccination of infants has been discussed from different epidemiological points of view. In some countries, including Italy, even after pediatric vaccination, vaccine serotypes are still responsible for most pneumonia and invasive diseases in the elderly. Although the Community-Acquired Pneumonia Immunization Trial in Adults (CAPITA) produced encouraging results, it has not showed the efficacy of the 13-valent conjugate vaccine in preventing pneumococcal community-acquired pneumonia regardless of the number of episodes and serotype. Addressing these points by monitoring the direct impact of adult vaccination in real life distinguished from the effects of herd immunity will assist public health decision-making on the most effective adult pneumococcal vaccination strategies.

  13. Antibody-Based Immunotherapy To Treat and Prevent Infection with Hypervirulent Klebsiella pneumoniae.

    Science.gov (United States)

    Diago-Navarro, Elizabeth; Calatayud-Baselga, Isabel; Sun, Donglei; Khairallah, Camille; Mann, Inderjit; Ulacia-Hernando, Amaia; Sheridan, Brian; Shi, Meiqing; Fries, Bettina C

    2017-01-01

    Hypervirulent Klebsiella pneumoniae (hvKp) strains are predicted to become a major threat in Asia if antibiotic resistance continues to spread. Anticapsular antibodies (Abs) were developed because disseminated infections caused by hvKp are associated with significant morbidity and mortality, even with antibiotic-sensitive strains. K1-serotype polysaccharide capsules (K1-CPS) are expressed by the majority of hvKp strains. In this study, K1-CPS-specific IgG Abs were generated by conjugation of K1-CPS to immunogenic anthrax protective antigen (PA) protein. Opsonophagocytic efficacy was measured in vitro and in vivo by intravital microscopy in murine livers. In vivo protection was tested in murine models, including a novel model for dissemination in hvKp-colonized mice. Protective efficacy of monoclonal antibodies (MAbs) 4C5 (IgG1) and 19A10 (IgG3) was demonstrated both in murine sepsis and pulmonary infection. In hvKp-colonized mice, MAb treatment significantly decreased dissemination of hvKp from the gut to mesenteric lymph nodes and organs. Intravital microscopy confirmed efficient opsonophagocytosis and clearance of bacteria from the liver. In vitro studies demonstrate that MAbs work predominantly by promoting FcR-mediated phagocytosis but also indicate that MAbs enhance the release of neutrophil extracellular traps (NETs). In anticipation of increasing antibiotic resistance, we propose further development of these and other Klebsiella-specific MAbs for therapeutic use. Copyright © 2017 American Society for Microbiology.

  14. Clinical cure and mortality outcomes with ceftobiprole medocaril versus ceftazidime plus linezolid in patients with early versus late-onset hospital-acquired pneumonia.

    NARCIS (Netherlands)

    Scheeren, Thomas; Welte, T.; Capellier, G.; Saulay, Mikal; Engelhardt, M.

    2015-01-01

    Objectives: Ceftobiprole, the active moiety of the prodrug ceftobiprole medocaril, is a novel cephalosporin for intravenous use, approved in certain European countries for the treatment of community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP) excluding ventilator-associated

  15. [Positive bronchoalveolar lavage and quantitative cultures results in suspected late-onset ventilator associated penumonia evaluation--retrospective study].

    Science.gov (United States)

    Vaz, A P; Amorim, A; Espinar, M J; Oliveira, T; Pereira, J M; Paiva, J A

    2011-01-01

    Bronchoalveolar lavage (BAL) with quantitative cultures has been used in order to increase ventilator associated pneumonia (VAP) diagnosis specificity, although the accurate technique for this entity diagnosis remains controversial. To evaluate the influence of using positive BAL and quantitative cultures results in microbiologic diagnosis and treatment of patients with suspected late VAP and prior antibiotherapy. Retrospective analysis of intensive care unit (UCI) patients, during a one year period, with clinical suspicion of late VAP and prior use of antibiotics that presented a growth in BAL cultures. Of 243 BAL performed, there were 71 (29.2%) positive cultures (60 patients, 76.7% male, 54 ± 19 years). BAL was done after 13 days (median) of invasive mechanical ventilation, 11 days of ICU antibiotherapy and in the day in which a new antibiotic for VAP suspicion was started. Colony forming units (CFU)/ml count was performed in 71.8% and endotracheal aspirate (ETA) simultaneously collected for qualitative analysis in 85.9%. Therapeutic approach was changed in 38.0%: correction (16.9%), de-escalation (12.7%) and directed antibiotherapy start (8.4%). Therapeutic changes were made in the presence of CFU > 10(4) in 84.2% and in agreement with ETA in 70.8%. In cases in which antibiotherapy was maintained (62.0%), quantitative cultures would have allowed de-escalation in 9.1%. Changes in prescription were more frequent when CFU was > 10(4) (48.5%), comparing with situations in which counts were lower and BAL analysis was qualitative (28.9%), p = 0.091. There were no significant differences between patients submitted to different therapeutic approaches concerning to ICU mortality or length of stay. In late onset VAP, positive BAL and quantitative cultures allowed therapeutic changes, leading to antibiotic adequacy and consumption reduction, which can however be maximised. Copyright © 2011. Published by Elsevier España.

  16. Ending Preventable Child Deaths from Pneumonia and Diarrhoea in Afghanistan: An Analysis of Intervention Coverage Scenarios Using the Lives Saved Tool.

    Science.gov (United States)

    Higgins-Steele, Ariel; Yousufi, Khaksar; Sultana, Sharmina; Ali, Alawi Sayed; Varkey, Sherin

    2017-01-01

    Background. Despite improvements in child health, Afghanistan still has a heavy burden of deaths due to preventable causes: 17% of under-5 deaths are due to pneumonia and 12% are due to diarrhoea. Objective. This article describes the situation of childhood pneumonia and diarrhoea in Afghanistan, including efforts to prevent, protect, and treat the two diseases. It estimates lives saved by scaling up interventions. Methods. A secondary analysis of data was conducted and future scenarios were modelled to estimate lives saved by scaling up a package of interventions. Results. The analysis reveals that 10,795 additional child deaths could be averted with a moderate scale-up of interventions, decreasing the under-five mortality rate in Afghanistan from 55 per 1,000 live births in 2015 to 40 per 1,000 in 2020. In an ambitious scale-up scenario, an additional 15,096 lives could be saved. There would be a 71% reduction in child deaths due to these two causes between 2016 and 2020 in the ambitious scenario compared to 47% reduction in the moderate scenario. Conclusion. Significant reductions in child mortality can be achieved through scale-up of essential interventions to prevent and treat pneumonia and diarrhoea. Strengthened primary health care functions and multisector collaboration on child health are suggested.

  17. Does non-invasive ventilation associated with chest physiotherapy improve outcome after lung resection?

    Science.gov (United States)

    Freynet, Anne; Falcoz, Pierre-Emmanuel

    2008-12-01

    A best evidence topic was constructed according to a structured protocol. The question addressed was whether the use of non-invasive ventilation (NIV) associated with chest physiotherapy (CPT) is effective in preventing respiratory complications in patients undergoing lung resection surgery. Of the 172 papers found using a report search, five presented the best evidence to answer the clinical question. The authors, journal, date and country of publication, study type, group studied, relevant outcomes and results of these papers are given. We conclude that, on the whole, the five studies were all in favor of NIV as an adjuvant to CPT for improving outcome after lung resection surgery. Indeed, the interest and benefit has been shown not only in the treatment of postoperative acute respiratory failure, but also in the prevention and treatment of respiratory complications (atelectasis, pneumonia and bronchial congestion). Hence, current evidence shows NIV associated with acute CPT management to be safe and effective in reducing postoperative complications and in improving patient recovery, thus enhancing the choice of available medical care and bettering outcome in lung resection surgery.

  18. Changing epidemiology of Pneumocystis pneumonia, Northern Ireland, UK and implications for prevention, 1 July 2011-31 July 2012.

    Science.gov (United States)

    Patterson, Lynsey; Coyle, Peter; Curran, Tanya; Verlander, Neville Q; Johnston, Jillian

    2017-11-01

    There is a lack of consensus about which non-human immunodeficiency virus (HIV) patient groups would benefit from prophylaxis. Here, we analysed an enhanced Pneumocystis jirovecii database to describe the epidemiology of Pneumocystis pneumonia (PCP) and P. jirovecii colonizations in Northern Ireland (NI) with a view to identifying risk groups who may benefit from prophylaxis. We prospectively collected information on demographics, clinical severity and clinical features for all hospital inpatients in NI aged ≥18 years with P. jirovecii confirmed in any respiratory tract sample. We defined P. jirovecii colonization or PCP according to clinical symptoms and radiological findings. We compared P. jirovecii colonization to PCP using exact logistic regression and presented the odds ratios (OR), 95 % confidence intervals (CI) and likelihood ratio test P-values.Results/Key findings. Overall, 36/49 (73 %) of P. jirovecii detections were categorized as PCP. A total of 28/36 (78 %) were in non-HIV patients, of which 18 (64 %) had cancer. The odds of PCP compared to P. jirovecii colonization were eight times higher in those with current exposure to chemotherapy (OR 8.73; 95 % CI 0.84, ∞), 16 times higher for those diagnosed with HIV (OR 16.2; 95 % CI 1.71, ∞) and 12 times higher for those ever exposed to another immunosuppressive drug (OR 12.1; 95 % CI 1.94, ∞). The greatest burden of PCP is now in the non-HIV group, particularly cancer patients. We recommend increasing clinician awareness of PCP risk and strengthening prevention guidelines in non-HIV patients, and promoting the consideration of prophylaxis on a case-by-case basis.

  19. Ventilator-Associated Pneumonia in Low Birth Weight Neonates at a Neonatal Intensive Care Unit: A Retrospective Observational Study

    Directory of Open Access Journals (Sweden)

    Pei-Lun Lee

    2017-02-01

    Methods: LBW infants (48 hours, 15 (13.2% of whom had VAP. Of these 15 patients, the average age at onset of VAP was 24.0 ± 11.2 days, the average postmenstrual age was 30.6 ± 1.8 weeks, and the mean gestational age was 27.1 ± 2.3 weeks, which was significantly lower than the mean gestational age in the group without VAP (30.2 ± 3.5 weeks. The mean birth body weight was 944.4 ± 268.4 g in the VAP group and 1340.1 ± 455.4 g in the group without VAP (p 48 hours in our neonatal intensive care unit. VAP most frequently occurred at a postmenstrual age of 30–32 weeks in this study. Longer duration of tube placement and parenteral nutrition were found in the VAP group. Early removal of the endotracheal tube and adequate enteral nutrition may decrease the occurrence of VAP in LBW infants.

  20. Parenteral vs oral antibiotics in the prevention of serious bacterial infections in children with Streptococcus pneumoniae occult bacteremia: a meta-analysis.

    Science.gov (United States)

    Rothrock, S G; Green, S M; Harper, M B; Clark, M C; McIlmail, D P; Bachur, R

    1998-06-01

    To determine whether parenteral antibiotics are superior to oral antibiotics in preventing serious bacterial infections in children with Streptococcus pneumoniae occult bacteremia. Using the MEDLINE database, the English language literature was searched for all publications concerning bacteremia, fever, or Streptococcus pneumoniae from 1966 to January 1, 1997. All nonduplicative studies with a series of children with S. pneumoniae occult bacteremia having both orally treated and parenterally treated groups were reviewed. Children were excluded from individual studies if at the time of their initial evaluation they were immunocompromised, had a serious bacterial infection, underwent a lumbar puncture, or did not receive antibiotics. Only 4 studies met study criteria. From these studies, 511 total cases of S. pneumoniae occult bacteremia were identified. Ten of 290 (3.4%) in the oral group and 5 of 221 (2.3%) in the parenteral antibiotic group developed serious bacterial infections (pooled p-value = 0.467, pooled OR = 1.48; 95% CI, 0.5-4.3). Two patients in the oral group (0.7%) and 2 patients in the parenteral group (0.9%) developed meningitis (pooled p-value = 0.699, pooled OR = 0.67; 95% CI, 0.1-5.1). The rates of serious bacterial infections and meningitis did not differ between children who were treated with oral and parenteral antibiotics. The extremely low rate of complications observed in both groups suggests no clinically significant difference between therapies. A study with >7,500 bacteremic children (or >300,000 febrile children) would be needed to have 80% power to prove parenteral antibiotics are superior to oral antibiotics in preventing serious bacterial infections.

  1. Pneumonia (image)

    Science.gov (United States)

    Pneumonia is an inflammation of the lungs caused by an infection. Many different organisms can cause it, including bacteria, viruses, and fungi. Pneumonia is a common illness that affects millions of ...

  2. Pneumonia - weakened immune system

    Science.gov (United States)

    ... carinii) pneumonia Pneumonia - cytomegalovirus Pneumonia Viral pneumonia Walking pneumonia Causes People whose immune system is not working well ... people. They are also more vulnerable to regular causes of pneumonia , which can affect anyone. Your immune system may ...

  3. Efficacy of a New Post-Mouthwash Intervention (Wiping Plus Oral Nutritional Supplements) for Preventing Aspiration Pneumonia in Elderly People: A Multicenter, Randomized, Comparative Trial.

    Science.gov (United States)

    Higashiguchi, Takashi; Ohara, Hiroshi; Kamakura, Yayoi; Kikutani, Takeshi; Kuzuya, Masafumi; Enoki, Hiromi; Sanada, Hiromi; Matsuzaki, Masami; Maruyama, Michio

    2017-01-01

    Aspiration pneumonia is a common cause of death among the elderly (≥90-year-old) in nursing homes. Studies suggest that its incidence could be reduced by oral care interventions. We aimed to evaluate the efficacy of a new oral care intervention: wiping plus oral nutritional supplements (ONS). This prospective observational study was conducted in 252 patients (age 88.0 ± 6.5 years) in 75 nursing homes, rehabilitation hospitals, and other care facilities. Patients were randomly divided into an intervention group (n = 74) and a control group (n = 107), whose members received conventional oral care. Body mass index, activities of daily living (Barthel index), and complete blood count and biochemistry parameters were measured at 2, 4, 6, and 8 months. The cumulative incidence of pneumonia at 8 months tended to be lower in the intervention than in the control group (7.8 vs. 17.7%, p = 0.056) and was significantly lower for men in the intervention group (p = 0.046). Our new intervention "wiping plus providing ONS" method appears to help prevent aspiration pneumonia, thereby reducing mortality risk. In this study, we disseminate information on how this method is used in Japan. © 2017 S. Karger AG, Basel.

  4. Frequency of nosocomial pneumonia in ICU Qazvin Razi hospital (2013

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    S. Makhlogi

    2016-12-01

    Full Text Available Background: Nosocomial pneumonia is the most prevalent cause of hospital-acquired infection in intensive care units (ICU. The aim of this research was to detect the frequency and predisposing factors of nosocomial Ventilator Associated Pneumonia, by cross sectional study on 188 patients that were hospitalized in ICU Qazvin Razi Hospital. Using questionnaire based on the national nosocomial infection surveillance system (NNIS data collected and analyzed. The average age of patients was 51±24 years old, 37 hospitalized patients (19/6% in the fourth day of admission were affected Ventilator Associated Pneumonia. The most common pathogenesis of causing nosocomial pneumonia were klebsiella in 13 patients (35/1%, staph in 8 patients (21/6%, sodomona in 8 patients (21/6%, ecoli in 3 patients (8/1%, cetrobacter in 2 patients (5/4%, antrococus and Proteus each of them in 1 patient (each 2/7%. Considering (19/6% frequency of nosocomial pneumonia in this study, it’s necessary to act standard protocols in nursing care and medication process.

  5. Effectiveness of 23-valent pneumococcal polysaccharide vaccination in preventing community-acquired pneumonia hospitalization and severe outcomes in the elderly in Spain.

    Directory of Open Access Journals (Sweden)

    Àngela Domínguez

    Full Text Available Pneumococcal pneumonia is a serious cause of morbidity and mortality in the elderly, but investigation of the etiological agent of community-acquired pneumonia (CAP is not possible in most hospitalized patients. The aim of this study was to estimate the effect of pneumococcal polysaccharide vaccination (PPSV23 in preventing CAP hospitalization and reducing the risk of intensive care unit admission (ICU and fatal outcomes in hospitalized people aged ≥65 years. We made a multicenter case-control study in 20 Spanish hospitals during 2013-2014 and 2014-2015. We selected patients aged ≥65 years hospitalized with a diagnosis of pneumonia and controls matched by sex, age and date of hospitalization. Multivariate analysis was performed using conditional logistic regression to estimate vaccine effectiveness and unconditional logistic regression to evaluate the reduction in the risk of severe and fatal outcomes. 1895 cases and 1895 controls were included; 13.7% of cases and 14.4% of controls had received PPSV23 in the last five years. The effectiveness of PPSV23 in preventing CAP hospitalization was 15.2% (95% CI -3.1-30.3. The benefit of PPSV23 in avoiding ICU admission or death was 28.1% (95% CI -14.3-56.9 in all patients, 30.9% (95% CI -32.2-67.4 in immunocompetent patients and 26.9% (95% CI -38.6-64.8 in immunocompromised patients. In conclusion, PPSV23 showed a modest trend to avoidance of hospitalizations due to CAP and to the prevention of death or ICU admission in elderly patients hospitalized with a diagnosis of CAP.

  6. Risk factors for mortality in ventilator-associated tracheobronchitis: a case-control study.

    Science.gov (United States)

    Pontes, Leonilda Giani; Menezes, Fernando Gatti de; Gonçalves, Priscila; Toniolo, Alexandra do Rosário; Silva, Claudia Vallone; Kawagoe, Julia Yaeko; Santos, Camila Marques Dos; Castagna, Helena Maria Fernandes; Martino, Marinês Dalla Valle; Corrêa, Luci

    2017-01-01

    To describe the microbiological characteristics and to assess the risk factors for mortality of ventilator-associated tracheobronchitis in a case-control study of intensive care patients. This case-control study was conducted over a 6-year period in a 40-bed medical-surgical intensive care unit in a tertiary care, private hospital in São Paulo, Brazil. Case patients were identified using the Nosocomial Infection Control Committee database. For the analysis of risk factors, matched control subjects were selected from the same institution at a 1:8.8 ratio, between January 2006 and December 2011. A total of 40 episodes of ventilator-associated tracheobronchitis were evaluated in 40 patients in the intensive care unit, and 354 intensive care patients who did not experience tracheobronchitis were included as the Control Group. During the 6-year study period, a total of 42 organisms were identified (polymicrobial infections were 5%) and 88.2% of all the microorganisms identified were Gram-negative. Using a logistic regression model, we found the following independent risk factors for mortality in ventilator-associated tracheobronchitis patients: Acute Physiology and Chronic Health Evaluation I score (odds ratio 1.18 per unit of score; 95%CI: 1.05-1.38; p=0.01), and duration of mechanical ventilation (odds ratio 1.09 per day of mechanical ventilation; 95%CI: 1.03-1.17; p=0.004). Our study provided insight into the risk factors for mortality and microbiological characteristics of ventilator-associated tracheobronchitis. Descrever as características microbiológicas e avaliar os fatores de risco para mortalidade na traqueobronquite associada à ventilação mecânica em um estudo caso-controle de pacientes de terapia intensiva. Estudo realizado ao longo de 6 anos em uma unidade de terapia intensiva médico-cirúrgica de 40 leitos, em um hospital privado e de nível terciário em São Paulo, Brasil. O Grupo Caso foi identificado usando o banco de dados da Comissão de

  7. 2-Chloroadenosine (2-CADO) treatment modulates the pro-inflammatory immune response to prevent acute lung inflammation in BALB/c mice suffering from Klebsiella pneumoniae B5055-induced pneumonia.

    Science.gov (United States)

    Kumar, Vijay; Harjai, Kusum; Chhibber, Sanjay

    2010-06-01

    Acute lung inflammation (ALI) is a life-threatening pathology and can develop during the course of several clinical conditions such as pneumonia, acid aspiration or sepsis. Adenosine plays a significant role in controlling acute inflammation via binding to A(2A) receptors on inflammatory cells, i.e. neutrophils or macrophages. The present study was designed to evaluate the anti-inflammatory and immunomodulatory effects of 2-chloroadenosine (2-CADO), alone or in combination with amoxicillin/clavulanic acid (AMC), in Klebsiella pneumoniae B5055-induced acute lung infection in mice. Acute lung infection in mice was induced by directly instilling the selected dose (10(4) colony-forming units/mL) of bacteria intranasally. Histopathological examination of the lungs was performed to reveal neutrophil infiltration into the lung alveoli. In addition to the major pro-inflammatory cytokines tumour necrosis factor-alpha (TNFalpha) and interleukin (IL)-1alpha, levels of the anti-inflammatory cytokine IL-10 were also determined. Intranasal instillation of bacteria caused profound neutrophil infiltration into the lung alveoli as well as a significant increase in the levels of pro-inflammatory mediators (i.e. TNFalpha and IL-1alpha). However, intravenous administration of 2-CADO 10 microg/kg/day, alone or in combination with an antibiotic (i.e. AMC), significantly decreased neutrophil infiltration into the lung alveoli. A significant decrease in TNFalpha and IL-1alpha along with elevation of IL-10 levels in the lung homogenate of mice with acute lung infection was observed upon treatment with 2-CADO alone, with no significant decrease in bacterial counts. Moreover, in combination with AMC, 2-CADO exhibited its immunomodulatory action in acute lung infection and prevented ALI, whilst an antibacterial action was exhibited by AMC. 2010 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

  8. [Multicenter, randomized, controlled clinical trial on preventing antibiotic-associated diarrhea in children with pneumonia using the live Clostridium butyricum and Bifidobacterium combined Powder].

    Science.gov (United States)

    2012-10-01

    Many previous meta-analysis have shown that the probiotics can lower the incidence of antibiotic-associated diarrhea (AAD) in children. However, the function and efficacy of probiotics drugs showed obvious strains specificity and dose dependence. Currently, most of the reported meta-analysis regarding probiotics AAD prevention have adopted Saccharomyces, Lactobacilleae, Streptococcus and Bifidobacterium. This study aimed to evaluate the efficacy and safety of the live Clostridium butyricum and Bifidobacterium Powder to prevent AAD in hospitalized children with pneumonia. This study was a multicenter, randomized, controlled clinical trial; 380 hospitalized children with pneumonia aged from 3 months to 3 years were enrolled from April to Dec. 2011. Totally 372 children completed the study, 179 children in control group received antibiotics as routine treatment for pneumonia; 193 children in treatment group received 5×10(9) colony-forming units of Clostridium butyricum and Bifidobacterium combined Powder daily for 7 days during the antibiotics treatment. The stool frequency and consistency (assessed according to the Bristol Excrement Assessment Scale) were observed for 7 consecutive days; the incidence of diarrhea and adverse drug reactions were recorded. Both treatment and control groups were similar in age distribution, sex, type of antibiotics, route of administration, and time of antibiotics used. During the 7 days period, the rate of AAD was 7.8% (13/193) in treatment group and 16.8% (30/179) in control group, there was significant difference; compared with the control group, the treatment with Clostridium butyricum and Bifidobacterium combined Powder can lead to 53.6% reduction in AAD risk (RR = 0.419, 95%CI 0.217 - 0.808; P = 0.008). The severity of diarrhea was comparable in both study groups, as evidenced by similar stool frequency, dehydration, fever and vomiting. There was significant difference (P = 0.008) in the AAD occurrence time distribution between

  9. What Is Walking Pneumonia?

    Science.gov (United States)

    ... pneumonia: What does it mean? What is walking pneumonia? How is it different from regular pneumonia? Answers from Eric J. Olson, M.D. Walking pneumonia is an informal term for pneumonia that isn' ...

  10. Congestive heart failure in children with pneumonia and respiratory failure.

    Science.gov (United States)

    Nimdet, Kachaporn; Techakehakij, Win

    2017-03-01

    Congestive heart failure (CHF) is one of the most common cardiac complications of pneumonia in adulthood leading to increased risk of morbidity and mortality. Little is known, however, of CHF and pneumonia in children. The aim of this study was therefore to investigate the characteristics and factors associated with CHF in under-5 children with pneumonia and respiratory failure. A retrospective cohort was conducted in hospitalized patients aged 2-59 months with community-acquired pneumonia and respiratory failure from June 2011 to June 2014 at Suratthani Hospital, Thailand. The characteristics, therapeutic strategy, and clinical outcomes of CHF were reviewed. Baseline characteristics and basic laboratory investigations on admission were compared between the CHF and non-CHF groups. Of 135 patients, 14 (10%) had CHF. Compared with patients without CHF, the CHF group had prolonged intubation and hospital stay and high rates of associated complications such as ventilator-associated pneumonia, sepsis, shock, and 30 day mortality. CHF was significantly associated with certain characteristics, including male sex and bacterial pneumonia. Pneumonia with respiratory failure is associated with CHF even in healthy children without cardiac risks. The awareness and early recognition of CHF, particularly in male, and bacterial pneumonia, is important in order to provide immediate treatment to reduce complications. © 2016 Japan Pediatric Society.

  11. Mycoplasma Pneumoniae Encephalitis

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2007-09-01

    Full Text Available The epidemiological, clinical, laboratory, and imaging findings of patients with M. pneumoniae encephalitis referred to the California Encephalitis Project are reported from the California Department of Health Services, Viral and Rickettsial Disease Laboratory, Richmond, CA, and the Centers for Disease Control and Prevention, Atlanta, GA.

  12. Burden of Severe Pneumonia, Pneumococcal Pneumonia and Pneumonia Deaths in Indian States: Modelling Based Estimates

    Science.gov (United States)

    Farooqui, Habib; Jit, Mark; Heymann, David L.; Zodpey, Sanjay

    2015-01-01

    results highlight the need to improve access to care and increase coverage and equity of pneumonia preventing vaccines in states with high pneumonia burden. PMID:26086700

  13. Neonatal pneumonia.

    OpenAIRE

    Webber, S; Wilkinson, A R; Lindsell, D; Hope, P L; Dobson, S R; Isaacs, D

    1990-01-01

    All babies admitted to the neonatal unit during a period of 41 months were prospectively studied to find out the incidence, aetiology, and outcome of neonatal pneumonia, and the value of routine cultures of endotracheal tubes. Pneumonia of early onset (before age 48 hours) occurred in 35 babies (incidence 1.79/1000 live births). In 20 (57%) it was caused by group B streptococci. Blood cultures showed the presence of organisms in 16 of the 35 (46%). There were 41 episodes of pneumonia of late ...

  14. Effectiveness of adjuvanted seasonal influenza vaccines (Inflexal V® and Fluad®) in preventing hospitalization for influenza and pneumonia in the elderly

    Science.gov (United States)

    Gasparini, Roberto; Amicizia, Daniela; Lai, Piero Luigi; Rossi, Stefania; Panatto, Donatella

    2013-01-01

    Annual vaccination is the main mean of preventing influenza in the elderly. In order to evaluate the effectiveness of the adjuvanted seasonal influenza vaccines available in Italy in preventing hospitalization for influenza and pneumonia, a matched case-control study was performed in elderly subjects during the 2010–2011 season in Genoa (Italy). Cases and controls were matched in a 1:1 ratio according to gender, age, socio-economic status and type of influenza vaccine. Vaccine effectiveness was calculated as IVE = [(1-OR)x100] and crude odds ratios were estimated through conditional logistic regression models. Adjusted odds ratios were estimated through multivariable logistic models. In the study area, influenza activity was moderate in the 2010–2011 season, with optimal matching between circulating viruses and vaccine strains. We recruited 187 case-control pairs; 46.5% of cases and 79.1% of controls had been vaccinated. The adjuvanted influenza vaccines (Fluad® considered together with Inflexal V®) were associated with a significant reduction in the risk of hospitalization, their effectiveness being 94.8% (CI 77.1–98.8). Adjusted vaccine effectiveness was 95.2% (CI 62.8–99.4) and 87.8 (CI 0.0–98.9) for Inflexal V® and Fluad®, respectively. Both adjuvanted vaccines proved effective, although the results displayed statistical significance only for Inflexal V® (p = 0.004), while for Fluad® statistical significance was not reached (p = 0.09). Our study is the first to provide information on the effectiveness of Inflexal V® in terms of reducing hospitalizations for influenza or pneumonia in the elderly, and demonstrates that this vaccine yields a high degree of protection and that its use would generate considerable saving for the National Health Service. PMID:23143775

  15. Viral pneumonia

    Science.gov (United States)

    ... Cough (with some pneumonias you may cough up mucus, or even bloody mucus) Fever , which may be mild or high Shaking ... virus. Those who are older and those with diabetes, asthma, chronic obstructive pulmonary disease (COPD), cancer, or ...

  16. Mycoplasma pneumoniae pneumonia in children

    OpenAIRE

    Youn, You-Sook; Lee, Kyung-Yil

    2012-01-01

    Mycoplasma pneumoniae (MP), the smallest self-replicating biological system, is a common cause of upper and lower respiratory tract infections, leading to a wide range of pulmonary and extra-pulmonary manifestations. MP pneumonia has been reported in 10 to 40% of cases of community-acquired pneumonia and shows an even higher proportion during epidemics. MP infection is endemic in larger communities of the world with cyclic epidemics every 3 to 7 years. In Korea, 3 to 4-year cycles have be...

  17. C. pneumoniae CdsL regulates CdsN ATPase activity, and disruption with a peptide mimetic prevents bacterial invasion

    Directory of Open Access Journals (Sweden)

    Chris Blair Stone

    2011-02-01

    Full Text Available Chlamydiae are obligate intracellular pathogens that likely require type III secretion (T3S to invade cells and replicate intracellulary within a cytoplasmic vacuole called an inclusion body. C. pneumoniae possess a YscL ortholog, CdsL, that has been shown to interact with the T3S ATPase (CdsN. In this report we demonstrate that CdsL down-regulates CdsN enzymatic activity in a dose-dependent manner. Using PepScan epitope mapping we identified two separate binding domains to which CdsL binds viz. CdsN 221-229 and CdsN265-270. We confirmed the binding domains using a pull-down assay and showed that GST-CdsN221-270, which encompasses these peptides, co-purified with His-CdsL. Next, we used orthology modeling based on the crystal structure of a T3S ATPase ortholog from E. coli, EscN, to map the binding domains on the predicted three dimensional structure of CdsN. The CdsL binding domains mapped to the catalytic domain of the ATPase, one in the central channel of the ATPase hexamer and one on the outer face. Since peptide mimetics have been used to disrupt essential protein interactions of the chlamydial T3S system and inhibit T3S-mediated invasion of HeLa cells, we hypothesized that if CdsL – CdsN binding is essential for regulating T3S then a CdsN peptide mimetic could be used to potentially block T3S and Chlamydial invasion. Treatment of EBs with a CdsN peptide mimetic inhibited C. pneumoniae invasion into HeLa cells in a dose-dependent fashion. This report represents the first use of Pepscan technology to identify binding domains for specific T3S proteins viz. CdsL on the ATPase, CdsN, and demonstrates that peptide mimetics can be used as anti-virulence factors to block bacterial invasion.

  18. Chlamydia pneumoniae pneumonia and Mycoplasma pneumoniae pneumonia: comparison of clinical findings and CT findings.

    Science.gov (United States)

    Okada, Fumito; Ando, Yumiko; Wakisaka, Masaki; Matsumoto, Shunro; Mori, Hiromu

    2005-01-01

    The objective of this study was to identify the clinical and pulmonary CT findings associated with Chlamydia pneumoniae pneumonia and to compare them with those of Mycoplasma pneumoniae pneumonia. The clinical features and CT scans of 40 patients with C. pneumoniae pneumonia and 42 patients with M. pneumoniae pneumonia were retrospectively reviewed. There were no significant differences between the two etiologic agents with regard to clinical signs. Chest CT findings in patients with C. pneumoniae pneumonia consisted mainly of ground-glass attenuation (n = 38) and acinar patterns (n = 28). Acinar patterns and pleural effusions (n = 12) were observed significantly more frequently than in patients with M. pneumoniae pneumonia (P pneumoniae pneumonia patients (P pneumoniae pneumonia.

  19. Preventing mismanagement of community-acquired pneumonia at an urban public hospital: implications for institution-specific practice guidelines.

    Science.gov (United States)

    Schwartz, D N; Furumoto-Dawson, A; Itokazu, G S; Chinikamwala, M; Levasseur, S; Weinstein, R A

    1998-03-01

    To assess institutional performance of key diagnostic and therapeutic interventions and to identify areas amenable to improvement in the management of community-acquired pneumonia (CAP). A chart-based retrospective study. Cook County Hospital, a large, urban, public teaching hospital. Adult inpatients with a hospital discharge diagnosis of CAP. None. Fifty hospital admissions were reviewed. Only 25 patients (50%) had two specimens obtained for blood culture, and sputum was sent for Gram's stain and culture for only 11 patients (22%). Approximately one third of the patients had portable anterior-posterior instead of standard posterior-anterior and lateral chest radiographs performed. Physicians in the emergency department (ED) tended to be less likely to note the presence of multilobar infiltrates or pleural effusions than the attending radiologists. The antibiotic regimens employed in the ED and on the inpatient wards were widely variable. The mean time from hospital entry until administration of the first dose of antibiotics was 5.5 h for the 18 patients for whom treatment was initiated in the ED vs 16.1 h for the 27 patients admitted through the ED for whom therapy was deferred until ward admission (p < 0.001, Student's t test). Institutional variations in the performance of basic diagnostic and therapeutic interventions for patients with CAP may be substantial. The local performance of these key processes of care should be assessed to help direct the formulation of institutional practice guidelines for the management of CAP.

  20. Efficacy of PPV23 in Preventing Pneumococcal Pneumonia in Adults at Increased Risk--A Systematic Review and Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Julia Schiffner-Rohe

    Full Text Available Pneumococcal community-acquired pneumonia (pCAP is the most frequent form of pneumonia. The elderly and adults with underlying diseases are at an increased risk of developing pCAP. The 23-valent pneumococcal polysaccharide vaccine (PPV23 was licensed over 30 years ago and is recommended as the standard intervention in many countries across the globe, although its efficacy continues to be debated. We performed a meta-analysis of randomized controlled trials (RCTs to investigate the effect of PPV23 for preventing pCAP in adults ≥60 years of age.An existing Cochrane Review was updated to Oct 2014 using a systematic literature search to select appropriate RCTs. DerSimonian and Laird random-effects meta-analyses were performed and odd ratios (OR with 95%-confidence intervals (CI and p-values were calculated for the descriptive analyses. Reasons for heterogeneity were explored by subgroup analyses.Meta-analysis of PPV23 efficacy included four studies. Three of them did not demonstrate efficacy for PPV23. The body of evidence indicated statistically significant heterogeneity (I2 = 78%, p = 0.004 that could be explained by subgroup analysis by "study setting". Further effect modifiers for pCAP were "continent of trial" (p<0.01, and "method of pneumococcal diagnostics" (p = 0.001. Subgroup analyses revealed that the only study showing efficacy for PPV23 was an outlier. Overall, the validity of the meta-analytic PPV23 efficacy assessment was confirmed by the meta-analysis of all-cause CAP including six studies.Inconsistencies in PPV23 treatment effects to prevent pCAP could solely be explained by one outlier study that was performed in nursing homes in Japan. The effect modifier "method of pneumococcal diagnostics" should be interpreted carefully, since methodological weaknesses are not restricted to one special method only, which would justify the exclusion of certain studies. Overall, we conclude from our meta-analysis that to date there is no proof

  1. Prevention of influenza and pneumococcal pneumonia in Canadian long-term care facilities: how are we doing?

    Science.gov (United States)

    Stevenson, C G; McArthur, M A; Naus, M; Abraham, E; McGeer, A J

    2001-05-15

    Influenza and pneumococcal pneumonia are serious health problems among elderly people and a major cause of death in long-term care facilities. We describe the results of serial surveys of vaccination coverage and influenza outbreak management in Canadian long-term care facilities over the last decade. Cross-sectional surveys consisting of questionnaires mailed to all Canadian residential long-term care facilities for elderly people in 1991 and to a random sample of respondents in 1995 and 1999. The response rates were 83% (430/515) in 1995 and 75% (380/506) in 1999. In 1999 the mean reported rates of influenza vaccination were 83% among residents and 35% among staff, and the mean rate of pneumococcal vaccination among residents was 71%; all 3 rates were significantly higher than those in 1991. The rates were also higher in facilities with an infection control practitioner than in those without such an individual (88% v. 82% for influenza vaccination among residents [p influenza vaccination among staff [p = 0.008] and 75% v. 63% for pneumococcal vaccination among residents [p vaccination on admission to the facility was associated with higher influenza and pneumococcal vaccination rates among residents (p = 0.04 and p influenza vaccination rates among residents and staff reported lower rates of influenza outbreaks (p = 0.08 and 0.03 respectively). Despite recommendations from the National Advisory Committee on Immunization, only 50% of the facilities had policies for amantadine prophylaxis during influenza A outbreaks. Amantadine was judged effective in controlling 76% of the influenza A outbreaks and was discontinued because of side effects in 3% of the residents. Influenza and pneumococcal vaccination rates among residents and staff in Canadian long-term care facilities have increased over the last decade but remain suboptimal. Vaccination of residents and staff against influenza is associated with a reduced risk of influenza outbreaks. Amantadine is effective in

  2. Post-pyloric versus gastric tube feeding for preventing pneumonia and improving nutritional outcomes in critically ill adults.

    Science.gov (United States)

    Alkhawaja, Sana; Martin, Claudio; Butler, Ronald J; Gwadry-Sridhar, Femida

    2015-08-04

    Nutritional support is an essential component of critical care. Malnutrition has been associated with poor outcomes among patients in intensive care units (ICUs). Evidence suggests that in patients with a functional gut, nutrition should be administered through the enteral route. One of the main concerns regarding use of the enteral route is the reduction in gastric motility that is often responsible for limited caloric intake. This increases the risk of aspiration pneumonia as well. Post-pyloric feeding, in which the feed is delivered directly into the duodenum or the jejunum, could solve these issues and provide additional benefits over routine gastric administration of the feed. To evaluate the effectiveness and safety of post-pyloric feeding versus gastric feeding for critically ill adults who require enteral tube feeding. We searched the following databases: Cochrane Central Register of Controlled Trials (CENTRAL;2013 Issue 10), MEDLINE (Ovid) (1950 to October 2013), EMBASE (Ovid) (1980 to October 2013) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) via EBSCO host (1982 to October 2013). We reran the search on 4 February 2015 and will deal with the one study of interest when we update the review. Randomized or quasi-randomized controlled trials comparing post-pyloric versus gastric tube feeding in critically ill adults. We extracted data using the standard methods of the Cochrane Anaesthesia, Critical and Emergency Care Group and separately evaluated trial quality and data extraction as performed by each review author. We contacted trials authors to request missing data. We pooled data from 14 trials of 1109 participants in a meta-analysis. Moderate quality evidence suggests that post-pyloric feeding is associated with low rates of pneumonia compared with gastric tube feeding (risk ratio (RR) 0.65, 95% confidence interval (CI) 0.51 to 0.84). Low-quality evidence shows an increase in the percentage of total nutrient delivered to the

  3. Mycoplasma pneumoniae pneumonia in children

    Directory of Open Access Journals (Sweden)

    You-Sook Youn

    2012-02-01

    Full Text Available Mycoplasma pneumoniae (MP, the smallest self-replicating biological system, is a common cause of upper and lower respiratory tract infections, leading to a wide range of pulmonary and extra-pulmonary manifestations. MP pneumonia has been reported in 10 to 40% of cases of community-acquired pneumonia and shows an even higher proportion during epidemics. MP infection is endemic in larger communities of the world with cyclic epidemics every 3 to 7 years. In Korea, 3 to 4-year cycles have been observed from the mid-1980s to present. Although a variety of serologic assays and polymerase chain reaction (PCR techniques are available for the diagnosis of MP infections, early diagnosis of MP pneumonia is limited by the lack of immunoglobulin (Ig M antibodies and variable PCR results in the early stages of the infection. Thus, short-term paired IgM serologic tests may be mandatory for an early and definitive diagnosis. MP infection is usually a mild and self-limiting disease without specific treatment, and if needed, macrolides are generally used as a first-choice drug for children. Recently, macrolide-resistant MP strains have been reported worldwide. However, there are few reports of apparent treatment failure, such as progression of pneumonia to acute respiratory distress syndrome despite macrolide treatment. The immunopathogenesis of MP pneumonia is believed to be a hyperimmune reaction of the host to the insults from MP infection, including cytokine overproduction and immune cell activation (T cells. In this context, immunomodulatory treatment (corticosteroids or/and intravenous Ig, in addition to antibiotic treatment, might be considered for patients with severe infection.

  4. Chlamydia Pneumoniae Pneumonia: An Evolving Clinical Spectrum

    Directory of Open Access Journals (Sweden)

    David Megran

    1995-01-01

    Full Text Available Chlamydia pneumoniae is a recently recognized respiratory tract pathogen. It accounts for 6 to 10% of all cases of community acquired pneumonia requiring admission to hospital. Two patients hospitalized with C pneumoniae pneumonia are presented to illustrate its range of severity and the extrapulmonary manifestations.

  5. Sub-inhibitory concentrations of vancomycin prevent quinolone-resistance in a penicillin-resistant isolate of Streptococcus pneumoniae

    Directory of Open Access Journals (Sweden)

    Moreillon Philippe

    2001-07-01

    Full Text Available Abstract Background The continuous spread of penicillin-resistant pneumococci represents a permanent threat in the treatment of pneumococcal infections, especially when strains show additional resistance to quinolones. The main objective of this study was to determine a treatment modality impeding the emergence of quinolone resistance. Results Exposure of a penicillin-resistant pneumococcus to increasing concentrations of trovafloxacin or ciprofloxacin selected for mutants resistant to these drugs. In the presence of sub-inhibitory concentrations of vancomycin, development of trovafloxacin-resistance and high-level ciprofloxacin-resistance were prevented. Conclusions Considering the risk of quinolone-resistance in pneumococci, the observation might be of clinical importance.

  6. Aspiration pneumonia

    OpenAIRE

    Chaiwongkarjohn, S; Heidari, A; Graber, CJ; Goetz, MB

    2015-01-01

    © Cambridge University Press (2008) 2015. Introduction Aspiration is the introduction of oropharyngeal or gastric contents into the respiratory tract. Three major syndromes may develop as a consequence of aspiration: chemical pneumonitis, bronchial obstruction secondary to aspiration of particulate matter, and bacterial aspiration pneumonia. Less commonly, interstitial lung disease occurs in persons with chronic aspiration. Which of these consequences emerges is determined by the amount and n...

  7. Awareness of childhood pneumonia in Benin City, Nigeria | Nwaneri ...

    African Journals Online (AJOL)

    Background: Mortality from pneumonia can be prevented by prompt recognition of symptoms of pneumonia by caregivers at home and appropriate seeking for medical care in a health facility. Active participation in pneumonia control by caregivers is dependent on the extent to which the members of the community are ...

  8. A cleaner burning biomass-fuelled cookstove intervention to prevent pneumonia in children under 5 years old in rural Malawi (the Cooking and Pneumonia Study): a cluster randomised controlled trial.

    Science.gov (United States)

    Mortimer, Kevin; Ndamala, Chifundo B; Naunje, Andrew W; Malava, Jullita; Katundu, Cynthia; Weston, William; Havens, Deborah; Pope, Daniel; Bruce, Nigel G; Nyirenda, Moffat; Wang, Duolao; Crampin, Amelia; Grigg, Jonathan; Balmes, John; Gordon, Stephen B

    2017-01-14

    WHO estimates exposure to air pollution from cooking with solid fuels is associated with over 4 million premature deaths worldwide every year including half a million children under the age of 5 years from pneumonia. We hypothesised that replacing open fires with cleaner burning biomass-fuelled cookstoves would reduce pneumonia incidence in young children. We did a community-level open cluster randomised controlled trial to compare the effects of a cleaner burning biomass-fuelled cookstove intervention to continuation of open fire cooking on pneumonia in children living in two rural districts, Chikhwawa and Karonga, of Malawi. Clusters were randomly allocated to intervention and control groups using a computer-generated randomisation schedule with stratification by site, distance from health centre, and size of cluster. Within clusters, households with a child under the age of 4·5 years were eligible. Intervention households received two biomass-fuelled cookstoves and a solar panel. The primary outcome was WHO Integrated Management of Childhood Illness (IMCI)-defined pneumonia episodes in children under 5 years of age. Efficacy and safety analyses were by intention to treat. The trial is registered with ISRCTN, number ISRCTN59448623. We enrolled 10 750 children from 8626 households across 150 clusters between Dec 9, 2013, and Feb 28, 2016. 10 543 children from 8470 households contributed 15 991 child-years of follow-up data to the intention-to-treat analysis. The IMCI pneumonia incidence rate in the intervention group was 15·76 (95% CI 14·89-16·63) per 100 child-years and in the control group 15·58 (95% CI 14·72-16·45) per 100 child-years, with an intervention versus control incidence rate ratio (IRR) of 1·01 (95% CI 0·91-1·13; p=0·80). Cooking-related serious adverse events (burns) were seen in 19 children; nine in the intervention and ten (one death) in the control group (IRR 0·91 [95% CI 0·37-2·23]; p=0·83). We found no evidence that an

  9. Pneumocystis Pneumonia (For Parents)

    Science.gov (United States)

    ... a Child Cope With a Parent's Suicide? Pneumocystis Pneumonia KidsHealth > For Parents > Pneumocystis Pneumonia Print A A A What's in this article? About PCP Diagnosing PCP Treating PCP Pneumocystis pneumonia (PCP) is an infection caused by Pneumocystis jiroveci , ...

  10. [Comparison of clinical presentation of mixed pneumonia with Chlamydia pneumoniae and Streptococcus pneumoniae and S. pneumoniae pneumonia].

    Science.gov (United States)

    Fukano, Hiroshi; Miyashita, Naoyuki; Mimura, Kimihiro; Mouri, Keiji; Yoshida, Kouichiro; Kobashi, Yoshihiro; Niki, Yoshihito; Matsushima, Toshiharu

    2004-02-01

    Chlamydia pneumoniae is a significant cause of both lower and upper acute respiratory illnesses, including community-acquired pneumonia. Furthermore, C. pneumoniae has been reported to frequently cause pneumonia in association with other respiratory pathogens, mainly Streptococcus pneumoniae. In this study, we investigated the clinical presentation of mixed pneumonia with Chlamydia pneumoniae and S. pneumoniae and compared it with S. pneumoniae pneumonia. A total of 13 cases of mixed pneumonia and 58 cases of S. pneumoniae pneumonia identified at Kawasaki Medical School and related hospitals between April 1996 and March 2001 were analyzed. The diagnosis of C. pneumoniae infection was based on isolation and serologic testing of antibodies by the microimmunofluorescence test. The clinical presentation of mixed pneumonia and S. pneumoniae pneumonia was almost identical and no statistical differences were observed between the two groups. This is the same as what was observed before except eleven out of the 13 of the mixed pneumonia patients responded to treatment with only beta-lactam antibiotics. Our results indicated that C. pneumoniae may not be the primary cause of community-acquired pneumonia but it might descript the normal clearance mechanisms, enabling other pathogens to invade.

  11. Resistance patterns and outcomes in intensive care unit (ICU)-acquired pneumonia. Validation of European Centre for Disease Prevention and Control (ECDC) and the Centers for Disease Control and Prevention (CDC) classification of multidrug resistant organisms.

    Science.gov (United States)

    Martin-Loeches, Ignacio; Torres, Antonio; Rinaudo, Mariano; Terraneo, Silvia; de Rosa, Francesca; Ramirez, Paula; Diaz, Emili; Fernández-Barat, Laia; Li Bassi, Gian Luigi; Ferrer, Miquel

    2015-03-01

    Bacterial resistance has become a major public health problem. To validate the definition of multidrug-resistant organisms (MDRO) based on the European Centre for Disease Prevention and Control (ECDC) and the Centers for Disease Control and Prevention (CDC) classification. Prospective, observational study in six medical and surgical Intensive-Care-Units (ICU) of a University hospital. Three-hundred-and-forty-three patients with ICU-acquired pneumonia (ICUAP) were prospectively enrolled, 140 patients had no microbiological confirmation (41%), 82 patients (24%) developed ICUAP for non-MDRO, whereas 121 (35%) were MDROs. Non-MDRO, MDRO and no microbiological confirmation patients did not present either a significant different previous antibiotic use (p 0.18) or previous hospital admission (p 0.17). Appropriate antibiotic therapy was associated with better ICU survival (105 [92.9%] vs. 74 [82.2%]; p = 0.03). An adjusted multivariate regression logistic analysis identified that only MDRO had a higher ICU-mortality than non-MDRO and no microbiological confirmation patients (OR 2.89; p < 0.05; 95% CI for Exp [β]. 1.02-8.21); Patients with MDRO ICUAP remained in ICU for a longer period than MDRO and no microbiological confirmation respectively (p < 0.01) however no microbiological confirmation patients had more often antibiotic consumption than culture positive ones. Patients who developed ICUAP due to MDRO showed a higher ICU-mortality than non-MDRO ones and use of ICU resources. No microbiological confirmation patients had more often antibiotic consumption than culture positive patients. Risk factors for MDRO may be important for the selection of initial antimicrobial therapy, in addition to local epidemiology. Copyright © 2014 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

  12. Pneumonia (For Parents)

    Science.gov (United States)

    ... of Braces Eating Disorders Mitral Valve Prolapse Arrhythmias Pneumonia KidsHealth > For Parents > Pneumonia Print A A A ... Call the Doctor? en español Neumonía What Is Pneumonia? Pneumonia is an infection of the lungs . The ...

  13. Pneumonia during Remission Induction Chemotherapy in Patients with Acute Leukemia

    Science.gov (United States)

    Garcia, Javier Barreda; Lei, Xiudong; Wierda, William; Cortes, Jorge E.; Dickey, Burton F.; Evans, Scott E.

    2013-01-01

    Background: Pneumonia is a major cause of death during induction chemotherapy for acute leukemia. The purpose of this study was to quantify the incidence, risk factors, and outcomes of pneumonia in patients with acute leukemia. Methods: We conducted a retrospective cohort study of 801 patients with acute myeloid leukemia (AML), myelodysplastic syndrome (MDS), or acute lymphocytic leukemia (ALL) who underwent induction chemotherapy. Measurements and Main Results: Pneumonia was present at induction start in 85 patients (11%). Of the 716 remaining patients, 148 (21%) developed pneumonia. The incidence rate of pneumonia was higher in MDS and AML than in ALL (0.013 vs. 0.008 vs. 0.003 pneumonias per day, respectively; P pneumonia was 17% (40 of 233). Competing risk analysis demonstrated that in the absence of pneumonia, death was rare: 28-day mortality was 6.2% for all patients but only 1.26% in those without pneumonia. Compared with patients without pneumonia, patients with pneumonia had more intensive care unit days, longer hospital stays, and 49% higher costs (P Pneumonia after induction chemotherapy for acute leukemia continues to be common, and it is the most important determinant of early mortality after induction chemotherapy. Given the high incidence, morbidity, mortality, and cost of pneumonia, interventions aimed at prevention are warranted in patients with acute leukemia. PMID:23987587

  14. Organising pneumonia due to dronedarone.

    Science.gov (United States)

    Thornton, D; Avery, S; Edey, A J; Medford, A R L

    2015-01-01

    Organising pneumonia is one of the responses of the lung to injury and can mimic bacterial pneumonia but importantly it does not respond to antibiotic therapy. We present the case of a 67-year-old male who was diagnosed with organising pneumonia secondary to dronedarone. Drug reactions are a common cause and early identification of the culprit is mandatory to prevent further morbidity and ensure a favourable outcome. On chest radiography there may be fleeting peripheral consolidation, while computed tomography can show a range of stereotyped patterns including perilobular consolidation. Bronchoscopic biopsy may not always be possible but response to steroids is often rapid following removal of the culprit drug. Dronedarone should be included in the list of possible drugs and the Pneumotox database remains a useful resource for the clinician when acute drug-related pneumotoxicity is suspected.

  15. Impact of intermittent preventive treatment in pregnancy with azithromycin-containing regimens on maternal nasopharyngeal carriage and antibiotic sensitivity of Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus: a cross-sectional survey at delivery.

    Science.gov (United States)

    Unger, Holger W; Aho, Celestine; Ome-Kaius, Maria; Wangnapi, Regina A; Umbers, Alexandra J; Jack, Wanda; Lafana, Alice; Michael, Audrey; Hanieh, Sarah; Siba, Peter; Mueller, Ivo; Greenhill, Andrew R; Rogerson, Stephen J

    2015-04-01

    Sulfadoxine-pyrimethamine (SP) plus azithromycin (AZ) (SPAZ) has the potential for intermittent preventive treatment of malaria in pregnancy (IPTp), but its use could increase circulation of antibiotic-resistant bacteria associated with severe pediatric infections. We evaluated the effect of monthly SPAZ-IPTp compared to a single course of SP plus chloroquine (SPCQ) on maternal nasopharyngeal carriage and antibiotic susceptibility of Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus at delivery among 854 women participating in a randomized controlled trial in Papua New Guinea. Serotyping was performed, and antibiotic susceptibility was evaluated by disk diffusion and Etest. Potential risk factors for carriage were examined. Nasopharyngeal carriage at delivery of S. pneumoniae (SPAZ, 7.2% [30/418], versus SPCQ, 19.3% [84/436]; P<0.001) and H. influenzae (2.9% [12/418] versus 6.0% [26/436], P=0.028), but not S. aureus, was significantly reduced among women who had received SPAZ-IPTp. The number of macrolide-resistant pneumococcal isolates was small but increased in the SPAZ group (13.3% [4/30], versus SPCQ, 2.2% [2/91]; P=0.033). The proportions of isolates with serotypes covered by the 13-valent pneumococcal conjugate vaccine were similar (SPAZ, 10.3% [3/29], versus SPCQ, 17.6% [16/91]; P=0.352). Although macrolide-resistant isolates were rare, they were more commonly detected in women who had received SPAZ-IPTp, despite the significant reduction of maternal carriage of S. pneumoniae and H. influenzae observed in this group. Future studies on SPAZ-IPTp should evaluate carriage and persistence of macrolide-resistant S. pneumoniae and other pathogenic bacteria in both mothers and infants and assess the clinical significance of their circulation. Copyright © 2015, American Society for Microbiology. All Rights Reserved.

  16. Colistin Dosage without Loading Dose Is Efficacious when Treating Carbapenem-Resistant Acinetobacter baumannii Ventilator-Associated Pneumonia Caused by Strains with High Susceptibility to Colistin.

    Science.gov (United States)

    Álvarez-Marín, Rocío; López-Rojas, Rafael; Márquez, Juan Antonio; Gómez, María José; Molina, José; Cisneros, José Miguel; Ortiz-Leyba, Carlos; Aznar, Javier; Garnacho-Montero, José; Pachón, Jerónimo

    2016-01-01

    This study aims to analyze the mortality and the length of ICU stay (LOS) of A. baumannii VAP compared to respiratory colonization in patients with mechanical ventilation (MV). A prospective cohort study was performed in an ICU of adult patients (February 2010-June 2011). One hundred patients on MV with A. baumannii in lower respiratory airways were recruited, and classified as VAP or airways colonization according to CPIS criteria, with a punctuation ≥6. LOS, 30-days mortality, A. baumannii bacteremia, and clinical features including antibiotic therapy were recorded. Multivariate analysis (linear and Cox regression) and survival analysis (Kaplan-Meier curves) were performed. Fifty-seven VAP and 43 colonized A. baumannii patients were analyzed. Among the A. baumannii strains, 99% were non-susceptible to carbapenems and the MIC90 of colistin was 0.12 mg/l. Therapy was appropriate in 94.6% of VAP patients, most of them with colistin 6 MIU/day, although in 13 (23.6%) cases colistin was started 48 hours after the onset of VAP. Mortality was similar in both groups (VAP 24.6% vs. colonized 27.9%, p = 0.7). Bacteremia and acute kidney insufficiency were associated with decreased survival (p = 0.02 and p = 0.04, respectively) in VAP patients. LOS was 21.5 (11.5-42.75) vs. 9 (6-22) days for VAP and colonized patients (p = 0.004). VAP (p = 0.003) and age (p = 0.01) were independently related to a longer LOS. Multidrug-resistant A. baumannii VAP treated with colistin does not have a different mortality compared to lower airways colonization, among patients on mechanical-ventilation, in a setting of high susceptibility to colistin of A. baumannii.

  17. Emergence of Extensively Drug Resistant Acinetobacter baumannii-Encoding Integrons and Extended-Spectrum Beta-Lactamase Genes Isolated from Ventilator-Associated Pneumonia Patients

    National Research Council Canada - National Science Library

    Mohammad Sadegh Rezai; Alireza Rafiei; Fatemeh Ahangarkani; Masoumeh Bagheri-Nesami; Attieh Nikkhah; Khaironesa Shafahi; Gohar Eslami; Azin Hajalibeig; Rezvan Khajavi

    2017-01-01

    ... of A. baumannii-associated VAP in developing countries such as Iran with limited resources. 2. The mcr-1 gene, encoded for phosphoethanolamine transferase, was borne on a mobile plasmid in E.coli and K...

  18. Association of autophagy-related 16-like 1 (ATG16L1) gene polymorphism with sepsis severity in patients with sepsis and ventilator-associated pneumonia

    NARCIS (Netherlands)

    Savva, A.; Plantinga, T.S.; Kotanidou, A.; Farcas, M.; Baziaka, F.; Raftogiannis, M.; Orfanos, S.E.; Dimopoulos, G.; Netea, M.G.; Giamarellos-Bourboulis, E.J.

    2014-01-01

    Autophagy is a highly conserved mechanism of eukaryotic cells implicated in cell homeostasis and elimination of intracellular pathogens. Functional polymorphisms in genes encoding for autophagy have been associated with susceptibility to inflammatory and infectious diseases, but data on severe

  19. Carbapenem-resistant Klebsiella pneumoniae colonization in pediatric and neonatal intensive care units: risk factors for progression to infection.

    Science.gov (United States)

    Akturk, Hacer; Sutcu, Murat; Somer, Ayper; Aydın, Derya; Cihan, Rukiye; Ozdemir, Aslı; Coban, Asuman; Ince, Zeynep; Citak, Agop; Salman, Nuran

    2016-01-01

    Little is known about factors associated with carbapenem-resistant Klebsiella pneumoniae infections in pediatric patients, who are initally colonized with carbapenem-resistant Klebsiella pneumoniae. A retrospective case-control study was conducted involving pediatric and neonatal intensive care units throughout a five-year period (January 2010-December 2014). Clinical and microbiological data were extracted from Hospital Infection Control Committee reports and patients' medical records. Risk factors were assessed in carbapenem-resistant Klebsiella pneumoniae colonized patients who developed subsequent systemic infection (cases) and compared to carbapenem-resistant Klebsiella pneumoniae colonized patients who did not develop infection (controls). Throughout the study period, 2.6% of patients admitted to neonatal intensive care units and 3.6% of patients admitted to pediatric intensive care units had become colonized with carbapenem-resistant Klebsiella pneumoniae. After a mean of 10.6±1.9 days (median: 7 days, range: 2-38 days) following detection of colonization, 39.0% of the carbapenem-resistant Klebsiella pneumoniae colonized patients in pediatric intensive care units and 18.1% of carbapenem-resistant Klebsiella pneumoniae colonized patients in neonatal intensive care units developed systemic carbapenem-resistant Klebsiella pneumoniae infection. Types of systemic carbapenem-resistant Klebsiella pneumoniae infections included bacteremia (n=15, 62.5%), ventilator-associated pneumonia (n=4, 16.6%), ventriculitis (n=2, 8.3%), intraabdominal infections (n=2, 8.3%), and urinary tract infection (n=1, 4.1%). A logistic regression model including parameters found significant in univariate analysis of carbapenem resistant Klebsiella pneumoniae colonization and carbapenem resistant Klebsiella pneumoniae infection groups revealed underlying metabolic disease (OR: 10.1; 95% CI: 2.7-37.2), previous carbapenem use (OR: 10.1; 95% CI: 2.2-40.1), neutropenia (OR: 13.8; 95% CI: 3

  20. Hydrocarbon pneumonia

    Science.gov (United States)

    ... by drinking or breathing in gasoline , kerosene , furniture polish , paint thinner, or other oily materials or solvents. ... number. You should call if you have any questions about poisoning or poison prevention. You can call ...

  1. Pneumonia - adults - discharge

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000017.htm Pneumonia in adults - discharge To use the sharing features on this page, please enable JavaScript. You have pneumonia, which is an infection in your lungs. In ...

  2. FastStats: Pneumonia

    Science.gov (United States)

    ... this? Submit What's this? Submit Button NCHS Home Pneumonia Recommend on Facebook Tweet Share Compartir Data are ... visits Number of visits to emergency departments with pneumonia as the primary hospital discharge diagnosis: 423,000 ...

  3. Pneumonia - children - discharge

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000011.htm Pneumonia in children - discharge To use the sharing features ... this page, please enable JavaScript. Your child has pneumonia, which is an infection in the lungs. In ...

  4. Pneumocystis jiroveci pneumonia

    Science.gov (United States)

    ... medlineplus.gov/ency/article/000671.htm Pneumocystis jiroveci pneumonia To use the sharing features on this page, please enable JavaScript. Pneumocystis jiroveci pneumonia is a fungal infection of the lungs. The ...

  5. Pneumonia - children - community acquired

    Science.gov (United States)

    Bronchopneumonia - children; Community-acquired pneumonia - children; CAP - children ... Viruses are the most common cause of pneumonia in infants and children. Ways your child can get CAP include: Bacteria and viruses living in the nose, sinuses, or mouth may spread ...

  6. Cryptogenic organising pneumonia

    National Research Council Canada - National Science Library

    Cordier, J-F

    2006-01-01

    ...s: Cryptogenic organising pneumonia Received: February 8, 2005 Accepted November 22, 2005 Organising pneumonia is defined histopathologically by intra-alveolar buds of granulation tissue, consisting of intermixed myofibroblasts and connective tissue...

  7. Chlamydia Pneumoniae Infections

    Science.gov (United States)

    ... Issues Listen Español Text Size Email Print Share Chlamydia Pneumoniae Infections Page Content Article Body When you hear ... of Chlamydia bacteria. Another species, called Chlamydia (or Chlamydophila ) pneumoniae, causes respiratory illnesses. These lung infections are spread ...

  8. Radiology of bacterial pneumonia

    Energy Technology Data Exchange (ETDEWEB)

    Vilar, Jose E-mail: vilar_jlu@gva.es; Domingo, Maria Luisa; Soto, Cristina; Cogollos, Jonathan

    2004-08-01

    Bacterial pneumonia is commonly encountered in clinical practice. Radiology plays a prominent role in the evaluation of pneumonia. Chest radiography is the most commonly used imaging tool in pneumonias due to its availability and excellent cost benefit ratio. CT should be used in unresolved cases or when complications of pneumonia are suspected. The main applications of radiology in pneumonia are oriented to detection, characterisation and follow-up, especially regarding complications. The classical classification of pneumonias into lobar and bronchial pneumonia has been abandoned for a more clinical classification. Thus, bacterial pneumonias are typified into three main groups: Community acquired pneumonia (CAD), Aspiration pneumonia and Nosocomial pneumonia (NP).The usual pattern of CAD is that of the previously called lobar pneumonia; an air-space consolidation limited to one lobe or segment. Nevertheless, the radiographic patterns of CAD may be variable and are often related to the causative agent. Aspiration pneumonia generally involves the lower lobes with bilateral multicentric opacities. Nosocomial Pneumonia (NP) occurs in hospitalised patients. The importance of NP is related to its high mortality and, thus, the need to obtain a prompt diagnosis. The role of imaging in NP is limited but decisive. The most valuable information is when the chest radiographs are negative and rule out pneumonia. The radiographic patterns of NP are very variable, most commonly showing diffuse multifocal involvement and pleural effusion. Imaging plays also an important role in the detection and evaluation of complications of bacterial pneumonias. In many of these cases, especially in hospitalised patients, chest CT must be obtained in order to better depict these associate findings.

  9. [Therapy-resistant pneumonia].

    Science.gov (United States)

    Oestmann, Andreas; Schäfer, Stephan Christian; Geiser, Thomas

    2014-10-15

    We report the case of a 72 year old patient with B-symptoms and a persistent pulmonary infiltrate despite an antibiotic therapy. Buds of granulation tissue were found by transbronchial biopsy proving an organizing pneumonia. B-Symptoms and pulmonary infiltrate were improved immediately by a therapy with steroids. Even though there were reasons for a secondary organizing pneumonia due to a known chronic lymphocytic leukemia and a pneumonia treated four months before, we consider a cryptogenic organizing pneumonia as most probable.

  10. [Erythema multiforme majus and Chlamydia pneumoniae infection].

    Science.gov (United States)

    Saada, D; Velasco, S; Vabres, P; Guillet, G

    2006-12-01

    Erythema multiforme majus of infectious origin is an acute eruptive syndrome seen more commonly in young subjects and characterised by an appearance of round target lesions. In most cases, it is associated with infection involving Herpes simplex virus or Mycoplasma pneumoniae. We report an original case of erythema multiforme majus subsequent to infection with Chlamydia pneumoniae. An 18 year-old man was hospitalised for management of generalised skin rash comprising lesions in rings, associated with bullous and post-bullous lesions, chiefly in the oral (preventing eating) and genital areas in a setting of febrile cough. Various bacterial agents (Mycoplasma pneumoniae, Chlamydia pneumoniae) and viral agents were suspected, but serological testing for Chlamydia pneumoniae alone was positive with IgM of 128 IU and IgG of 64 IU. The outcome was favourable within several days following administration of symptomatic treatment (rehydration, mouthwashes, etc.) and aetiological treatment (acyclovir: 30 mg/kg/d, ofloxacine: 400 mg/d). At D15, serologic tests for Mycoplasma pneumoniae continued to be negative. Anti-Chlamydia pneumoniae IgM and IgG were 256 IU. At D30, IgM was 128 IU while IgG remained at 256 IU. The existence of a systematic skin rash comprising typical target lesions and mucosal lesions in the oral and genital areas suggested to us a diagnosis of erythema multiforme majus. Screening for the agents generally responsible was negative and drug-induced rash was ruled out. Serological tests for Chlamydia pneumoniae were positive at various times, resulting in diagnosis of erythema multiforme majus secondary to infection with Chlamydia pneumoniae. Following demonstration of the presence of Chlamydia pneumoniae using reliable methods and the elimination of other causes of erythema multiforme majus, dermatologists should opt for this aetiology in order to optimise treatment.

  11. Incidence, risk factors and mortality of nosocomial pneumonia in Intensive Care Units: A prospective study

    Directory of Open Access Journals (Sweden)

    Voss Andreas

    2004-09-01

    Full Text Available Abstract To determine the frequency, risk factors and mortality of nosocomial pneumonia a prospective study was conducted in the intensive care units. In the study period, 2402 patients were included. The nosocomial pneumonia was defined according to the Centers for Disease Control Criteria. Overall, 163 (6.8% of the patients developed nosocomial pneumonia and 75.5% (n = 123 of all patients with nosocomial pneumonia were ventilator-associated pneumonia. 163 patients who were admitted to the intensive care unit during the same period but had no bacteriologic or histologic evidence of pneumonia were used as a control group. The APACHE II score, coma, hypoalbuminemia, mechanical ventilation, tracheotomy, presence of nasogastric tube were found as independent risk factors. Crude and attributable mortality were 65% and 52.6%, respectively. The mortality rate was five times greater in the cases (OR: 5.2; CI 95%: 3.2–8.3. The mean length of stay in the intensive care unit and hospital in the cases were longer than controls (p

  12. streptococcus pneumoniae , klebsiella pneumoniae proteus vulgaris

    African Journals Online (AJOL)

    DR. AMINU

    ABSTRACT. This investigation was conducted to determine the in-vitro effect of aqueous, ethanol and methanol crude extracts of Euphorbia hirta at concentrations ranging from 10mg/ml – 100mg/ml against three pathogenic bacteria (Streptococcus pneumoniae, Klebsiella pneumoniae and Proteus vulgaris) using cup plate ...

  13. Reflections on pneumonia in the tropics

    Directory of Open Access Journals (Sweden)

    Michael P Alpers

    2014-03-01

    Full Text Available This review of pneumonia in the tropics is based on experience with respiratory infections in Papua New Guinea since the 1970s. It discusses ideas, principles, historical aspects of pneumonia research and the need to work with people in the community. In order to understand pneumonia in a tropical setting and evaluate new interventions it is essential to study the ecosystem of the causative infections, within the host and the community and between interacting microorganisms. Vaccines are much-needed preventive tools, and for pneumonia in a highly endemic setting the prevention of severe and fatal disease takes priority over the prevention of infection. In this setting mild infection plays an important role in preventing severe disease. For achieving long-term sustainable outcomes, sometimes ‘less is more’. A multipronged approach is required to control and prevent pneumonia, and in devising new ways of doing so. This includes appropriate and accessible clinical care, a clean, smoke-free environment, good nutrition and a range of vaccines. Also required are persistent advocacy from the global scientific community and strong engagement with and by the communities that bear the burden of disease. Better health care must be pursued in conjunction with raising literacy rates and reducing poverty

  14. Nosocomial pneumonia

    National Research Council Canada - National Science Library

    Jarvis, William R. (William Robert)

    2000-01-01

    ... Diseases'' at the meeting of the Association of American Physicians. He said: ''Modern medicine has made the concept of causation its own. On it is founded all rational progress in prophylaxis and therapy. First to comprehend the cause, then to intercept and suppress it, and thereby to prevent the next step is the kernel of medical science and practic...

  15. Prevención de la neumonía adquirida en la comunidad PREVENTION OF COMMUNITY-ACQUIRED PNEUMONIA IN ADULTS

    OpenAIRE

    Manuel Barros M.; Claudia Cartagena S.; Luis Bavestrello F.

    2005-01-01

    La vacuna anti neumocóccica polivalente disponible desde 1983 incluye 23 serotipos de Streptococcus pneumoniae, que representan cerca de 90% de las cepas que ocasionan enfermedad neumocóccica invasora en adultos inmunocompetentes. La vacuna confiere protección contra la enfermedad neumocóccica invasora. Se recomienda vacunar a los adultos sanos sobre 65 años de edad, portadores de enfermedades crónicas (cardiopatías, EPOC, nefropatías, diabetes mellitus, cirrosis hepática, pérdida crónica de ...

  16. The history of Mycoplasma pneumoniae pneumonia

    Directory of Open Access Journals (Sweden)

    Takeshi eSaraya

    2016-03-01

    Full Text Available In the United States in the 1930s, although the pathogen was not known, atypical pneumonia was clinically distinguished from pneumococcal pneumonia by its resistance to sulfonamides. In 1938, Reimann reported seven patients with an unusual form of tracheobronchopneumonia and severe constitutional symptoms. He believed the clinical picture of this disease differed from that of the disease caused by influenza viruses or known bacteria and instead suspected primary atypical pneumonia. For many years, the responsible infectious agent was tentatively classified as a filterable virus that could pass through a Seitz filter to remove bacteria and was reported to be a psittacosis-like or new virus. After that, in the early 1940s, Eaton et al. identified an agent that was the principal cause of primary atypical pneumonia using cotton rats, hamsters, and chick embryos. Eaton and colleagues did not perform an inoculation study in human volunteers. During the 1940s, there were three groups engaged in discovering the etiology of the primary atypical pneumonia. 1 Commission on Acute Respiratory Diseases directed by John Dingle 2 Dr Monroe Eaton’s group, the Virus Research Laboratory of the California State Public Health Department, 3 The Hospital of the Rockefeller Institute for Medical Research directed by Horsfall. During 1940s, the members of the Commission on Acute Respiratory Diseases concluded that the bacteria-free filtrates obtained from the patients, presumably containing a virus, could induce primary atypical pneumonia in human volunteers via Pinehurst trials. During 1950s, serological approaches for identification of the Eaton agent developed such as Fluorescent-Stainable Antibody, and at the beginning of the1960s, the Eaton agent successfully grew in media, and finally accepted as a cause of primary atypical pneumonia.Thus, technical difficulties with visualizing the agent and failure to recognize the full significance of the Pinehurst

  17. Serotypes and antibiotic susceptibility of Streptococcus pneumoniae isolated from hospitalized patients with community-acquired pneumonia in Italy.

    Science.gov (United States)

    Di Pasquale, Marta; Aliberti, Stefano; Azzari, Chara; Moriondo, Maria; Nieddu, Francesco; Blasi, Francesco; Mantero, Marco

    2017-01-01

    Pneumonia remain an important public health problem. The primary objective was to determine the proportion of community-acquired pneumonia that is attributable to Streptococcus pneumoniae infection; secondary objectives were the description of community-acquired pneumonia attributable to Streptococcus pneumoniae according to socio-demographic and clinical variables, the clinical evolution of community-acquired pneumonia and the description of the serotype distribution of vaccine-preventable disease and antibiotic resistance rate of pneumococcal infections. An observational, prospective study was conducted on consecutive patients coming from the community, who were hospitalized with pneumonia. Data on admission, at discharge and 30 days after discharge were collected. Logistic regression models were used to evaluate the risk factors independently associated with pneumococcal pneumonia. Among the 193 patients enrolled in the study, the etiology of community-acquired pneumonia was identified in 60 patients (33%) and 35 (18%) of evaluable patients had community-acquired pneumonia due to Streptococcus pneumoniae. Of all clinical characteristics, if no previous antibiotic treatment was performed, there was a 13-fold higher risk of presenting community-acquired pneumonia due to Streptococcus pneumoniae (odds ratio, 12.9; 95% confidence interval, 1.42-117.9). Moreover, the most frequent isolated serotypes were 35F, 3 and 24 (29%, 23% and 16%, respectively). The most frequent serotypes in pneumococcal community-acquired pneumonia are 35F, 3, 24, 6 and 7A, and thus almost 50% of Streptococcus pneumoniae strains could be covered by pneumococcal conjugate vaccine 13 in adult patients with risk factors for pneumococcal infections.

  18. Imipenem resistance of Pseudomonas in pneumonia: a systematic literature review.

    Science.gov (United States)

    Zilberberg, Marya D; Chen, Joyce; Mody, Samir H; Ramsey, Andrew M; Shorr, Andrew F

    2010-08-26

    Pneumonia, and particularly nosocomial (NP) and ventilator-associated pneumonias (VAP), results in high morbidity and costs. NPs in particular are likely to be caused by Pseudomonas aeruginosa (PA), ~20% of which in observational studies are resistant to imipenem. We sought to identify the burden of PA imipenem resistance in pneumonia. We conducted a systematic literature review of randomized controlled trials (RCT) of imipenem treatment for pneumonia published in English between 1993 and 2008. We extracted study, population and treatment characteristics, and proportions caused by PA. Endpoints of interest were: PA resistance to initial antimicrobial treatment, clinical success, microbiologic eradication and on-treatment emergence of resistance of PA. Of the 46 studies identified, 20 (N = 4,310) included patients with pneumonia (imipenem 1,667, PA 251; comparator 1,661, PA 270). Seven were double blind, and 7 included US data. Comparator arms included a β-lactam (17, [penicillin 6, carbapenem 4, cephalosporin 7, monobactam 1]), aminoglycoside 2, vancomycin 1, and a fluoroquinolone 5; 5 employed double coverage. Thirteen focused exclusively on pneumonia and 7 included pneumonia and other diagnoses. Initial resistance was present in 14.6% (range 4.2-24.0%) of PA isolates in imipenem and 2.5% (range 0.0-7.4%) in comparator groups. Pooled clinical success rates for PA were 45.2% (range 0.0-72.0%) for imipenem and 74.9% (range 0.0-100.0%) for comparator regimens. Microbiologic eradication was achieved in 47.6% (range 0.0%-100.0%) of isolates in the imipenem and 52.8% (range 0.0%-100.0%) in the comparator groups. Resistance emerged in 38.7% (range 5.6-77.8%) PA isolates in imipenem and 21.9% (range 4.8-56.5%) in comparator groups. In the 15 years of RCTs of imipenem for pneumonia, PA imipenem resistance rates are high, and PA clinical success and microbiologic eradication rates are directionally lower for imipenem than for comparators. Conversely, initial and treatment

  19. Healthcare-associated infection prevention in pediatric intensive care units: a review.

    Science.gov (United States)

    Joram, N; de Saint Blanquat, L; Stamm, D; Launay, E; Gras-Le Guen, C

    2012-10-01

    The objective of this review was to summarize the current knowledge base on the prevention of nosocomial infections in pediatric intensive care units (PICUs). Healthcare-associated infections (HAIs) are a crucial problem in PICUs because of their impact on patient outcome, length of hospital stay, and costs. Studies published between 1998 and 2011 were identified using the MEDLINE and Cochrane databases. Randomized, cohort, case-control studies, and meta-analyses concerning global strategies of prevention, general organization of the wards, general recommendations on antibiotic management, and measures for the prevention of ventilator-associated pneumonia (VAP), bloodstream infections (BSIs), urinary tract infections (UTIs), and surgical site infections (SSIs) were incorporated. Limits of age from 1 month to 18 years were used. When recommendations could not be supported by the pediatric literature, adult studies were also reviewed. This review excludes the neonate population. Specific pediatric data are often lacking so as to establish specific evidence-based pediatric recommendations. This review underlines the absolute necessity of pediatric studies and to harmonize the definitions of HAIs.

  20. Specimen collection for the diagnosis of pediatric pneumonia

    NARCIS (Netherlands)

    Hammitt, Laura L.; Murdoch, David R.; Scott, J. Anthony G.; Driscoll, Amanda; Karron, Ruth A.; Levine, Orin S.; O'Brien, Katherine L.; Black, Robert; Bhutta, Zulfiqar A.; Campbell, Harry; Cherian, Thomas; Crook, Derrick W.; de Jong, Menno D.; Dowell, Scott F.; Graham, Stephen M.; Klugman, Keith P.; Lanata, Claudio F.; Madhi, Shabir A.; Martin, Paul; Nataro, James P.; Piazza, Franco M.; Qazi, Shamim; Zar, Heather J.

    2012-01-01

    Diagnosing the etiologic agent of pneumonia has an essential role in ensuring the most appropriate and effective therapy for individual patients and is critical to guiding the development of treatment and prevention strategies. However, establishing the etiology of pneumonia remains challenging

  1. Incidence of pneumonia and gastroenteritis among infants admitted ...

    African Journals Online (AJOL)

    Introduction. Pneumonia and gastroenteritis are the leading causes of preventable childhood morbidity and mortality representing more than one third of mortality among children less than 5 years of age globally 1. Mortality from pneumonia among American children decreased by more than 90% from 1939 to 1996 largely.

  2. 77 FR 26014 - Prospective Grant of Exclusive License: P4 Peptide From Streptococcus Pneumoniae

    Science.gov (United States)

    2012-05-02

    ... Prospective Grant of Exclusive License: P4 Peptide From Streptococcus Pneumoniae AGENCY: Technology Transfer... polysaccharide vaccine conjugate for prevention of Streptococcus pneumonia infection in humans'') to practice the... ``Functional Epitopes of Streptococcus Pneumoniae PsaA Antigen and Uses Thereof,'' filed 7/ 18/2008, claiming...

  3. Comparison of the Nosocomial Pneumonia Mortality Prediction (NPMP) model with standard mortality prediction tools.

    Science.gov (United States)

    Srinivasan, M; Shetty, N; Gadekari, S; Thunga, G; Rao, K; Kunhikatta, V

    2017-07-01

    Severity or mortality prediction of nosocomial pneumonia could aid in the effective triage of patients and assisting physicians. To compare various severity assessment scoring systems for predicting intensive care unit (ICU) mortality in nosocomial pneumonia patients. A prospective cohort study was conducted in a tertiary care university-affiliated hospital in Manipal, India. One hundred patients with nosocomial pneumonia, admitted in the ICUs who developed pneumonia after >48h of admission, were included. The Nosocomial Pneumonia Mortality Prediction (NPMP) model, developed in our hospital, was compared with Acute Physiology and Chronic Health Evaluation II (APACHE II), Mortality Probability Model II (MPM72 II), Simplified Acute Physiology Score II (SAPS II), Multiple Organ Dysfunction Score (MODS), Sequential Organ Failure Assessment (SOFA), Clinical Pulmonary Infection Score (CPIS), Ventilator-Associated Pneumonia Predisposition, Insult, Response, Organ dysfunction (VAP-PIRO). Data and clinical variables were collected on the day of pneumonia diagnosis. The outcome for the study was ICU mortality. The sensitivity and specificity of the various scoring systems was analysed by plotting receiver operating characteristic (ROC) curves and computing the area under the curve for each of the mortality predicting tools. NPMP, APACHE II, SAPS II, MPM72 II, SOFA, and VAP-PIRO were found to have similar and acceptable discrimination power as assessed by the area under the ROC curve. The AUC values for the above scores ranged from 0.735 to 0.762. CPIS and MODS showed least discrimination. NPMP is a specific tool to predict mortality in nosocomial pneumonia and is comparable to other standard scores. Copyright © 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  4. Chronic Klebsiella pneumonia: a rare manifestation of Klebsiella pneumonia

    OpenAIRE

    Boonsarngsuk, Viboon; Thungtitigul, Poungrat; Suwatanapongched, Thitiporn

    2015-01-01

    K. pneumoniae can present as two forms of community-acquired pneumonia, acute and chronic. Although acute pneumonia may turn into necrotizing pneumonia, which results in a prolonged clinical course, it often has a rapidly progressive clinical course. In contrast, chronic Klebsiella pneumonia runs a protracted indolent course that mimics other chronic pulmonary infections and malignancies. Herein, we present two cases of chronic Klebsiella pneumonia. The diagnosis was made by microorganism ide...

  5. Fibrosing organising pneumonia.

    Science.gov (United States)

    Beardsley, Brooke; Rassl, Doris

    2013-10-01

    Organising pneumonia (otherwise referred to as bronchiolitis obliterans organising pneumonia) is characterised histologically by plugs of granulation tissue, which are present predominantly within small airways, alveolar ducts and peri-bronchiolar alveoli. This pattern is not specific for any disorder or cause, but is one type of inflammatory response to pulmonary injury, which may be seen in a wide variety of clinical conditions. Typically, organising pneumonia responds very well to corticosteroid treatment; however, a small percentage of patients appear to develop progressive fibrosis.

  6. Higiene bucal: prática relevante na prevenção de pneumonia hospitalar em pacientes em estado crítico Higiene bucal: práctica relevante en la prevención de neumonía hospitalaria en pacientes en estado crítico Oral hygiene: a relevant practice to prevent hospital pneumonia in critically ill patients

    Directory of Open Access Journals (Sweden)

    Isa Rodrigues da Silveira

    2010-10-01

    Full Text Available Este artigo objetivou atualizar o conhecimento a respeito dos aspectos microbiológicos da cavidade oral e sua relação com a higiene bucal na prevenção da pneumonia associada à ventilação mecânica. Estudos analisados têm sido favoráveis ao uso de antissépticos para descontaminação da orofaringe, embora ainda não exista uma padronização de condutas a respeito da técnica e produtos.Este artículo tuvo por objetivo actualizar el conocimiento sobre aspectos microbiológicos de la cavidad oral y verificar la relación de la higiene bucal con la prevención de la neumonía asociada a la ventilación mecánica. Los estudios analizados se han mostrado favorables al uso de antisépticos para descontaminar la cavidad oral y la faringe, a pesar de que todavía no existe una estandarización de conductas sobre la técnica y de los productos utilizados en ese proceso.The objective of this article was to update knowledge on the microbiological aspects of the oral cavity and, verify the relation of oral hygiene with the prevention of pneumonia associated with mechanical ventilation. The studies analyzed were in favor of the use of antiseptics for decontaminating the oral cavity and pharynx, although there is still no standardization of procedures on the technique and products used in this process.

  7. Comparative study of community-acquired pneumonia caused by Streptococcus pneumoniae, Legionella pneumophila or Chlamydia pneumoniae.

    Science.gov (United States)

    Sopena, Nieves; Pedro-Botet, Maria Luisa; Sabrià, Miquel; García-Parés, Delia; Reynaga, Esteban; García-Nuñez, Marian

    2004-01-01

    The objective of this study was to compare epidemiological data and clinical presentation of community-acquired pneumonia (CAP) caused by Streptococcus pneumoniae, Legionella pneumophila or Chlamydia pneumoniae. From May 1994 to February 1996, 157 patients with S. pneumoniae (n = 68), L. pneumophila (n = 48) and C. pneumoniae (n = 41) pneumonia with definitive diagnosis, were prospectively studied. The following comparisons showed differences at a level of at least p pneumoniae pneumonia had more frequently underlying diseases (HIV infection and neoplasm) and those with C. pneumoniae pneumonia were older and had a higher frequency of chronic obstructive pulmonary disease (COPD), while L. pneumophila pneumonia prevailed in patients without comorbidity, but with alcohol intake. Presentation with cough and expectoration were significantly more frequent in patients with S. pneumoniae or C. pneumoniae pneumonia, while headache, diarrhoea and no response to betalactam antibiotics prevailed in L. pneumophila pneumonia. However, duration of symptoms > or = 7 d was more frequent in C. pneumoniae pneumonia. Patients with CAP caused by L. pneumophila presented hyponatraemia and an increase in CK more frequently, while AST elevation prevailed in L. pneumophila and C. pneumoniae pneumonia. In conclusion, some risk factors and clinical characteristics of patients with CAP may help to broaden empirical therapy against atypical pathogens until rapid diagnostic tests are available.

  8. Symptoms, Diagnosis and Treatment of Pneumonia

    Science.gov (United States)

    ... Lung Health and Diseases > Lung Disease Lookup > Pneumonia Pneumonia Symptoms, Causes, and Risk Factors Anyone can get ... risk for pneumonia. What Are the Symptoms of Pneumonia? Pneumonia symptoms can vary from mild to severe, ...

  9. Self-limiting pneumonia due to Chlamydia pneumoniae.

    Science.gov (United States)

    Miyashita, Naoyuki; Fukano, Hiroshi; Mouri, Keiji; Fukuda, Minoru; Yoshida, Koichiro; Kobashi, Yoshihiro; Niki, Yoshihito; Oka, Mikio

    2005-08-01

    A case of self-limiting pneumonia due to Chlamydia pneumoniae is described. A 39-year-old male visited our hospital complaining of a persistent cough. No antibiotics were administered to this patient because of the absence of fever and a mild positive inflammatory response, but an infiltrate on a chest radiograph improved. Finally, a diagnosis of C. pneumoniae pneumonia was made by seroconversion of the C. pneumoniae-specific antibody and detection of the C. pneumoniae gene in bronchoalveolar lavage fluid. Self-limiting C. pneumoniae pneumonia is rarely encountered, although self-limiting upper respiratory tract infections due to C. pneumoniae are common. Thus, most self-limiting C. pneumoniae pneumonia may be missed when symptoms are minimal.

  10. Top 9 Ways to Reduce the Risk of Pneumonia If You or a Loved One Is Hospitalized

    Science.gov (United States)

    ... of organisms, including bacteria, viruses and fungi, can cause pneumonia. Certain people are more likely to get sick ... Other vaccines that can help prevent diseases that cause pneumonia are Haemophilus influenzae type b vaccine (Hib), pertussis, ...

  11. Respective impact of implementation of prevention strategies, colonization with multiresistant bacteria and antimicrobial use on the risk of early- and late-onset VAP: An analysis of the OUTCOMEREA network.

    Directory of Open Access Journals (Sweden)

    Wafa Ibn Saied

    Full Text Available The impact of prevention strategies and risk factors for early-onset (EOP versus late-onset (LOP ventilator-associated pneumonia (VAP are still debated.To evaluate, in a multicenter cohort, the risk factors for EOP and LOP, as the evolution of prevention strategies.7,784 patients with mechanical ventilation (MV for at least 48 hours were selected into the multicenter prospective OUTCOMEREA database (1997-2016. VAP occurring between the 3rd and 6th day of MV defined EOP, while those occurring after defined LOPs. We used a Fine and Gray subdistribution model to take the successful extubation into account as a competing event.Overall, 1,234 included patients developed VAP (EOP: 445 (36%; LOP: 789 (64%. Male gender was a risk factor for both EOP and LOP. Factors specifically associated with EOP were admission for respiratory distress, previous colonization with multidrug-resistant Pseudomonas aeruginosa, chest tube and enteral feeding within the first 2 days of MV. Antimicrobials administrated within the first 2 days of MV were all protective of EOP. ICU admission for COPD exacerbation or pneumonia were early risk factors for LOP, while imidazole and vancomycin use within the first 2 days of MV were protective factors. Late risk factors (between the 3rd and the 6th day of MV were the intra-hospital transport, PAO2-FIO2<200 mmHg, vasopressor use, and known colonization with methicillin-resistant Staphylococcus aureus. Among the antimicrobials administered between the 3rd and the 6th day, fluoroquinolones were the solely protective one.Contrarily to LOP, the risk of EOP decreased across the study time periods, concomitantly with an increase in the compliance with bundle of prevention measures.VAP risk factors are mostly different according to the pneumonia time of onset, which should lead to differentiated prevention strategies.

  12. Pneumocystis jirovecii pneumonia

    DEFF Research Database (Denmark)

    Cordonnier, Catherine; Cesaro, Simone; Maschmeyer, Georg

    2016-01-01

    Pneumocystis jirovecii can cause life-threatening pneumonia following treatment for haematological malignancies or after HSCT. The mortality rate of P. jirovecii pneumonia (PCP) in these patients is 30%-60%, especially after HSCT. The clinical presentation of PCP in haematology differs from...

  13. Mycoplasma pneumoniae Infections

    Science.gov (United States)

    ... younger than 5 years, they are a leading cause of pneumonia in school-aged children and young adults. Community- ... be given for more serious symptoms associated with pneumonia and ear infections. What Is the Prognosis? This infection often causes wheezing in children with asthma or reactive airways. ...

  14. Klebsiella pneumoniae Siderophores Induce Inflammation, Bacterial Dissemination, and HIF-1α Stabilization during Pneumonia.

    Science.gov (United States)

    Holden, Victoria I; Breen, Paul; Houle, Sébastien; Dozois, Charles M; Bachman, Michael A

    2016-09-13

    iron from its host by secreting siderophores, small iron-chelating molecules. Classically, siderophores are thought to worsen infections by promoting bacterial growth. In this study, we determined that siderophore-secreting K. pneumoniae causes lung inflammation and bacterial dissemination to the bloodstream independently of bacterial growth. Furthermore, we determined that siderophore-secreting K. pneumoniae activates a host protein, hypoxia inducible factor (HIF)-1α, and requires it for siderophore-dependent bacterial dissemination. Although HIF-1α can protect against some infections, it appears to worsen infection with K. pneumoniae Together, these results indicate that bacterial siderophores directly alter the host response to pneumonia in addition to providing iron for bacterial growth. Therapies that disrupt production of siderophores could provide a two-pronged attack against K. pneumoniae infection by preventing bacterial growth and preventing bacterial dissemination to the blood. Copyright © 2016 Holden et al.

  15. Nurses' perceptions of standardised assessment and prevention of complications in an ICU.

    Science.gov (United States)

    Soh, Kim Lam; Davidson, Patricia M; Leslie, Gavin; DiGiacomo, Michelle; Soh, Kim Geok

    2013-03-01

    To describe nurses' perceptions of evidence-based recommendations to prevent complications in a Malaysian intensive care unit. Ventilator-associated pneumonia, catheter-related blood stream infection and pressure ulcer are three frequent adverse events in the intensive care unit. Implementing evidenced-based practice is critical in prevention of these complications. A qualitative focus group study. Focus groups were conducted with nurses in the intensive care unit of a regional hospital in Malaysia following evidence-based interventions. Focus group transcripts were analysed using the method of thematic analyses. Thirty-four nurses participated in eight focus groups. The main themes derived from the interviews: (1) nurses' knowledge impacts on the change process; (2) initial resistance, ambivalence and movement to acceptance; and (3) hierarchical organisational structure can hinder the change process. Enhancing nurses' knowledge and attitudes of evidence-based practice, providing them with tools to monitor their clinical practice, and empowering them to change practice are likely to be important in influencing clinical outcomes. Increasing the emphasis on evidence-based practice in nursing curricula and engaging in cultural change processes in the workplace are necessary to improve clinical outcomes. These findings provide valuable information for implementing clinical practice improvement interventions. © 2012 Blackwell Publishing Ltd.

  16. PENICILLIN–RESISTANT STREPTOCOCCUS PNEUMONIAE – A ...

    African Journals Online (AJOL)

    This is a review of literature on the epidemiology, mechanism of resistance, laboratory identification, treatment, prevention and control of Penicillin Resistant Pneumococci (PRP), with emphasis on the problems of identification and reporting in developing countries. Key Words: penicillin, Streptococcus pneumoniae, resistant ...

  17. Osteopontin promotes host defense during Klebsiella pneumoniae-induced pneumonia

    NARCIS (Netherlands)

    van der Windt, G. J. W.; Hoogerwerf, J. J.; de Vos, A. F.; Florquin, S.; van der Poll, T.

    2010-01-01

    Klebsiella pneumoniae is a common cause of nosocomial pneumonia. Osteopontin (OPN) is a phosphorylated glycoprotein involved in inflammatory processes, some of which is mediated by CD44. The aim of this study was to determine the role of OPN during K. pneumoniae-induced pneumonia. Wild-type (WT) and

  18. Relationship between functional independence measure and geriatric nutritional risk index in pneumonia patients in long-term nursing care facilities.

    Science.gov (United States)

    Mitani, Yuji; Oki, Yutaro; Fujimoto, Yukari; Yamaguchi, Takumi; Iwata, Kentaro; Watanabe, Yu; Takahashi, Kazuki; Yamada, Kanji; Ishikawa, Akira

    2017-10-01

    The prevention of pneumonia is an urgent issue among Japanese older adults. However, little has been reported on the relationship between a Functional Independence Measure (FIM) and the Geriatric Nutrition Risk Index (GNRI) for the prevention of pneumonia in patients in long-term care facilities in Japan. We aimed to clarify the relevance of FIM and GNRI for inpatients with and without pneumonia. We identified 233 patients who were hospitalized in our long-term nursing hospital from April 2012 to September 2013. We compared differences in FIM among GNRI classes for four groups: (i) pneumonia/high GNRI; (ii) pneumonia/low GNRI; (iii) no pneumonia/high GNRI; and (iv) no pneumonia/low GNRI. To assess the pneumonia predictors, we used a logistic regression for long-term nursing patients. Receiver operating characteristic analysis showed cut-off values and the area under the curve. A total of 88 (37.8%) of 233 inpatients had pneumonia. FIM of the pneumonia/low GNRI groups was significantly lower than that of the no pneumonia/high and low GNRI groups. Logistic regression showed that FIM (P pneumonia. The cut-off values for FIM and GNRI were 26.6 (P pneumonia. FIM and GNRI are useful predictor tools that could help to prevent pneumonia in Japanese patients in long-term care facilities. Geriatr Gerontol Int 2017; 17: 1617-1622. © 2016 Japan Geriatrics Society.

  19. Infection Prevention Practices in Japan, Thailand, and the United States: Results From National Surveys.

    Science.gov (United States)

    Krein, Sarah L; Greene, M Todd; Apisarnthanarak, Anucha; Sakamoto, Fumie; Tokuda, Yasuharu; Sakihama, Tomoko; Fowler, Karen E; Ratz, David; Saint, Sanjay

    2017-05-15

    Numerous evidence-based practices for preventing device-associated infections are available, yet the extent to which these practices are regularly used in acute care hospitals across different countries has not been compared, to our knowledge. Data from hospital surveys conducted in Japan, the United States, and Thailand in 2012, 2013, and 2014, respectively, were evaluated to determine the use of recommended practices to prevent central line-associated bloodstream infection (CLABSI), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infection (CAUTI). The outcomes were the percentage of hospitals reporting regular use (a score of 4 or 5 on a scale from 1 [never use] to 5 [always use]) of each practice across countries and identified hospital characteristics associated with the use of selected practices in each country. Survey response rates were 71% in Japan and the United States and 87% in Thailand. A majority of hospitals in Japan (76.6%), Thailand (63.2%), and the United States (97.8%) used maximum barrier precautions for preventing CLABSI and semirecumbent positioning to prevent VAP (66.2% for Japan, 86.7% for Thailand, and 98.7% for the United States). Nearly all hospitals (>90%) in Thailand and the United States reported monitoring CLABSI, VAP, and CAUTI rates, whereas in Japan only CLABSI rates were monitored by a majority of hospitals. Regular use of CAUTI prevention practices was variable across the 3 countries, with only a few practices adopted by >50% of hospitals. A majority of hospitals in Japan, Thailand, and the United States have adopted certain practices to prevent CLABSI and VAP. Opportunities for targeting prevention activities and reducing device-associated infection risk in hospitals exist across all 3 countries.

  20. Pneumonia a Varicella zoster Varicella zoster pneumonia

    Directory of Open Access Journals (Sweden)

    Carla Ferreira Santos

    2010-06-01

    Full Text Available A varicela é uma doença infecto contagiosa comum na infância, ocorrendo pouco mais de 2% dos casos em adultos. Desde a década de 80 que a sua incidência nos adultos tem vindo a aumentar, dos quais apenas 7% são seronegativos¹. A pneumonia a Varicella zoster, se bem que rara, constitui a complicação mais grave e mais frequente no adulto. Os autores apresentam um caso clínico ilustrativo de pneumonia a Varicella zoster num adulto fumador e imunocompetente e fazem uma breve revisão teórica sobre o tema.Varicella (chickenpox is a common contagious infection of childhood, with fewer than 2% of the cases occurring in adults. Since the early 1980s the incidence of chickenpox in adults has been increasing and only 7% of them are seronegative for Varicella zoster antibodies. Pneumonia, although rare, is the most common and serious complication of chickenpox infection in adults. The authors present an illustrative case of varicella pneumonia in an immunocompetent adult with smoking habits and make a brief thematic review.

  1. [Analysis of pathogens of pneumonia in children based on association rules].

    Science.gov (United States)

    Mao, Xiaojian; Wang, Heyong; An, Dong

    2012-12-01

    The present paper was aimed to study the relationship between the pneumonia clinical features and the pathogens of pneumonia in children by making use of association rules based on the clinical data of 6 300 cases of pneumonia. Through software analysis, the different association relationship can be obtained between different clinical features of pneumonia in children, such as gender, age and region, etc., and the pathogens of pneumonia. For example, children of different sex with the same pathogen showed different association relationships. Due to the different association relationships between the pneumonia clinical features and the pathogens of pneumonia in children of Guangzhou area, different methods in prevention and treatment of children's pneumonia should be adopted according to actual condition, in order to achieve the best results.

  2. Republished: Fibrosing organising pneumonia.

    Science.gov (United States)

    Beardsley, Brooke; Rassl, Doris

    2014-08-01

    Organising pneumonia (otherwise referred to as bronchiolitis obliterans organising pneumonia) is characterised histologically by plugs of granulation tissue, which are present predominantly within small airways, alveolar ducts and peri-bronchiolar alveoli. This pattern is not specific for any disorder or cause, but is one type of inflammatory response to pulmonary injury, which may be seen in a wide variety of clinical conditions. Typically, organising pneumonia responds very well to corticosteroid treatment; however, a small percentage of patients appear to develop progressive fibrosis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  3. [Acute rhabdomyolysis during pneumococcal pneumonia: two cases].

    Science.gov (United States)

    Aouina, H; Aïssa, I; Baccar, M A; Gharbi, L; Azzabi, S; Bouacha, H

    2007-04-01

    Acute rhabdomyolysis is a clinical and biological syndrome generally with a toxic or traumatic cause. Only 5% of cases are infectious, and rarely in relation to a pneumococcal infection. We report two cases of acute rhabdomyolysis which developed in patients with severe Streptococcus pneumoniae pneumonia. No other cause could be identified in these two patients aged 32 and 37 years. Rhabdomyolysis was discovered in the first patient because of acute kidney failure and elevated serum transaminase levels. The second patient presented an inflammatory edema affecting the soft tissues. Blood cultures isolated a pneumococcus in both patients. The rhabdomyolysis regressed favorably in both patients despite the transient renal failure in the first patient. Prognosis is generally poor for rhabdomyolysis during the course of pneumococcal pneumonia, with increased morbidity and mortality for these infections. Early detection of bacteriemia enables rapid and adequate treatment and prevention of renal failure.

  4. Emergence of Klebsiella pneumoniae ST273 Carrying blaNDM-7 and ST656 Carrying blaNDM-1 in Manila, Philippines.

    Science.gov (United States)

    Chou, Andrew; Roa, Marylette; Evangelista, Michael A; Sulit, Arielle Kae; Lagamayo, Evelina; Torres, Brian C; Klinzing, David C; Daroy, Maria Luisa G; Navoa-Ng, Josephine; Sucgang, Richard; Zechiedrich, Lynn

    2016-10-01

    We sought to determine the epidemiology of carbapenem-resistant Enterobacteriaceae and to investigate the emergence of carbapenem-resistant Klebsiella pneumoniae in two teaching hospitals in Manila, Philippines. We screened 364 Enterobacteriaceae for carbapenem resistance between 2012 and 2013 and detected four carbapenem-resistant K. pneumoniae isolates from three different patients. We used whole genome sequencing to determine the antibiotic resistance profiles and confirmed the presence of carbapenemase genes by multiplex PCR. We used multilocus sequence typing and PCR-based replicon typing to genetically characterize the carbapenem-resistant isolates. The carbapenemase gene blaNDM was detected in K. pneumoniae isolates from two patients. The first patient had ventilator-associated pneumonia and lumbar shunt infection from K. pneumoniae ST273 carrying blaNDM-7. The second patient had asymptomatic genitourinary colonization with K. pneumoniae ST656 carrying blaNDM-1. The third patient had a gluteal abscess with K. pneumoniae ST1 that did not carry a carbapenemase gene, but did carry blaDHA-1, blaOXA-1, and blaSHV-1. In this study, we report the first cases of blaNDM-carrying pathogens in the Philippines and add to the growing evidence of the worldwide spread of ST273 and NDM-7, a more efficient carbapenem hydrolyzer than NDM-1.

  5. The management of pneumonia in internal medicine.

    Science.gov (United States)

    Bouza, E; Giannella, M; Pinilla, B; Pujol, R; Capdevila, J A; Muñoz, P

    2013-01-01

    Pneumonia generates a high workload for internal medicine departments. Management of this disease is challenging, because patients are usually elderly and have multiple comorbid conditions. Furthermore, the interpretation and adherence to guidelines are far from clear in this setting. We report the opinion of 43 internists especially interested in infectious diseases that were questioned at the 2011 XXXII National Conference of Spanish Society of Internal Medicine about the main issues involved in the management of pneumonia in the internal medicine departments, namely, classification, admission criteria, microbiological workup, therapeutic management, discharge policy, and prevention of future episodes. Participants were asked to choose between 2 options for each statement by 4 investigators. Consensus could not be reached in many cases. The most controversial issues concerned recognition and management of healthcare-associated pneumonia (HCAP). Most participants were aware of the differences in terms of underlying diseases, etiological distribution, and outcome of HCAP compared with community-acquired pneumonia, but only a minority agreed to manage HCAP as hospital-acquired pneumonia, as suggested by some guidelines. A clinical patient-to-patient approach proved to be the option preferred by internists in the management of HCAP. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  6. Chlamydia pneumoniae and Mycoplasma pneumoniae pneumonia: comparison of clinical, epidemiological characteristics and laboratory profiles.

    Science.gov (United States)

    Puljiz, I; Kuzman, I; Dakovic-Rode, O; Schönwald, N; Mise, B

    2006-06-01

    The purpose of our retrospective 3-year study was to analyse and compare clinical and epidemiological characteristics in hospitalized patients older than 6 years with community-acquired pneumonia (CAP) caused by Chlamydia pneumoniae (87 patients) and Mycoplasma pneumoniae (147 patients). C. pneumoniae and M. pneumoniae infection was confirmed by serology. C. pneumoniae patients were older (42.12 vs. 24.64 years), and were less likely to have a cough, rhinitis, and hoarseness (Ppneumoniae patients had higher levels of C-reactive protein (CRP), and aspartate aminotransferase (AST) than M. pneumoniae patients (Ppneumoniae (8.84 vs. 3.37%). There were no characteristic epidemiological and clinical findings that would distinguish CAP caused by M. pneumoniae from C. pneumoniae. However, some factors are indicative for C. pneumoniae such as older age, lack of cough, rhinitis, hoarseness, and higher value of CRP, and AST.

  7. Review and analysis of existing mobile phone applications for health care-associated infection prevention.

    Science.gov (United States)

    Schnall, Rebecca; Iribarren, Sarah J

    2015-06-01

    The expanding number of mobile health applications (apps) holds potential to reduce and eliminate health care-associated infections (HAIs) in clinical practice. The purpose of this review was to identify and provide an overview of the apps available to support prevention of HAIs and to assess their functionality and potential uses in clinical care. We searched 3 online mobile app stores using the following terms: infection prevention, prevention, hand hygiene, hand washing, and specific HAI terms (catheter-associated urinary tract infection [CAUTI], central line-associated bloodstream infections, surgical site infection, and ventilator associated pneumonia [VAP]). Search queries yielded a total of 2,646 potentially relevant apps, of which 17 met our final inclusion criteria. The areas of focus were CAUTI (n = 1, 5.9%), VAP (n = 1, 5.9%), environmental monitoring (n = 2, 11.8%), and hand hygiene (n = 2, 11.8%); the remainder (n = 11, 64.7%) were focused on >1 area (eg, multiple infection prevention bundles, infection prevention guidelines). Almost all of the apps (70.6%) had a maximum of two functions. Mobile apps may help reduce HAI by providing easy access to guidelines, hand hygiene monitoring support, or step-by-step procedures aimed at reducing infections at the point of clinical care. Given the dearth of available apps and the lack of functionality with those that are available, there is a need for further development of mobile apps for HAI prevention at the point of care. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  8. Hospital-acquired pneumonia

    Science.gov (United States)

    ... get pneumonia while in the hospital if they: Abuse alcohol Have had chest surgery or other major ... Treatments may include: Antibiotics through your veins (IV) to treat the lung infection. The antibiotic you are given will fight the germs that ...

  9. How Is Pneumonia Diagnosed?

    Science.gov (United States)

    ... can occur if pneumonia is not treated. The pleura is a membrane that consists of two large, ... Pleurisy is when the two layers of the pleura become irritated and inflamed, causing sharp pain each ...

  10. How Is Pneumonia Treated?

    Science.gov (United States)

    ... can occur if pneumonia is not treated. The pleura is a membrane that consists of two large, ... Pleurisy is when the two layers of the pleura become irritated and inflamed, causing sharp pain each ...

  11. What Is Pneumonia?

    Science.gov (United States)

    ... can occur if pneumonia is not treated. The pleura is a membrane that consists of two large, ... Pleurisy is when the two layers of the pleura become irritated and inflamed, causing sharp pain each ...

  12. [Varicella zoster pneumonia].

    Science.gov (United States)

    Ferreira Santos, Carla; Gomes, Ana; Garrido, António; Albuquerque, Ana; Melo, Eduardo; Barros, Inês; Marques, António; Saraiva, José Pedro

    2010-01-01

    Varicella (chickenpox) is a common contagious infection of childhood, with fewer than 2% of the cases occurring in adults. Since the early 1980s the incidence of chickenpox in adults has been increasing and only 7% of them are seronegative for Varicella zoster antibodies. Pneumonia, although rare, is the most common and serious complication of chickenpox infection in adults. The authors present an illustrative case of varicella pneumonia in an immunocompetent adult with smoking habits and make a brief thematic review.

  13. Pneumonia a Varicella zoster

    Directory of Open Access Journals (Sweden)

    Carla Ferreira Santos

    2010-05-01

    Full Text Available Resumo: A varicela é uma doença infectocontagiosa comum na infância, ocorrendo pouco mais de 2% dos casos em adultos. Desde a década de 80 que a sua incidência nos adultos tem vindo a aumentar, dos quais apenas 7% são seronegativos1. A pneumonia a Varicella zoster, se bem que rara, constitui a complicação mais grave e mais frequente no adulto.Os autores apresentam um caso clínico ilustrativo de pneumonia a Varicella zoster num adulto fumador e imunocompetente e fazem uma breve revisão teórica sobre o tema.Rev Port Pneumol 2010; XVI (3: 493-505 Abstract: Varicella (chickenpox is a common contagious infection of childhood, with fewer than 2% of the cases occurring in adults. Since the early 1980s the incidence of chickenpox in adults has been increasing and only 7% of them are seronegative for Varicella zoster antibodies. Pneumonia, although rare, is the most common and serious complication of chickenpox infection in adults.The authors present an illustrative case of varicella pneumonia in an immunocompetent adult with smoking habits and make a brief thematic review.Rev Port Pneumol 2010; XVI (3: 493-505 Palavras-chave: Varicela, pneumonia, ARDS, Key-words: Chickenpox, pneumonia, ARDS

  14. Pneumonia a Varicella zoster

    Directory of Open Access Journals (Sweden)

    Carla Ferreira Santos

    2010-05-01

    Full Text Available Resumo: A varicela é uma doença infecto contagiosa comum na infância, ocorrendo pouco mais de 2% dos casos em adultos. Desde a década de 80 que a sua incidência nos adultos tem vindo a aumentar, dos quais apenas 7% são seronegativos1. A pneumonia a Varicella zoster, se bem que rara, constitui a complicação mais grave e mais frequente no adulto.Os autores apresentam um caso clínico ilustrativo de pneumonia a Varicella zoster num adulto fumador e imunocompetente e fazem uma breve revisão teórica sobre o tema. Abstract: Varicella (chickenpox is a common contagious infection of childhood, with fewer than 2% of the cases occurring in adults. Since the early 1980s the incidence of chickenpox in adults has been increasing and only 7% of them are seronegative for Varicella zoster antibodies. Pneumonia, although rare, is the most common and serious complication of chickenpox infection in adults.The authors present an illustrative case of varicella pneumonia in an immunocompetent adult with smoking habits and make a brief thematic review. Palavras-chave: Varicela, pneumonia, ARDS, Key-words: Chickenpox, pneumonia, ARDS

  15. Prevention

    Science.gov (United States)

    Kerry Britton; Barbara Illman; Gary Man

    2010-01-01

    Prevention is considered the most cost-effective element of the Forest Service Invasive Species Strategy (USDA Forest Service 2004). What makes prevention difficult is the desire to maximize free trade and the resulting benefits to society while, at the same time, protecting natural resources. The role of science is to first identify which commodities pose an...

  16. Prevention

    DEFF Research Database (Denmark)

    Halken, S; Høst, A

    2001-01-01

    , breastfeeding should be encouraged for 4-6 months. In high-risk infants a documented extensively hydrolysed formula is recommended if exclusive breastfeeding is not possible for the first 4 months of life. There is no evidence for preventive dietary intervention neither during pregnancy nor lactation....... Preventive dietary restrictions after the age of 4-6 months are not scientifically documented....

  17. Prediction of pneumonia hospitalization in adults using health checkup data.

    Science.gov (United States)

    Uematsu, Hironori; Yamashita, Kazuto; Kunisawa, Susumu; Otsubo, Tetsuya; Imanaka, Yuichi

    2017-01-01

    Community-acquired pneumonia is a common cause of hospitalization, and pneumococcal vaccinations are recommended for high-risk individuals. Although risk factors for pneumonia have been identified, there are currently no pneumonia hospitalization prediction models based on the risk profiles of healthy subjects. This study aimed to develop a predictive model for pneumonia hospitalization in adults to accurately identify high-risk individuals to facilitate the efficient prevention of pneumonia. We conducted a retrospective database analysis using health checkup data and health insurance claims data for residents of Kyoto prefecture, Japan, between April 2010 and March 2015. We chose adults who had undergone health checkups in the first year of the study period, and tracked pneumonia hospitalizations over the next 5 years. Subjects were randomly divided into training and test sets. The outcome measure was pneumonia hospitalization, and candidate predictors were obtained from the health checkup data. The prediction model was developed and internally validated using a LASSO logistic regression analysis. Lastly, we compared the new model with comparative models. The study sample comprised 54,907 people who had undergone health checkups. Among these, 921 were hospitalized for pneumonia during the study period. The c-statistic for the prediction model in the test set was 0.71 (95% confidence interval: 0.69-0.73). In contrast, a comparative model with only age and comorbidities as predictors had a lower c-statistic of 0.55 (95% confidence interval: 0.54-0.56). Our predictive model for pneumonia hospitalization performed better than comparative models, and may be useful for supporting the development of pneumonia prevention measures.

  18. Childhood Pneumonia and under-five morbidity and mortality at the ...

    African Journals Online (AJOL)

    Background: Childhood mortality which remains high in children under the age of 5years is largely due to infectious and other preventable causes such as Human immunodeficiency virus/ Acquired Immunodeficiency Syndrome ((HIV/AIDS), pneumonia and malaria1 . The prevention of pneumonia deaths is therefore an ...

  19. Interaction of lipocalin 2, transferrin, and siderophores determines the replicative niche of Klebsiella pneumoniae during pneumonia.

    Science.gov (United States)

    Bachman, Michael A; Lenio, Steven; Schmidt, Lindsay; Oyler, Jennifer E; Weiser, Jeffrey N

    2012-11-20

    Pathogenic bacteria require iron for replication within their host. Klebsiella pneumoniae and other Gram-negative pathogens produce the prototypical siderophore enterobactin (Ent) to scavenge iron in vivo. In response, mucosal surfaces secrete lipocalin 2 (Lcn2), an innate immune protein that binds Ent to disrupt bacterial iron acquisition and promote acute inflammation during colonization. A subset of K. pneumoniae isolates attempt to evade Lcn2 by producing glycosylated Ent (Gly-Ent, salmochelin) or the alternative siderophore yersiniabactin (Ybt). However, these siderophores are not functionally equivalent and differ in their abilities to promote growth in the upper respiratory tract, lungs, and serum. To understand how Lcn2 exploits functional differences between siderophores, isogenic mutants of an Ent(+) Gly-Ent(+) Ybt(+) K. pneumoniae strain were inoculated into Lcn2(+/+) and Lcn2(-/-) mice, and the pattern of pneumonia was examined. Lcn2 effectively protected against the iroA ybtS mutant (Ent(+) Gly-Ent(-) Ybt(-)). Lcn2(+/+) mice had small foci of pneumonia, whereas Lcn2(-/-) mice had many bacteria in the perivascular space. The entB mutant (Ent(-) Ybt(+) Gly-Ent(-)) caused moderate bronchopneumonia but did not invade the transferrin-containing perivascular space. Accordingly, transferrin blocked Ybt-dependent growth in vitro. The wild type and the iroA mutant, which both produce Ent and Ybt, had a mixed phenotype, causing a moderate bronchopneumonia in Lcn2(+/+) mice and perivascular overgrowth in Lcn2(-/-) mice. Together, these data indicate that Lcn2, in combination with transferrin, confines K. pneumoniae to the airways and prevents invasion into tissue containing the pulmonary vasculature. Gram-negative bacteria are a common cause of severe hospital-acquired infections. To cause disease, they must obtain iron and secrete the small molecule enterobactin to do so. Animal models of pneumonia using Klebsiella pneumoniae indicate that enterobactin promotes

  20. Pathophysiology of Escherichia coli pneumonia: Respective contribution of pathogenicity islands to virulence.

    Science.gov (United States)

    Phillips-Houlbracq, Mathilde; Ricard, Jean-Damien; Foucrier, Arnaud; Yoder-Himes, Deborah; Gaudry, Stéphane; Bex, Julie; Messika, Jonathan; Margetis, Dimitri; Chatel, Jérémie; Dobrindt, Ulrich; Denamur, Erick; Roux, Damien

    2018-03-01

    Ventilator-associated pneumonia (VAP) remains the most frequent life-threatening nosocomial infection. Enterobacteriaceae including Escherichia coli are increasingly involved. If a cumulative effect of pathogenicity islands (PAIs) has been shown for E. coli virulence in urinary tract or systemic infections, very little is known regarding pathophysiology of E. coli pneumonia. This study aimed to determine the role of each of the 7 PAIs present in pathogenic E. coli strain 536 in pneumonia pathophysiology. We used mutant strains to screen pathophysiological role of PAI in a rat pneumonia model. We also test individual gene mutants within PAI identified to be involved in pneumonia pathogenesis. Finally, we determined the prevalence of these genes of interest in E. coli isolates from feces and airways of ventilated patients. Only PAIs I and III were significantly associated with rat pneumonia pathogenicity. Only the antigen-43 (Ag43) gene in PAI III was significantly associated with bacterial pathogenicity. The prevalence of tested genes in fecal and airway isolates of ventilated patients did not differ between isolates. In contrast, genes encoding Ag43, the F17-fimbriae subunits, HmuR and SepA were more prevalent in VAP isolates with statistical significance for hmuR when compared to airway colonizing isolates. The E. coli PAIs involved in lung pathogenicity differed from those involved in urinary tract and bloodstream infections. Overall, extraintestinal E. coli virulence seems to rely on a combination of numerous virulence genes that have a cumulative effect depending on the infection site. Copyright © 2018 Elsevier GmbH. All rights reserved.

  1. C. pneumoniae community-acquired pneumonia (CAP) in mimicking Mycoplasma pneumoniae meningoencephalitis complicated by asthma.

    Science.gov (United States)

    Cunha, Burke A; Pherez, Francisco M

    2009-01-01

    Chlamydophila (Chlamydia) pneumoniae is a common, non-zoonotic cause of community-acquired pneumonia (CAP) in ambulatory young adults. C. pneumoniae clinically presents as a mycoplasma-like illness frequently accompanied by laryngitis. C. pneumoniae CAP may also cause nursing home outbreaks in the elderly. Similar to Mycoplasma pneumoniae in immunocompetent hosts, C. pneumoniae CAP usually manifests as a mild/moderately severe CAP. In contrast with Legionnaire's disease, central nervous system involvement is usually not a feature of C. pneumoniae CAP. M. pneumoniae may rarely present with meningoencephalitis accompanied by high cold agglutinin titers. We present the case of a young man who presented with M. pneumoniae-like illness and was hospitalized for severe CAP that was accompanied by a pertussis-like cough and severe headache. Although his chest x-ray showed a right upper lobe infiltrate, a lumbar puncture was performed to rule out meningitis, but his cerebrospinal fluid profile was unremarkable. Titers for non-zoonotic atypical pneumonia pathogens were negative except for a highly elevated C. pneumoniae immunoglobulin-M titer (1:320). Testing for legionella and pertussis was negative. Q fever and adenoviral titers were also negative. Cold agglutinin titers were repeatedly negative. The patient was successfully treated with moxifloxacin but developed permanent asthma after C. pneumoniae CAP. This case is unusual in several aspects. First, C. pneumoniae usually presents as a mild to moderate CAP, but in this case it was severe. Second, hoarseness was absent, which would have suggested C. pneumoniae. Third, wheezing was an important clue to the diagnosis of C. pneumoniae, which is not a clinical finding with other causes of CAP. Fourth, permanent asthma may follow C. pneumoniae, as well as M. pneumoniae CAP. Fifth, severe headache mimicking M. pneumoniae meningoencephalitis may rarely accompany C. pneumoniae CAP.

  2. Prevention

    Science.gov (United States)

    ... Tips Latest Research Getting More Help Related Topics Cancer COPD Dementia Depression Diabetes Drug and Substance Abuse Falls Prevention Hearing Loss Heart Attack High Blood Pressure Nutrition Osteoporosis Shingles Skin Cancer Related News Quitting Smoking, ...

  3. Lung-Protective Ventilation Strategies for Relief from Ventilator-Associated Lung Injury in Patients Undergoing Craniotomy: A Bicenter Randomized, Parallel, and Controlled Trial

    Directory of Open Access Journals (Sweden)

    Chaoliang Tang

    2017-01-01

    Full Text Available Current evidence indicates that conventional mechanical ventilation often leads to lung inflammatory response and oxidative stress, while lung-protective ventilation (LPV minimizes the risk of ventilator-associated lung injury (VALI. This study evaluated the effects of LPV on relief of pulmonary injury, inflammatory response, and oxidative stress among patients undergoing craniotomy. Sixty patients undergoing craniotomy received either conventional mechanical (12 mL/kg tidal volume [VT] and 0 cm H2O positive end-expiratory pressure [PEEP]; CV group or protective lung (6 mL/kg VT and 10 cm H2O PEEP; PV group ventilation. Hemodynamic variables, lung function indexes, and inflammatory and oxidative stress markers were assessed. The PV group exhibited greater dynamic lung compliance and lower respiratory index than the CV group during surgery (P0.05. Patients receiving LPV during craniotomy exhibited low perioperative inflammatory response, oxidative stress, and VALI.

  4. Successful Treatment of Klebsiella pneumoniae Harboring a Klebsiella pneumoniae Carbapenemase Isolated from Lumbar Wound Infection and Blood in a Patient with Hardware Retention

    OpenAIRE

    Alan Bulbin; Carol Bono; Tena Philp; Noriel Mariano; Carl Urban

    2017-01-01

    Infections caused by carbapenem-resistant Enterobacteriaceae, especially carbapenemase producing Klebsiella pneumoniae, represent an urgent threat as outlined by the Centers for Disease Control and Prevention (CDC). We present a 66-year-old male with spinal stenosis who underwent elective L2-pelvis posterior spinal fusion at an outside institution and rapidly developed a complicated infection with Klebsiella pneumoniae harboring Klebsiella pneumoniae carbapenemase. This is the first described...

  5. Epidemiology and Virulence of Klebsiella pneumoniae.

    Science.gov (United States)

    Clegg, Steven; Murphy, Caitlin N

    2016-02-01

    Strains of Klebsiella pneumoniae are frequently opportunistic pathogens implicated in urinary tract and catheter-associated urinary-tract infections of hospitalized patients and compromised individuals. Infections are particularly difficult to treat since most clinical isolates exhibit resistance to several antibiotics leading to treatment failure and the possibility of systemic dissemination. Infections of medical devices such as urinary catheters is a major site of K. pneumoniae infections and has been suggested to involve the formation of biofilms on these surfaces. Over the last decade there has been an increase in research activity designed to investigate the pathogenesis of K. pneumoniae in the urinary tract. These investigations have begun to define the bacterial factors that contribute to growth and biofilm formation. Several virulence factors have been demonstrated to mediate K. pneumoniae infectivity and include, but are most likely not limited to, adherence factors, capsule production, lipopolysaccharide presence, and siderophore activity. The development of both in vitro and in vivo models of infection will lead to further elucidation of the molecular pathogenesis of K. pneumoniae. As for most opportunistic infections, the role of host factors as well as bacterial traits are crucial in determining the outcome of infections. In addition, multidrug-resistant strains of these bacteria have become a serious problem in the treatment of Klebsiella infections and novel strategies to prevent and inhibit bacterial growth need to be developed. Overall, the frequency, significance, and morbidity associated with K. pneumoniae urinary tract infections have increased over many years. The emergence of these bacteria as sources of antibiotic resistance and pathogens of the urinary tract present a challenging problem for the clinician in terms of management and treatment of individuals.

  6. [Cryptogenic organising pneumonia].

    Science.gov (United States)

    Lazor, Romain

    2005-06-01

    Organising Pneumonia (formerly called Bronchiolitis Obliterans with Organising Pneumonia) is a particular form of inflammatory and fibroproliferative lung disease. Its idiopathic form called Cryptogenic Organising Pneumonia, was recently defined by an ATS/ERS consensus conference. The disease onset is subacute with cough, dyspnea, fever, asthenia, weight loss, crackles, and elevation of biological inflammatory markers. Bronchoalveolar lavage reveals a mixed alveolitis with elevated lymphocyte, neutrophil, and eosinophil counts. Chest imaging usually shows multifocal alveolar opacities predominating in the subpleural regions, often with a migratory pattern. Lung biopsy reveals budding connective tissue filling the distal airspaces. Diagnosis is established by combining clinical, radiological and histological criteria. Similarities with other disease processes can lead to delayed or erroneous diagnosis. Most patients respond well to corticosteroid therapy. Relapses are frequent but can generally be controlled with moderate doses of prednisone and do not worsen the prognosis. The therapeutic strategy aims at reducing the steroid doses while maintaining an optimal disease control.

  7. Community-acquired pneumonia.

    Science.gov (United States)

    Falguera, M; Ramírez, M F

    2015-11-01

    This article not only reviews the essential aspects of community-acquired pneumonia for daily clinical practice, but also highlights the controversial issues and provides the newest available information. Community-acquired pneumonia is considered in a broad sense, without excluding certain variants that, in recent years, a number of authors have managed to delineate, such as healthcare-associated pneumonia. The latter form is nothing more than the same disease that affects more frail patients, with a greater number of risk factors, both sharing an overall common approach. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  8. Pneumonia in Goilala.

    Science.gov (United States)

    Kevau, Isi Henao; Saweri, Adolf

    2010-01-01

    The clinical syndrome of pneumonia in adults in Port Moresby, the capital city of Papua New Guinea, has changed from the 1970s to the present. The severe lobar pneumonia commonly diagnosed in young adult men, characteristically from Goilala and living in settlements in Port Moresby, is no longer seen. Today pneumonia in adults is likely to be milder and bronchopneumonic in type. Possible explanations for the change include changes in immunity and in the bacteria found in the environment and carried in the nasopharynx of recent immigrants to the city. A change in treatment-seeking behaviour together with the wide availability of oral antibiotics is considered to be the most likely cause of the altered clinical syndrome that we have observed.

  9. Prevention

    Science.gov (United States)

    ... Protection Equipment (PPE) Sequence for Putting on Personal Protection Equipment (PPE) [PDF – 2.85MB] Select Your PPE Equipment Combination Guidance ... PDF, DOC, PPT, MPEG) on this site? Adobe PDF file Microsoft PowerPoint file Microsoft Word ... last updated: May 11, 2015 Content Source: Centers for Disease Control and Prevention National Center ...

  10. [Acute renal failure following Chlamydia pneumoniae pneumonia in a child].

    Science.gov (United States)

    Nasser, H; Dib Nehme, G; Camoin-Schweitzer, M-C; Andre, J-L

    2010-08-01

    Acute renal failure (ARF) following Chlamydia pneumoniae pneumonia is rarely reported in adults. We present an observation in a 10-year-old child, who had C. pneumoniae pneumonia treated with roxithromycin for a period of 10 days, without any other nephrotoxic drug, in particular nonsteroidal anti-inflammatory drugs. At the end of antibiotic treatment, he presented with asthenia, polyuria, polydipsia, increased plasma creatinine, metabolic acidosis, hypokalemia, and markers of tubular damage. The etiological investigations showed positive C. pneumoniae antibodies, increased serum concentrations of C3 and C4 complement, IgA, and IgG. No uveitis was noted. The diagnosis was tubulointerstitial nephropathy after C. pneumoniae pneumonia. C. pneumoniae pneumonia should be considered a differential diagnosis of community-acquired pneumonia, especially in cases of poor response to conventional antibiotic therapy. It may be associated with tubulointerstitial nephropathy and/or rapidly progressive glomerulonephritis whose severity varies in children as in adults. Early and effective treatment of C. pneumoniae infection with macrolide antibiotics usually provides favorable progression of renal function. Copyright (c) 2010 Elsevier Masson SAS. All rights reserved.

  11. Prevalence of Mycoplasma pneumoniae and Chlamydia pneumoniae in pneumonia patients in four major hospitals in Trinidad.

    Science.gov (United States)

    Nagalingam, N A; Adesiyun, A A; Swanston, W H; Bartholomew, M

    2004-10-01

    The prevalence of current Mycoplasma pneumoniae and Chlamydia pneumoniae infections in patients with pneumonia in Trinidad, and the relationship between pneumonia and risk factors were investigated. Blood samples were collected from 132 patients diagnosed by attending physicians, as suffering from pneumonia at four hospitals in Trinidad. Serum samples were tested for M. pneumoniae IgM and IgG and C. pneumoniae IgM by the enzyme immunoassay (EIA). In addition, C. pneumoniae IgM and IgG were detected using microimmunofluorescence (MIF). A comprehensive questionnaire which addressed demographic information as well as risk factors for pneumonia was administered to patients. All analyses were done using the Statistical Package for Social Sciences (SPSS), version 9. Seroprevalences of 46.0% (58 of 126) were found for C. pneumoniae Ig M/G, and 66.7% (88 of 132) for M. pneumoniae Ig M/G. The difference was statistically significant (p pneumoniae Ig M/acute Ig G and 28.8% (36 of 125) of M. pneumoniae IgM were not statistically significant (p > 0.05; chi2). Hospital, gender and ethnicity of patients did not significantly (p > 0.05; chi2) affect the seroprevalence of the bacteria assayed for. However, the prevalence of C. pneumoniae (23.3%) in patients under 21 years old compared to other age groups was statistically significant (p = 0.043; chi2). Overall, the seroprevalence to both pathogens was not significantly (p > 0.05; chi2) affected by comorbidities and signs/symptoms. It was concluded that new infections by C. pneumoniae in pneumonia patients may be an important aetiological agent for the condition in Trinidad.

  12. Community-acquired pneumonia among smokers.

    Science.gov (United States)

    Almirall, Jordi; Blanquer, José; Bello, Salvador

    2014-06-01

    Recent studies have left absolutely no doubt that tobacco increases susceptibility to bacterial lung infection, even in passive smokers. This relationship also shows a dose-response effect, since the risk reduces spectacularly 10 years after giving up smoking, returning to the level of non-smokers. Streptococcus pneumoniae is the causative microorganism responsible for community-acquired pneumonia (CAP) most frequently associated with smoking, particularly in invasive pneumococcal disease and septic shock. It is not clear how it acts on the progress of pneumonia, but there is evidence to suggest that the prognosis for pneumococcal pneumonia is worse. In CAP caused by Legionella pneumophila, it has also been observed that smoking is the most important risk factor, with the risk rising 121% for each pack of cigarettes smoked a day. Tobacco use may also favor diseases that are also known risk factors for CAP, such as periodontal disease and upper respiratory viral infections. By way of prevention, while giving up smoking should always be proposed, the use of the pneumococcal vaccine is also recommended, regardless of the presence of other comorbidities. Copyright © 2013 SEPAR. Published by Elsevier Espana. All rights reserved.

  13. Insulin Resistance in Critically Injured Adults: Contribution of Pneumonia, Diabetes, Nutrition, and Acuity.

    Science.gov (United States)

    Mukherjee, Kaushik; Sowards, Kendell J; Brooks, Steven E; Norris, Patrick R; Jenkins, Judith M; Smith, Miya A; Bonney, Paul M; Boord, Jeffrey B; May, Addison K

    2015-10-01

    Changes in insulin resistance (IR) cause stress-induced hyperglycemia after trauma, but the numerous factors involved in IR have not been delineated clearly. We hypothesized that a statistical model could help determine the relative contribution of different clinical co-variates to IR in critically injured patients. We retrospectively studied 726 critically injured patients managed with a computer-assisted glycemic protocol at an academic level I trauma center (639 ventilated controls without pneumonia (VWP) and 87 patients with ventilator-associated pneumonia (VAP). Linear regression using age, gender, body mass index (BMI), diabetes mellitus, pneumonia, and glycemic provision was used to estimate M, a marker of IR that incorporates both the serum blood glucose concentration (BG) and insulin dose. Increasing M (ppneumonia (10.9%; 95% CI 9.31%-12.6%), and glycemic provision (27.3% [95% CI 6.6%-28.1%] per 100 g of glucose). Total parenteral nutrition was associated with a decrease in M of 10.3%; 95% CI 8.52%-12.1%; p<0.001. Clinical factors can be used to construct a model of IR. Prospective validation might enable early detection and treatment of infection or other conditions associated with increased IR.

  14. Klebsiella pneumoniae survives within macrophages by avoiding delivery to lysosomes.

    Science.gov (United States)

    Cano, Victoria; March, Catalina; Insua, Jose Luis; Aguiló, Nacho; Llobet, Enrique; Moranta, David; Regueiro, Verónica; Brennan, Gerard P; Millán-Lou, Maria Isabel; Martín, Carlos; Garmendia, Junkal; Bengoechea, José A

    2015-11-01

    Klebsiella pneumoniae is an important cause of community-acquired and nosocomial pneumonia. Evidence indicates that Klebsiella might be able to persist intracellularly within a vacuolar compartment. This study was designed to investigate the interaction between Klebsiella and macrophages. Engulfment of K. pneumoniae was dependent on host cytoskeleton, cell plasma membrane lipid rafts and the activation of phosphoinositide 3-kinase (PI3K). Microscopy studies revealed that K. pneumoniae resides within a vacuolar compartment, the Klebsiella-containing vacuole (KCV), which traffics within vacuoles associated with the endocytic pathway. In contrast to UV-killed bacteria, the majority of live bacteria did not co-localize with markers of the lysosomal compartment. Our data suggest that K. pneumoniae triggers a programmed cell death in macrophages displaying features of apoptosis. Our efforts to identify the mechanism(s) whereby K. pneumoniae prevents the fusion of the lysosomes to the KCV uncovered the central role of the PI3K-Akt-Rab14 axis to control the phagosome maturation. Our data revealed that the capsule is dispensable for Klebsiella intracellular survival if bacteria were not opsonized. Furthermore, the environment found by Klebsiella within the KCV triggered the down-regulation of the expression of cps. Altogether, this study proves evidence that K. pneumoniae survives killing by macrophages by manipulating phagosome maturation that may contribute to Klebsiella pathogenesis. © 2015 John Wiley & Sons Ltd.

  15. Additive inhibition of complement deposition by pneumolysin and PspA facilitates Streptococcus pneumoniae septicemia.

    Science.gov (United States)

    Yuste, Jose; Botto, Marina; Paton, James C; Holden, David W; Brown, Jeremy S

    2005-08-01

    Streptococcus pneumoniae is a common cause of septicemia in the immunocompetent host. To establish infection, S. pneumoniae has to overcome host innate immune responses, one component of which is the complement system. Using isogenic bacterial mutant strains and complement-deficient immune naive mice, we show that the S. pneumoniae virulence factor pneumolysin prevents complement deposition on S. pneumoniae, mainly through effects on the classical pathway. In addition, using a double pspA-/ply- mutant strain we demonstrate that pneumolysin and the S. pneumoniae surface protein PspA act in concert to affect both classical and alternative complement pathway activity. As a result, the virulence of the pspA-/ply- strain in models of both systemic and pulmonary infection is greatly attenuated in wild-type mice but not complement deficient mice. The sensitivity of the pspA-/ply- strain to complement was exploited to demonstrate that although early innate immunity to S. pneumoniae during pulmonary infection is partially complement-dependent, the main effect of complement is to prevent spread of S. pneumoniae from the lungs to the blood. These data suggest that inhibition of complement deposition on S. pneumoniae by pneumolysin and PspA is essential for S. pneumoniae to successfully cause septicemia. Targeting mechanisms of complement inhibition could be an effective therapeutic strategy for patients with septicemia due to S. pneumoniae or other bacterial pathogens.

  16. Bacteremia with Streptococcus pneumoniae

    DEFF Research Database (Denmark)

    Christensen, J S; Jensen, T G; Kolmos, H J

    2012-01-01

    We conducted a hospital-based cohort study among adult patients with first-time Streptococcus pneumoniae bacteremia (SPB) from 2000 through 2008. Patients were identified in a population-based bacteremia database and followed up for mortality through the Danish Civil Registration System (CRS...

  17. Role of Mycoplasma pneumoniae and Chlamydia pneumoniae in children with community-acquired pneumonia in Istanbul, Turkey.

    Science.gov (United States)

    Somer, Ayper; Salman, Nuran; Yalçin, Işik; Ağaçfidan, Ali

    2006-06-01

    To investigate the role of Mycoplasma pneumoniae and Chlamydia pneumoniae infection in pediatric pneumonia, in Istanbul, Turkey, we conducted a prospective study covering all the children between 2 months and 15 years hospitalized for community-acquired pneumonia. A total of 140 children (85 males, median age 2.5 years) with community-acquired pneumonia were enrolled. Acute and convalescent sera were tested for IgM and IgG antibodies to M. pneumoniae (enzyme-linked immunosorbent assay, Serion ELISA classic) and for IgM and IgG antibodies to C. pneumoniae (microimmunofluorescence, Savyon, Israel). Mycoplasma pneumoniae infection was diagnosed in 38 patients (27%) and C. pneumoniae infection in 7 (5%). In 2 children M. pneumoniae and C. pneumoniae co infection was observed. The average age of the M. pneumoniae cases was 5.3 years and that of the C. pneumoniae was 1.5 years. The average age of pneumonia cases caused by other pathogens was 3.4 years (ppneumoniae and C. pneumoniae infection and in those without M. pneumoniae and C. pneumoniae infection. The results of this study suggest a remarkable role for M. pneumoniae and C. pneumoniae in childhood community-acquired pneumonia, and the knowledge of the true prevalence of these two types of infections discovered in the community might lead to modifications in the present empirical treatment of bacterial pneumonia.

  18. Pneumonia a Legionella pneumophila.

    Directory of Open Access Journals (Sweden)

    E. Álvares

    1998-03-01

    Full Text Available RESUMO: A Legionella pneumophila é uma bacteria comum do ambiente e um agente causal importante de pneumonias graves da comunidade. O diagnóstico em fase precoce da doença, nem sempre é fácil.Procedemos a um estudo retrospectivo, com o objectivo de caracterizar os doentes intemados na Unidade de Cuidados lntensivos Respiratórios (UCIR, com o diagnóstico de pneumonia a Legionella pneumophila (pLp, durante dez anos (1986-1996. Foram analisados doze processos clinicos que repre-sentavam 6,7% das pneumonias da comunidade intemados nesse perfodo. Comparam-se também as pneumonias a Legionella pneumophila com as outras pneumonias da comunidade, durante o mesmo perído de internamento. Onze doentes eram do sexo masculino e uma do sexo feminino, comidade média de 49,6±11, 9 anos. O TISS foi de 25,8±9,5, o APACHE II de 23,4±6,5 e o APS de 20,3±6,5. Apenas 1 doente não necessitou de ventilação medcânica, tendo sido o tempo médio de ventilação de 11,5±12,5 dias (min: 1 e máx: 44. Quatro pneumonias ocorreram fora da época sazonal habitual e só quatro doentes tinham história epidemiológica sugestiva. Apenas um doente, não tinha factores de risco. A confirmação diagnóstica foi feita por serologia e imunonuorescência directa das secreçõs brônquicas. Em relação às complicaçõoes, 9 doentes tiveram disfunção hepática, 7 insuficiência renal, 1 endocardite e 1 desenvolveu SDRA. A septicemia noscomial, ocorreu em 5 doentes. Faleceram 58,3% dos doentes que tinham índices de gravidade mais elevados.Os doentes com pLp, apresentavam maior gravidade que se traduziu por uma maior necessidade de suporte ventilatorio. A mortalidade embora mais elevada nos doentes com pLp (58,3% versus 31,8%, não foi significativamente diferente nos dois grupos quando consideramos apenas os doentes ventilados.Os autores concluem que a pneumonia da comunidade causada por Legionella pneumophila, é uma situaçã o grave que se acompanha de

  19. Mycoplasma pneumoniae pneumonia: CT features in 16 patients

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Inho; Kim, Tae Sung; Yoon, Hye-Kyung [Sungkyunkwan University School of Medicine, Department of Radiology and Center for Imaging Science, Samsung Medical Center, Seoul (Korea)

    2006-03-15

    The objective of this study was to assess the computed tomography (CT) features of Mycoplasma pneumoniae pneumonia. We retrospectively reviewed CT findings of 16 patients (M:F=9:7, age range 1-74 years, median 9 years) with serologically proven Mycoplasma pneumoniae pneumonia and with chest CT scan available. Two distinctive patterns of CT features of M. pneumoniae pneumonia were noted between the paediatric (age <18 years) and the adult (age {>=}18 years) groups. The pediatric group (n=11) showed lobar or segmental consolidation (100%) with frequent pleural effusion (82%) and regional lymphadenopathy (82%) and mild volume decrease of the involved lobe (73%), while four of the five adult patients showed diffuse and/or multifocal, centrilobular or peribronchovascular areas of ground-glass attenuation (80%) with a lobular distribution, and frequent thickening of interlobular septa (60%) and the bronchial walls (40%) were also detected at high-resolution CT. The CT finding of a lobar or segmental consolidation with a parapneumonic effusion seen in our children with M. pneumoniae pneumonia was similar to that of bacterial lobar pneumonia. In contrast, the CT findings noted in our adult patients consisted of a mixture of a bacterial bronchopneumonia pattern and a viral interstitial pneumonia pattern. (orig.)

  20. [Economic cost of Streptococcus pneumoniae community-acquired pneumonia, meningitis and bacteremia in an adult population that required hospitalization in Bogotá, Colombia].

    Science.gov (United States)

    Calderón, Claudia; Dennis, Rodolfo

    2014-01-01

    Streptococcus pneumoniae infection in adults is related to pneumonia, meningitis and bacteremia. Its care costs in adults are not well documented in Colombia and it has a greater impact in people over 45 years old. The aims of this study were to analyze the associated costs of pneumonia, bacteremia and meningitis in invasive S. pneumoniae infection in Colombia among hospitalized adults and to estimate outpatient costs for community-acquired pneumonia. Additionally, we wanted to serve as a starting point for future economic evaluations. We performed a direct cost study associated with S. pneumoniae outpatient community-acquired pneumonia, bacteremia and meningitis costs confirmed by cultures. A cohort of hospitalized adults treated between January 2010 and June 2011 in three third level hospitals in Bogotá was analyzed. We evaluated 107 records and 60 bills charged to the payer. The data were classified according to care and treatment costs. We performed an estimate of direct costs for community-acquired pneumonia for outpatient cases through Delphi methodology using expert clinicians. The average direct costs associated with pneumococcal disease were US$ 6,283, US$ 3,886, and US$ 4,768 for pneumonia, meningitis and bacteremia, respectively (exchange rate 1 US$ = Col$ 1,938.34; average variation between 2010 and 2011). Pneumonia cases were 70% men and 30% women; the distribution for meningitis was the same for both genders (50%); and for bacteremia we had 67% men and 33% women. Outpatient cost of community-acquired pneumonia was estimated at US$ 82.2 ( Col $ 159,280 ) in adults. For special cases, direct cost increased to US$ 142 ( Col $ 274,427). The management of S. pneumoniae infection in people over 45 years old represents a high cost due to the use of drugs and hospitalization, which has a direct impact on health resources. Prevention and early treatment for pneumonia can reduce the cost and the burden of the disease.

  1. Hemophagocytic Syndrome Associated with Mycoplasma pneumoniae Pneumonia

    Directory of Open Access Journals (Sweden)

    Yuji Koike

    2013-01-01

    Full Text Available Mycoplasma pneumoniae (Mp sometimes causes immunological complications in children. We present a rare case of hemophagocytic syndrome (HPS caused by Mp in a previously healthy 7-year-old Japanese girl. A chest radiograph obtained to evaluate the source of her fever showed infiltration in the lower right lung with mild splenomegaly. We could diagnose the patient with HPS on the basis of the hemophagocytic-lymphohistiocytosis- (HLH 2004 criteria. She met the criteria for fever, splenomegaly, neutrophil count (265 mg/dL, and ferritin level (>500 ng/mL. Furthermore, a peripheral blood smear showed an increased number of monocytes/macrophages with erythrophagocytosis. Treatment with clarithromycin and prednisolone, which was initiated soon after the diagnosis, was successful. Mp infection might partly progress to HPS in certain conditions. Clinicians should be aware of HPS caused by Mp and start appropriate treatment as soon as possible if the disease is suspected.

  2. Pneumonia lipóide Lipoid pneumonia

    OpenAIRE

    Gunther Kissmann; Mauro Zamboni; Andreia Salarini Monteiro; Aureliano M Cavalcanti de Sousa; Marilene Nascimento; Mauro Esteves; Paulo de Biasi; Deborah Cordeiro Lannes

    2008-01-01

    Dentre as afecções pulmonares exógenas, a pneumonia lipóide (PL), causada pela broncoaspiração de lipídeos, é uma doença pouco diagnosticada. Ela resulta da reacção tipo corpo estranho que se segue à presença de material lipídico dentro do parênquima pulmonar. Em geral, o agente etiológico é o óleo mineral utilizado como agente laxativo. Doentes com histórico de constipação intestinal e uso crónico de óleo mineral, com tosse e dispneia, devem ser pesquisados quanto a esta doença. Apresentamos...

  3. Pneumonia lipóide

    Directory of Open Access Journals (Sweden)

    Gunther Kissmann

    2008-07-01

    Full Text Available Resumo: Dentre as afecções pulmonares exógenas, a pneumonia lipóide (PL, causada pela broncoaspiração de lipídeos, é uma doença pouco diagnosticada. Ela resulta da reacção tipo corpo estranho que se segue à presença de material lipídico dentro do parênquima pulmonar. Em geral, o agente etiológico é o óleo mineral utilizado como agente laxativo. Doentes com histórico de constipação intestinal e uso crónico de óleo mineral, com tosse e dispneia, devem ser pesquisados quanto a esta doença. Apresentamos um caso de pneumonia lipóide associada ao uso de óleo mineral como agente laxativo, acentuamos as dificuldades relacionadas com a definição diagnóstica e revemos a literatura pertinente ao tema.Rev Port Pneumol 2008; XIV (4: 545-549 Abstract: Lipoid pneumonia (LP is a pneumonitis resulting from the aspiration of lipids, and is commonly associated with the use of mineral oil as a laxative. LP is relatively unfamiliar to clinicians and is probably underdiagnosed. Making a diagnosis of LP requires a high degree of clinical suspicion. The aim of this publication are to present a case of a patient with LP and to increase physician awareness of LP, its diagnosis and prevention.Rev Port Pneumol 2008; XIV (4: 545-549 Palavras-chave: Pneumonia lipóide, óleo mineral, doenças pulmonares intersticiais, idoso, Key-words: Lipid pneumonia, mineral oil, interstitial lung diseases, aged

  4. Etiology of community-acquired pneumonia in 1500 hospitalized children.

    Science.gov (United States)

    Oumei, Hao; Xuefeng, Wang; Jianping, Liu; Kunling, Shen; Rong, Ma; Zhenze, Cui; Li, Deng; Huimin, Yan; Lining, Wang; Zhaolan, Liu; Xinmin, Li; Hua, Xu; Zhiyan, Jiang; Yanning, Li; Yan, Huang; Baoqing, Zhang; Xiaochun, Feng; Chunhui, He; Yonghong, Jiang; Xue, Zhao; Wei, Wei; Zi, Wang

    2018-03-01

    Childhood community-acquired pneumonia (CAP) is a common illness; however, comprehensive studies of hospitalizations for CAP among children in China based on prospective and multicenter data collection are limited. The aim of this investigation was to determine the respiratory pathogens responsible for CAP in hospitalized children. From January to December 2015, oropharyngeal swabs and blood serum were collected from hospitalized children with CAP symptoms ranging in age from 6 months to 14 years at 10 hospitals across China. We used immunofluorescence to detect antibodies for eight respiratory viruses and passive agglutination to detect specific IgM against Mycoplasma pneumoniae (M. pneumoniae). Of 1500 children presenting with CAP, 691 (46.1%) tested positive for at least one pathogen (virus or M. pneumoniae). M. pneumoniae (32.4%) was detected most frequently, followed by respiratory syncytial virus (11.5%), adenovirus (5.0%), influenza A virus (4.1 %), influenza B virus (3.4%), parainfluenza virus types 2 and 3 type (3.1 %), parainfluenza virus type 1 (2.9%), and human metapneumovirus (0.3%). Co-infections were identified in 128 (18.5%) of the 691 cases. These data provide a better understanding of viral etiology and M. pneumoniae in CAP in children between 6 months and 14 years in China. More study of the etiologic investigations that would further aid the management of pneumonia is required. With effective immunization for RSV, ADV, and M. pneumoniae infections, more than one-half of the pneumonia cases in this study could have been prevented. © 2017 Wiley Periodicals, Inc.

  5. Diagnosis, treatment and prevention of hospital-acquired pneumonia in the elderly patients%老年患者医院获得性肺炎的诊治和预防策略

    Institute of Scientific and Technical Information of China (English)

    高金明

    2012-01-01

    医院获得性肺炎(HAP)是常见的医院内感染之一,尤其对老年人,因其高发病率以及病死率,已经成为具有挑战性的临床问题.医院获得性肺炎的发生与宿主状态、病原体(特别是多耐药病原体的出现)以及大量使用抗生素三者之间的相互作用有关,其诊断应包括临床和细菌学两个方面.抗菌药物治疗时应考虑到医院获得性肺炎是早发性还是迟发性,初始经验治疗应尽可能覆盖可能的病原体;同时还应结合来自下呼吸道定量或半定量培养的证据指导目标治疗,并且适时进行抗生素降阶梯治疗.对于老年患者预防HAP的发生尤为重要.%Hospital-acquired pneumonia(HAP)is one of common causes of hospital-associated infections.Because of the higher prevalence and mortality in elderly patients,HAP has been becoming the challenge for the clinicians.HAP is highly associated with host status,pathogen(particularly the occurrence of multidrug resistant pathogens),and the extensive use of antibiotics.The diagnostics should include clinical and bacteriologic strategies.The initial therapy with antibiotics should consider whether HAP was early-onset or late-onset and cover the potential pathogens.The quantitative or semiquantitative cultures of the samples from low respiratory tracts are used to direct the target and step down therapy.The prevention of HAP in the elderly patients is a priority.

  6. Osteopontin promotes host defense during Klebsiella pneumoniae-induced pneumonia.

    Science.gov (United States)

    van der Windt, G J W; Hoogerwerf, J J; de Vos, A F; Florquin, S; van der Poll, T

    2010-12-01

    Klebsiella pneumoniae is a common cause of nosocomial pneumonia. Osteopontin (OPN) is a phosphorylated glycoprotein involved in inflammatory processes, some of which is mediated by CD44. The aim of this study was to determine the role of OPN during K. pneumoniae-induced pneumonia. Wild-type (WT) and OPN knockout (KO) mice were intranasally infected with 10⁴ colony forming units of K. pneumoniae, or administered Klebsiella lipopolysaccharides (LPS). In addition, recombinant OPN (rOPN) was intranasally administered to WT and CD44 KO mice. During Klebsiella pneumonia, WT mice displayed elevated pulmonary and plasma OPN levels. OPN KO and WT mice showed similar pulmonary bacterial loads 6 h after infection; thereafter, Klebsiella loads were higher in lungs of OPN KO mice and the mortality rate in this group was higher than in WT mice. Early neutrophil recruitment into the bronchoalveolar space was impaired in the absence of OPN after intrapulmonary delivery of either Klebsiella bacteria or Klebsiella LPS. Moreover, rOPN induced neutrophil migration into the bronchoalveolar space, independent from CD44. In vitro, OPN did not affect K. pneumoniae growth or neutrophil function. In conclusion, OPN levels were rapidly increased in the bronchoalveolar space during K. pneumoniae pneumonia, where OPN serves a chemotactic function towards neutrophils, thereby facilitating an effective innate immune response.

  7. Pneumonia research in Papua New Guinea: 1967-1986.

    Science.gov (United States)

    Riley, Ian D

    2010-01-01

    Between 1967 and 1985 research on pneumonia in Papua New Guinea (PNG) was fundamental not only to standard treatments of disease in PNG, but also to the establishment of the World Health Organization's global Program for Control of Acute Respiratory Infections. Pneumonia was the leading cause of death in both population-based and hospital studies. Research that began in 1967 revealed a pattern of disease in adults reminiscent of that seen in industrialized countries in the early 20th century. Streptococcus pneumoniae (pneumococcus) was the predominant causative organism. Pneumococci were commensals of the upper respiratory tract that invaded first the lungs and then the blood stream. Some serotypes were more invasive than others and case fatality increased with deeper levels of invasion. The pandemic of Hong Kong (H3N2) influenza spread to the Southern Highlands in 1969 resulting in 2000 deaths. The conclusion that pneumococcal pneumonia had been the principal cause of death led to the establishment of a pneumonia research unit in Tari. A field trial of pneumococcal polysaccharide vaccine showed the vaccine to be most effective in preventing invasive disease. Vaccination reduced pneumonia mortality by 44% in previously healthy adults. The epidemiological situation was more complex in children than in adults because many different species and serotypes of bacteria could be isolated from lung aspirate. Although many of these organisms would normally have been regarded as non-pathogenic, S. pneumoniae and Haemophilus influenzae, recognized pathogens, were the principal causes of severe morbidity and mortality. The same principles of carriage of and invasion by upper respiratory commensals applied as much to children as they did to adults, and the rank order of invasive serotypes of S. pneumoniae and H. influenzae was the same in different age groups. Slow maturation of a child's immune system meant, however, that children could be susceptible to invasion by particular

  8. Pneumonia in the tropics.

    Science.gov (United States)

    Lim, Tow Keang; Siow, Wen Ting

    2018-01-01

    Pneumonia in the tropics poses a heavy disease burden. The complex interplay of climate change, human migration influences and socio-economic factors lead to changing patterns of respiratory infections in tropical climate but also increasingly in temperate countries. Tropical and poorer countries, especially South East Asia, also bear the brunt of the global tuberculosis (TB) pandemic, accounting for almost one-third of the burden. But, as human migration patterns evolve, we expect to see more TB cases in higher income as well as temperate countries, and rise in infections like scrub typhus from ecotourism activities. Fuelled by the ease of air travel, novel zoonotic infections originating from the tropics have led to global respiratory pandemics. As such, clinicians worldwide should be aware of these new conditions as well as classical tropical bacterial pneumonias such as melioidosis. Rarer entities such as co-infections of leptospirosis and chikungunya or dengue will need careful consideration as well. In this review, we highlight aetiologies of pneumonia seen more commonly in the tropics compared with temperate regions, their disease burden, variable clinical presentations as well as impact on healthcare delivery. © 2017 Asian Pacific Society of Respirology.

  9. Pediatric Round Pneumonia

    Directory of Open Access Journals (Sweden)

    Yen-Lin Liu

    2014-12-01

    Full Text Available “Round pneumonia” or “spherical pneumonia” is a well-characterized clinical entity that seems to be less addressed by pediatricians in Taiwan. We herein report the case of a 7-year-old boy who presented with prolonged fever, cough, and chest X-rays showing a well-demarcated round mass measuring 5.9 × 5.6 × 4.3 cm in the left lower lung field, findings which were typical for round pneumonia. The urinary pneumococcal antigen test was positive, and serum anti-Mycoplasma pneumoniae antibody titer measurement using a microparticle agglutination method was 1:160 (+. After oral administration of antibiotics including azithromycin and amoxicillin/clavulanate, which was subsequently replaced by ceftibuten due to moderate diarrhea, the fever subsided 2 days later and the round patch had completely resolved on the 18th day after the diagnosis. Recent evidence suggests treating classical round pneumonia with antibiotics first and waiving unwarranted advanced imaging studies, while alternative etiologies such as abscesses, tuberculosis, nonbacterial infections, congenital malformations, or neoplasms should still be considered in patients with atypical features or poor treatment response.

  10. Hypervirulent (hypermucoviscous) Klebsiella pneumoniae

    Science.gov (United States)

    Shon, Alyssa S.; Bajwa, Rajinder P.S.; Russo, Thomas A.

    2013-01-01

    A new hypervirulent (hypermucoviscous) variant of Klebsiella pneumoniae has emerged. First described in the Asian Pacific Rim, it now increasingly recognized in Western countries. Defining clinical features are the ability to cause serious, life-threatening community-acquired infection in younger healthy hosts, including liver abscess, pneumonia, meningitis and endophthalmitis and the ability to metastatically spread, an unusual feature for enteric Gram-negative bacilli in the non-immunocompromised. Despite infecting a healthier population, significant morbidity and mortality occurs. Although epidemiologic features are still being defined, colonization, particularly intestinal colonization, appears to be a critical step leading to infection. However the route of entry remains unclear. The majority of cases described to date are in Asians, raising the issue of a genetic predisposition vs. geospecific strain acquisition. The traits that enhance its virulence when compared with “classical” K. pneumoniae are the ability to more efficiently acquire iron and perhaps an increase in capsule production, which confers the hypermucoviscous phenotype. An objective diagnostic test suitable for routine use in the clinical microbiology laboratory is needed. If/when these strains become increasingly resistant to antimicrobials, we will be faced with a frightening clinical scenario. PMID:23302790

  11. Three cases of meningococcal pneumonia

    OpenAIRE

    Jones, E. M.; Brown, N. M.; Harvey, J E; Reeves, D S; MacGowan, A P

    1997-01-01

    Three cases of pneumonia due to Neisseria meningitidis are described. In all three cases the organism was isolated only from blood cultures, but in the presence of good clinical and radiological evidence of pneumonia. The isolates belonged to three different serogroups: B type 2b, C, and Y. The cases illustrate the fact that N meningitidis can cause pneumonia and that culture of blood plays an important part in the diagnosis. Clinically there is nothing to differentiate meningococcal pn...

  12. Bronchiolitis Obliterans with Organizing Pneumonia (BOOP)

    Science.gov (United States)

    ... What can you tell me about cryptogenic organizing pneumonia? Answers from Teng Moua, M.D. Previously called bronchiolitis obliterans with organizing pneumonia, cryptogenic organizing pneumonia (COP) is a rare lung ...

  13. Klebsiella pneumoniae FimK Promotes Virulence in Murine Pneumonia.

    Science.gov (United States)

    Rosen, David A; Hilliard, Julia K; Tiemann, Kristin M; Todd, Elizabeth M; Morley, S Celeste; Hunstad, David A

    2016-02-15

    Klebsiella pneumoniae, a chief cause of nosocomial pneumonia, is a versatile and commonly multidrug-resistant human pathogen for which further insight into pathogenesis is needed. We show that the pilus regulatory gene fimK promotes the virulence of K. pneumoniae strain TOP52 in murine pneumonia. This contrasts with the attenuating effect of fimK on urinary tract virulence, illustrating that a single factor may exert opposing effects on pathogenesis in distinct host niches. Loss of fimK in TOP52 pneumonia was associated with diminished lung bacterial burden, limited innate responses within the lung, and improved host survival. FimK expression was shown to promote serum resistance, capsule production, and protection from phagocytosis by host immune cells. Finally, while the widely used K. pneumoniae model strain 43816 produces rapid dissemination and death in mice, TOP52 caused largely localized pneumonia with limited lethality, thereby providing an alternative tool for studying K. pneumoniae pathogenesis and control within the lung. © The Author 2015. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

  14. Pneumonia aguda fibrinosa e organizante

    Directory of Open Access Journals (Sweden)

    Cláudia Santos

    2010-07-01

    Full Text Available Resumo: O padrão histológico de Pneumonia Aguda Fibrinosa e Organizante (AFOP – Acute Fibrinous And Organizing Pneumonia, descrito por Beasley em 2002, caracteriza-se pela existência de fibrina intra-alveolar sob a forma de bolas de fibrina e pneumonia organizativa difusa. A apresentação clínica desta doença intersticial pulmonar pode ser aguda ou subaguda, diferindo no entanto dos outros padrões histológicos habitualmente associados a lesão pulmonar aguda – Lesão Alveolar Difusa (DAD, Pneumonia Organizativa (OP e Pneumonia Eosinofílica (EP.A propósito deste tema, os autores fazem uma revisão da literatura e descrevem o caso clínico de um doente de 44 anos, com aspectos imagiológicos e evolução pouco habituais. Abstract: The histologic pattern of Acute Fibrinous and Organizing Pneumonia (AFOP, described by Beasley in 2002, is characterized by the existence of intra alveolar fibrin in the form of fibrin “balls” and diffuse organizing pneumonia. Presenting symptoms of this interstitial pulmonary disease can be acute or subacute. However, it differs from the well-recognized histologic patterns of acute pulmonary lesion – Diffuse Alveolar Damage (DAD, Organizing Pneumonia (OP and Eosinophilic Pneumonia (EP.The authors carry out a review of the literature concerning this topic and describe the clinical case of a 44-year-old patient with unusual imaging features and outcome. Palavras-chave: AFOP, bolas de fibrina, pneumonia organizativa, Key-word: AFOP, fibrin balls, organizing pneumonia

  15. FDG/PET uptake in asymptomatic multilobar Chlamydia pneumoniae pneumonia.

    Science.gov (United States)

    Bianco, Andrea; Mazzarella, Gennaro; Rocco, Danilo; Gasperi, Maurizio; Di Marco, Roberto; Brunese, Luca

    2010-06-01

    FDG-PET is a diagnostic imaging procedure effective in staging primary and recurrent cancer. False-positive uptake already has been described in both inflammatory and infectious respiratory diseases, although no reports associate Chlamydia pneumoniae infection to FDG uptake. An incidental diagnosis of asymptomatic multilobar pneumonia during screening for thyroid malignancy is reported. Three areas of pulmonary consolidation strongly positive on PET/CT scan, mimicking pulmonary malignancy were identified. Both radiologic features and serum IgM antibodies for Chlamydia pneumoniae suggested the diagnosis of an unusual presentation of a Chlamydia pneumoniae respiratory infection. Specific antibiotic therapy induced a complete resolution of the areas of pulmonary consolidation. This case suggests that positive PET is not an absolute indicator for malignancy. Chlamydia pneumoniae respiratory infections can exhibit positive uptake on FDG-PET.

  16. Community-acquired pneumonia in children. A changing spectrum of disease

    Energy Technology Data Exchange (ETDEWEB)

    Le Roux, David M. [Red Cross War Memorial Children' s Hospital, Cape Town (South Africa); New Somerset Hospital, Department of Paediatrics, Cape Town (South Africa); Zar, Heather J. [Red Cross War Memorial Children' s Hospital, Cape Town (South Africa)

    2017-10-15

    Pneumonia remains the leading cause of death in children outside the neonatal period, despite advances in prevention and management. Over the last 20 years, there has been a substantial decrease in the incidence of childhood pneumonia and pneumonia-associated mortality. New conjugate vaccines against Haemophilus influenzae type b and Streptococcus pneumoniae have contributed to decreases in radiologic, clinical and complicated pneumonia cases and have reduced hospitalization and mortality. The importance of co-infections with multiple pathogens and the predominance of viral-associated disease are emerging. Better access to effective preventative and management strategies is needed in low- and middle-income countries, while new strategies are needed to address the residual burden of disease once these have been implemented. (orig.)

  17. A106 HOST-PATHOGEN INTERACTIONS: Short-Term Cigarette Smoke Exposure Increases Acute Lung Injury In Antibiotic Treated Pneumococcal Pneumonia In Mice

    National Research Council Canada - National Science Library

    J E Gotts; L Chun; J Abbott; N Takasaka; S Nishimura; C S Calfee; M A Matthay

    2017-01-01

    Mouse models of pneumonia have not typically employed antibiotic treatment, limiting clinical relevance to hospitalized patients in whom effective microbial control often fails to prevent progression...

  18. Risk Factors for Aspiration Pneumonia in Older Adults.

    Directory of Open Access Journals (Sweden)

    Toshie Manabe

    Full Text Available Aspiration pneumonia is a dominant form of community-acquired and healthcare-associated pneumonia, and a leading cause of death among ageing populations. However, the risk factors for developing aspiration pneumonia in older adults have not been fully evaluated. The purpose of the present study was to determine the risk factors for aspiration pneumonia among the elderly.We conducted an observational study using data from a nationwide survey of geriatric medical and nursing center in Japan. The study subjects included 9930 patients (median age: 86 years, women: 76% who were divided into two groups: those who had experienced an episode of aspiration pneumonia in the previous 3 months and those who had not. Data on demographics, clinical status, activities of daily living (ADL, and major illnesses were compared between subjects with and without aspiration pneumonia. Two hundred and fifty-nine subjects (2.6% of the total sample were in the aspiration pneumonia group. In the univariate analysis, older age was not found to be a risk factor for aspiration pneumonia, but the following were: sputum suctioning (odds ratio [OR] = 17.25, 95% confidence interval [CI]: 13.16-22.62, p < 0.001, daily oxygen therapy (OR = 8.29, 95% CI: 4.39-15.65, feeding support dependency (OR = 8.10, 95% CI: 6.27-10.48, p < 0.001, and urinary catheterization (OR = 4.08, 95% CI: 2.81-5.91, p < 0.001. In the multiple logistic regression analysis, the risk factors associated with aspiration pneumonia after propensity-adjustment (258 subjects each were sputum suctioning (OR = 3.276, 95% CI: 1.910-5.619, deterioration of swallowing function in the past 3 months (OR = 3.584, 95% CI: 1.948-6.952, dehydration (OR = 8.019, 95% CI: 2.720-23.643, and dementia (OR = 1.618, 95% CI: 1.031-2.539.The risk factors for aspiration pneumonia were sputum suctioning, deterioration of swallowing function, dehydration, and dementia. These results could help improve clinical management for preventing

  19. Pneumonia prevention: Cost-effectiveness analyses of two vaccines among refugee children aged under two years, Haemophilus influenzae type b-containing and pneumococcal conjugate vaccines, during a humanitarian emergency, Yida camp, South Sudan.

    Science.gov (United States)

    Gargano, Lisa M; Hajjeh, Rana; Cookson, Susan T

    2017-01-11

    By September 2013, war between Sudan and South Sudan resulted in >70,000 Sudanese refugees and high pneumonia incidence among the 20,000 refugees in Yida camp, South Sudan. Using Médecins Sans Frontières (MSF)-provided data and modifying our decision-tree models, we estimated if administering Haemophilus influenzae type b (Hib)-containing (pentavalent vaccine, also with diphtheria pertussis and tetanus [DPT] and hepatitis B) and pneumococcal conjugate (PCV) vaccines were cost-effective against hospitalized pneumonia. Among children vaccination, one- and two-doses of combined Hib-containing and PCV would avert an estimated 118 and 125 pneumonia cases, and 8.5 and 9.1 deaths, respectively. The cost per Disability-Adjusted-Life-Year averted for administering combined one- and two-doses was US$125 and US$209, respectively. MSF demonstrated that it was possible to administer these vaccines during an emergency and our analysis found it was highly cost-effective, even with just one-dose of either vaccine. Despite unknown etiology, there is strong field and now economic rationale for administering Hib and PCV during at least one humanitarian emergency. Published by Elsevier Ltd.

  20. New horizons in hospital acquired pneumonia in older people.

    Science.gov (United States)

    Ewan, Victoria; Hellyer, Thomas; Newton, Julia; Simpson, John

    2017-05-01

    Approximately 1.5% of hospital patients develop hospital acquired pneumonia. Aspiration is the major risk factor for pneumonia and is associated with reduced ability to mechanically clear respiratory pathogens into the stomach. Currently non-invasive methods of diagnosing hospital acquired pneumonia are less robust than invasive methods, and lead to over-diagnosis. Accurate diagnosis is key to surveillance, prevention and treatment of HAP, and also to improving outcomes; newer imaging modalities such as phase contrast X-ray imaging and nanoparticle enhanced magnetic resonance imaging may help. Potential preventative strategies such as systematic swallowing assessment in non-stroke patients, and interventions such as improving oral hygiene need further, robust randomised controlled trials. Antibiotics are likely to continue to be the mainstay of treatment, and new antibiotics such as ceftobiprole are likely to have a role in treating hospital acquired pneumonia. Given the spread of antimicrobial resistance, alternative treatment strategies including bacteriophages, peptides and antibodies are under investigation. Reducing the incidence of hospital acquired pneumonia could decrease length of hospital stay, reduce inappropriate antibiotic use, and both improve functional outcomes and mortality in our increasingly aged population. © The Author 2017. Published by Oxford University Press on behalf of the British Geriatrics Society.All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  1. Enteral Tube Feeding and Pneumonia

    Science.gov (United States)

    Gray, David Sheridan; Kimmel, David

    2006-01-01

    To determine the effects of enteral tube feeding on the incidence of pneumonia, we performed a retrospective review of all clients at our institution who had gastrostomy or jejunostomy tubes placed over a 10-year period. Ninety-three subjects had a history of pneumonia before feeding tube insertion. Eighty had gastrostomy and 13, jejunostomy…

  2. [Symposium: Pneumonia 2010 - state of the art].

    Science.gov (United States)

    Barten, G; Schütte, H; Bals, R; Pletz, M; Rohde, G

    2011-04-01

    Community-acquired pneumonia (CAP) is associated with significant morbidity and mortality. It ranks as the fourth leading cause of death in the Western industrialized countries. New insights in the epidemiology and pathogenesis, recent developments in diagnosis and risk-stratification, and current recommendations on prevention and therapy were presented at the symposium "Pneumonie 2010 - State of the Art", held in Kassel, Germany, on the 4. - 5. November 2010. This symposium was organized by the CAPNETZ STIFTUNG. More than 70 experts from medical research, academia, and industry participated. This report provides an overview of issues, insights, and conclusions that were discussed during the meeting. © Georg Thieme Verlag KG Stuttgart · New York.

  3. Antimicrobial Resistant Streptococcus pneumoniae

    Directory of Open Access Journals (Sweden)

    B Khanal

    2010-09-01

    Full Text Available Introduction: Pneumococcal infections are important cause of morbidity and mortality. Knowledge of antimicrobial susceptibility patterns plays important role in the selection of appropriate therapy. Present study was undertaken to analyze the susceptibility patterns of pneumococcal isolates against commonly used antimicrobials with special reference to determination of minimum inhibitory concentration (MIC of penicillin in a tertiary care hospital in eastern Nepal. Methods: Twenty-six strains of S. pneumoniae isolated from various clinical specimens submitted to microbiology laboratory were evaluated. All isolates were tested for antimicrobial susceptibility by disk diffusion method. MIC of penicillin was tested by broth dilution method. Results: Of the total isolates 19 (73% were from invasive infections. Seven isolates were resistant to cotrimoxazole. No resistance to penicillin was seen in disk diffusion testing. Less susceptibility to penicillin (MIC 0.1-1.0 mg/L was observed in five (17% isolates. High level resistance to penicillin was not detected. One isolate was multidrug resistant. Conclusions: S. pneumoniaeisolates with intermediate resistance to penicillin prevail in Tertiary Care Hospital in eastern Nepal, causing invasive and noninvasive infections. As intermediate resistance is not detected in routine susceptibility testing, determination of MIC is important. It helps not only in the effective management of life threatening infections but is also essential in continuous monitoring and early detection of resistance. In addition, further study on pneumococcal infections, its antimicrobial resistance profile and correlation with clinical and epidemiological features including serotypes and group prevalence is recommended in future. Keywords: antimicrobial susceptibility pattern, penicillin, Streptococcus pneumoniae.

  4. Risk Factors for Pneumonia in Ventilated Trauma Patients with Multiple Rib Fractures

    Directory of Open Access Journals (Sweden)

    Hyun Oh Park

    2017-10-01

    Full Text Available Background: Ventilator-associated pneumonia (VAP is a common disease that may contribute to morbidity and mortality among trauma patients in the intensive care unit (ICU. This study evaluated the associations between trauma factors and the development of VAP in ventilated patients with multiple rib fractures. Methods: We retrospectively and consecutively evaluated 101 patients with multiple rib fractures who were ventilated and managed at our hospital between January 2010 and December 2015, analyzing the associations between VAP and trauma factors in these patients. Trauma factors included sternal fracture, flail chest, diaphragm injury, traumatic aortic dissection, combined cardiac injury, pulmonary contusion, pneumothorax, hemothorax, hemopneumothorax, abbreviated injury scale score, thoracic trauma severity score, and injury severity score. Results: Forty-six patients (45.5% had at least 1 episode of VAP, 10 (21.7% of whom died in the ICU. Of the 55 (54.5% patients who did not have pneumonia, 9 (16.4% died in the ICU. Using logistic regression analysis, we found that VAP was associated with severe lung contusion (odds ratio, 3.07; 95% confidence interval, 1.12 to 8.39; p=0.029. Conclusion: Severe pulmonary contusion (pulmonary lung contusion score 6–12 is an independent risk factor for VAP in ventilated trauma patients with multiple rib fractures.

  5. Rates and Risk Factors for Recurrent Pneumonia in Patients Hospitalized With Community-Acquired Pneumonia: Population-Based Prospective Cohort Study With 5 Years of Follow-up

    Science.gov (United States)

    Dang, T. T.; Eurich, D. T.; Weir, D. L.; Marrie, T. J.; Majumdar, S. R.

    2014-01-01

    Background. The rates and risk factors for developing recurrent pneumonia following hospitalization with community-acquired pneumonia (CAP) are poorly understood. Methods. We examined a population-based cohort of patients with CAP who survived hospital admission and who were free of pneumonia for at least 3 months. We collected clinical, functional, and medication-related information and pneumonia severity index (PSI). Using linked databases we followed patients for 5 years and captured any clinical episode of pneumonia 90 days or more post-discharge. We used Cox proportional hazards models (adjusted for age, sex, PSI, functional status, medications) to determine rates and independent correlates of recurrent pneumonia. Results. The final cohort included 2709 inpatients; 43% were 75 years or older, 34% were not fully independent, and 56% had severe pneumonia. Over 5 years of follow–up, 245 (9%; 95% confidence interval [CI], 8%–10%) patients developed recurrent pneumonia, and 156 (64%) of these episodes required hospitalization. Rate of recurrence was 3.0/100 person–years and median time to recurrence was 317 days (interquartile range, 177–569); 32 (13%) patients had 2 or more recurrences. In multivariable analyses only age >75 years (adjusted P = .047) and less than fully independent functional status (12% recurrence rate with impaired functional status vs 7% for fully independent; adjusted hazard ratio, 1.7; 95% CI, 1.3–2.2; P pneumonia. Conclusions. One of 11 patients who survived CAP hospitalization had recurrent pneumonia over 5 years and those with impaired functional status were at particularly high risk. Recurrent pneumonia is common and more attention to preventive strategies at discharge and closer follow-up over the long-term seem warranted. PMID:24729503

  6. Preparation and evaluation of monoclonal antibodies against chlamydial protease-like activity factor to detect Chlamydia pneumoniae antigen in early pediatric pneumonia.

    Science.gov (United States)

    Zheng, J; Ding, T; Chen, Z; Fang, H; Li, H; Lu, H; Wu, Y

    2015-07-01

    Chlamydia pneumoniae causes diseases in humans, including community-acquired pneumonia, bronchitis, and sinusitis. It is also associated with atherosclerosis, coronary heart disease, and hyperlipidemia. In this study, we investigated novel materials with which to develop a sensitive and specific method to identify early C. pneumoniae infection, to allow more effective clinical treatment and prevention. We prepared novel monoclonal antibodies (mAbs) against a recombinant protein equivalent to the immunodominant region of chlamydial protease-like activity factor (CPAF) from C. pneumoniae. The mAbs specifically reacted with the endogenous CPAF antigen of the C. pneumoniae type strain in immunoblotting and indirect immunofluorescence (IIF) assays, but did not react with C. trachomatis type strains or genital secretions from patients with acute C. trachomatis infection. The mAb with the highest titer was used to develop a new IIF assay and enzyme-linked immunosorbent assay (ELISA) to detect the C. pneumoniae antigen in clinical specimens from child patients suspected of pneumonia. The sensitivity, specificity, and concordance rate of the mAb-based IIF and ELISA tests were compared with those of polymerase chain reaction (PCR). Our results show that these mAbs have excellent specificity and may be used to develop new screening tools for the diagnosis of early pediatric pneumonia.

  7. Management of Rhodococcus equi pneumonia in foals

    Directory of Open Access Journals (Sweden)

    Johns I

    2013-11-01

    Full Text Available Imogen Johns Department of Clinical Sciences and Services, Royal Veterinary College, North Mymms, UK Abstract: Rhodococcus equi, a gram-positive facultative intracellular bacterial pathogen, is the most important cause of pneumonia in foals aged 3 weeks to 5 months. The disease occurs worldwide, resulting in significant morbidity and mortality on endemically affected farms. Foals appear to become infected early in life, but clinical signs are typically delayed until 1–3 months of age because of the insidious nature of the disease. Although pneumonia is the most common clinical manifestation, up to 74% of foals may concurrently have extrapulmonary disorders, including both extrapulmonary infections (abdominal abscessation, colitis, osteomyelitis and immune-mediated disorders (nonseptic synovitis, uveitis. Diagnosis is based on the combination of clinical signs and abnormalities on hematologic screening and thoracic imaging in an appropriately aged foal and is confirmed by bacteriologic culture of the organism. Management of R. equi infections, in particular on farms with endemic disease, combines appropriate treatment of affected foals with preventative measures targeted at preventing infection and identifying foals before the development of severe disease. The combination of rifampin and a macrolide antimicrobial is recommended for treatment, as the combination is synergistic, reaches high intracellular concentrations, and should minimize the development of antimicrobial resistance. The prognosis for survival for foals with R. equi pneumonia is good, especially in foals mildly or subclinically affected, as is the prognosis for future athletic performance. Screening for early identification before the development of clinical signs has been advocated on endemically affected farms, although the most appropriate method, the timing of screening, and the selection of foals requiring treatment have yet to be determined. Recent evidence suggests that

  8. Bronchiolitis obliterans with organizing pneumonia.

    Science.gov (United States)

    Nagai, S; Izumi, T

    1996-09-01

    In 1955, Epler and Colby first described idiopathic bronchiolitis obliterans with organizing pneumonia. Davison and colleagues termed the entity cryptogenic organizing pneumonia. Clinically, the disease resembles a flu-like syndrome of acute or subacute onset. Other features include crackles, patchy infiltrates on chest radiograph, restrictive function, and decrease in diffusing capacity. Most cases of idiopathic bronchiolitis obliterans with organizing pneumonia (BOOP) respond dramatically to corticosteroids. However, some patients deteriorate rapidly. Differences between idiopathic or secondary BOOP and other interstitial lung diseases are vast. CT findings and bronchoalveolar lavage fluid lymphocytosis are helpful in differentiating BOOP from idiopathic pulmonary fibrosis.

  9. [Pneumocystis carinii pneumonia].

    Science.gov (United States)

    Gabriel Botella, F; Balaguer Martínez, J V; Labios Gómez, M; Vera Sempere, G; Manzanera Escarti, R; García Fuster, M J

    1991-12-01

    We present twelve cases of Pneumocystis Carinii Pneumonia (PCP) hospitalized at the Internal Medicine Service of the Hospital Clínico de Valencia between 1989 and 1990. All patients were infected by HIV-1, with ages between 25 and 32 years, with circulating CD4 lymphocytes lower than 25% or 200 cells per cubic millimeter and with positive p24 antigen. Ten of them were parenterally drug addicts and two of them, homosexuals. Diagnosis was made by fibrobronchoscopy (FB) with bronchoaspiration (BAS) and bronchoalveolar lavage (BAL), or sputum induced by physiological serum aerosol at three per cent, using in both cases blue tinction with toluidine 0 of the samples obtained. Given the foreseeable increase of this disease in our country, we stress the risk of a potential change in its clinical spectrum, affecting new population groups, mainly the elderly, as well as the development of new early diagnosis techniques and the emergence of new treatments, including corticotherapy.

  10. Streptococcus pneumoniae: the forgotten microorganism in neonatal sepsis.

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    Rodriguez, Beatriz Fernandez; Mascaraque, Luis Rubio; Fraile, Leticia Ruiz; Perez, Irene Cuadrado; Kuder, Krzysztof

    2015-06-01

    Streptococcus pneumoniae is a rarely cause of neonatal sepsis. Its prevalence is low but with a mortality of 50%. Measures to prevent Streptococcus agalactiae transmission could help to increase Invasive Pneumococcal Disease (IPD) in newborns. Transmission could be from mother intrapartum; or in those cases of late onset sepsis, the community carriers. Systematic vaccination with PCV-7 and PCV-13 has reduced IPD rates. We present a case of a newborn with no perinatal risk factors for infection. In the first 24 hours after surgery of an ovarian cyst, the patient started with bad general condition with fever and regular perfusion. Empiric antibiotic treatment was started. Streptococcus pneumoniae was isolated in blood culture. In neonatal sepsis, we always think in Streptococcus agalactiae. Streptococcus pneumoniae is rare but with a high morbidity and mortality. Systematic vaccination is a measure that has demonstrated a reduction in the incidence of Invasive pneumococcal disease.

  11. A rare case of sepsis in newborn: Streptococcus pneumoniae septicemia.

    Science.gov (United States)

    Karabayir, Nalan; Hatipoglu, Nevin; Adal, Erdal; Sanli, Kamuran

    2010-11-01

    Streptococcus pneumoniae is a rare cause of sepsis in the newborn. The term baby was admitted on complaint of dyspnea, and antibiotherapy was begun after samples for hemocultures were obtained with the suspicion of sepsis according to the clinical and laboratory data. S. pneumoniae was demonstrated in the vaginal culture of the mother of the patient whose lumbar punction and chest roentgenogram were normal but hemoculture revealed the propagation of S. pneumoniae. The patient, treated with antibiotherapy for 14 days, was discharged without any complications. In preventing the probable complications, it is important to absolutely treat the maternal pneumococcal colonization that can cause severe infections in the newborn and also to treat the newborns even if they are asymptomatic.

  12. Epidemiology of severe pneumonia caused by Legionella longbeachae, Mycoplasma pneumoniae, and Chlamydia pneumoniae: 1-year, population-based surveillance for severe pneumonia in Thailand.

    Science.gov (United States)

    Phares, Christina R; Wangroongsarb, Piyada; Chantra, Somrak; Paveenkitiporn, Wantana; Tondella, Maria-Lucia; Benson, Robert F; Thacker, W Lanier; Fields, Barry S; Moore, Matthew R; Fischer, Julie; Dowell, Scott F; Olsen, Sonja J

    2007-12-15

    Legionella species, Mycoplasma pneumoniae, and Chlamydia pneumoniae are recognized as important causes of pneumonia in high-income countries, but their significance in middle-income countries, such as Thailand, is unknown. Population-based surveillance identified inpatient 3489 cases of clinically-defined pneumonia in a rural Thai province for 1 year. Patients who had a chest radiograph performed (for 2059 cases of pneumonia) were enrolled in an etiology study (which included 755 cases of pneumonia among 738 patients). Paired serum, nasopharyngeal swab, and urine specimens were obtained for diagnostic immunologic and molecular tests. Patients aged pneumonia due to Legionella longbeachae requiring hospitalization was 5-29 cases per 100,000 population. No case of Legionella pneumophila pneumonia was observed. The definite C. pneumoniae pneumonia incidence was 3-23 cases per 100,000 population; rates were highest among patients aged or=70 years (23-201 cases per 100,000 population). M. pneumoniae pneumonia had a similar age distribution, with an overall incidence of 6-44 cases per 100,000 population. These pathogens were associated with 15% of all cases of pneumonia. A nonsignificantly higher proportion of patients with pneumonia associated with L. longbeachae, compared with patients with pneumonia associated with M. pneumoniae or C. pneumoniae, required supplemental oxygen or mechanical ventilation (45% vs. 18%; Ppneumonia, only 15% received antibiotics with activity against the associated pathogen. M. pneumoniae, C. pneumoniae, and L. longbeachae, but not L. pneumophila, are frequently associated with severe pneumonia in rural Thailand. Few patients receive antibiotics that cover atypical pathogens.

  13. Pneumonia caused by a relatively resistant strain of Streptococcus pneumoniae.

    Science.gov (United States)

    Davis, R L; Rompalo, A M; Tartaglione, T A

    1986-06-01

    A patient with pneumonia caused by a relatively resistant strain of Streptococcus pneumoniae that did not respond to prolonged therapy with intravenous ampicillin is described, and general principles of treatment for such cases are reviewed. The patient was a 16-month-old, 10-kg girl who was admitted to a hospital for treatment of severe smoke inhalation and burns. The patient was intubated immediately, but her respiratory status remained unstable. Chest roentgenograms showed numerous episodes of pneumonia; the organism was later identified as Strep. pneumoniae. Despite empiric therapy with ampicillin and tobramycin followed by a prolonged course of ampicillin and subsequent treatment with cefazolin, the patient's respiratory status did not improve, and she continued to have elevated temperatures. Strep. pneumoniae isolated from her blood was identified as relatively resistant to penicillin but sensitive to chloramphenicol. After a seven-day course of chloramphenicol, the patient recovered and was later discharged. Relatively resistant Strep. pneumoniae (RRSP) infections often occur at sites where high antibiotic concentrations are not achieved, such as in the CNS. Prior antibiotic therapy may increase or have no effect on the incidence of RRSP. The mechanism for RRSP is unknown, and these infections often are not detected until a patient has failed to respond to conventional therapy. Also, the incidence of RRSP has not been determined because many hospitals do not perform susceptibility tests for pneumococcal isolates routinely. Vancomycin or chloramphenicol may be alternates to penicillin for the treatment of RRSP, but antibiotic sensitivities should be determined for each isolate to ensure susceptibility.

  14. Clostridium Difficile Infection Due to Pneumonia Treatment: Mortality Risk Models.

    Science.gov (United States)

    Chmielewska, M; Zycinska, K; Lenartowicz, B; Hadzik-Błaszczyk, M; Cieplak, M; Kur, Z; Wardyn, K A

    2017-01-01

    One of the most common gastrointestinal infection after the antibiotic treatment of community or nosocomial pneumonia is caused by the anaerobic spore Clostridium difficile (C. difficile). The aim of this study was to retrospectively assess mortality due to C. difficile infection (CDI) in patients treated for pneumonia. We identified 94 cases of post-pneumonia CDI out of the 217 patients with CDI. The mortality issue was addressed by creating a mortality risk models using logistic regression and multivariate fractional polynomial analysis. The patients' demographics, clinical features, and laboratory results were taken into consideration. To estimate the influence of the preceding respiratory infection, a pneumonia severity scale was included in the analysis. The analysis showed two statistically significant and clinically relevant mortality models. The model with the highest prognostic strength entailed age, leukocyte count, serum creatinine and urea concentration, hematocrit, coexisting neoplasia or chronic obstructive pulmonary disease. In conclusion, we report on two prognostic models, based on clinically relevant factors, which can be of help in predicting mortality risk in C. difficile infection, secondary to the antibiotic treatment of pneumonia. These models could be useful in preventive tailoring of individual therapy.

  15. Advances in the diagnosis of pneumonia in children.

    Science.gov (United States)

    Zar, Heather J; Andronikou, Savvas; Nicol, Mark P

    2017-07-26

    Pneumonia remains a major cause of childhood mortality and morbidity globally. Accurate diagnosis and attribution of the causes of pneumonia are important for measuring the burden of disease, implementing appropriate preventive or treatment strategies, and developing more effective interventions. This review summarizes recent diagnostic advances in radiological techniques, specimen collection, and laboratory methods. Although chest ultrasound and chest magnetic resonance imaging are promising modalities for radiological diagnosis, their role in clinical management and their impact on outcomes need further study. Rapid, highly sensitive, multiplex laboratory tests performed on upper respiratory tract samples or induced sputum can detect nucleic acid from potential pathogens in most children with pneumonia. However, it may be difficult to attribute causality because it is often impossible to distinguish between organisms colonizing or infecting the upper respiratory tract and those causing pneumonia. Currently available host biomarkers lack accuracy for distinguishing bacterial or mixed bacterial-viral infections from viral infections. New biomarkers derived from host transcriptional profile analysis may be more accurate but require validation. Prospective studies with appropriate control populations, including studies of clinical impact, are needed to improve our understanding of the role of tests. Although progress has been made in radiological techniques and laboratory testing, current methods for diagnosing and attributing the causes of pneumonia are suboptimal. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  16. Bronchiolitis obliterans organizing pneumonia after stereotactic ablative radiation therapy for lung cancer: A case report.

    Science.gov (United States)

    Fanetti, G; Bazzani, F; Ferrari, A; Alterio, D; Donghi, S M; Pounou Kamga, F A; Orecchia, R; Jereczek-Fossa, B A

    2018-02-01

    Bronchiolitis obliterans organizing pneumonia is an interstitial lung disease rarely occurring after radiotherapy probably due to an activation of autoimmune processes. Most cases have been described after postoperative radiotherapy for breast cancer. Corticosteroids represent the main treatment, prognosis is generally favorable. We described a case of bronchiolitis obliterans organizing pneumonia after stereotactic ablative radiation therapy for a recurrent lung cancer. Antibiotics and steroids were administered to solve the clinical picture. After three years, a new lesion at the right lung was found and treated with stereotactic ablative radiation therapy and concomitant long course of steroids with no recurrence of bronchiolitis obliterans organizing pneumonia. Bronchiolitis obliterans organizing pneumonia is a rare event after radiotherapy with undefined risk factors. In our case, steroids played an important role in management and, maybe, in preventing bronchiolitis obliterans organizing pneumonia recurrence after second course of stereotactic ablative radiation therapy. Copyright © 2017. Published by Elsevier SAS.

  17. Aetiology of hospital-acquired pneumonia and trends in antimicrobial resistance.

    Science.gov (United States)

    Enne, Virve I; Personne, Yoann; Grgic, Ljuban; Gant, Vanya; Zumla, Alimuddin

    2014-05-01

    Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) continue to present very significant diagnostic and management challenges. The development, introduction and use of a wider range of immunosuppressive therapies are leading to a broader spectrum of microorganisms causing HAP and VAP. The persistent clinical dilemma regarding their cause is that detection of a microorganism from a respiratory tract sample does not necessarily signify it is the causative agent of the pneumonia. The ever-increasing antibiotic resistance problem means that HAP and VAP are becoming progressively more difficult to treat. In this article, we review the cause, antimicrobial resistance, diagnosis and treatment of HAP and VAP and encapsulate recent developments and concepts in this rapidly moving field. Although the microbial causes of HAP and VAP remain at present similar to those identified in previous studies, there are marked geographical differences. Resistance rates among Gram-negative bacteria are continually increasing, and for any species, multiresistance is the norm rather than the exception. The development and introduction of rapid point-of-care diagnostics may improve understanding of the cause of HAP and VAP and has immense potential to influence the treatment and clinical outcomes in HAP/VAP, with patients likely to receive much faster, microorganism-specific treatment with obvious downstream improvements to clinical outcome and antimicrobial stewardship. We describe recent trends in aetiology of HAP and VAP and recent trends in antimicrobial resistance, including resistance mechanisms causing particular concern. The potential for novel molecular diagnostics to revolutionize the diagnosis and treatment of HAP/VAP is discussed.

  18. Pneumonia in bighorn sheep: Risk and resilience

    Science.gov (United States)

    Cassirer, E. Frances; Manlove, Kezia R.; Almberg, Emily S.; Kamath, Pauline; Cox, Mike; Wolff, Peregrine L.; Roug, Annette; Shannon, Justin M.; Robinson, Rusty; Harris, Richard B.; Gonzales, Ben J.; Plowright, Raina K.; Hudson, Peter J.; Cross, Paul C.; Dobson, Andrew; Besser, Thomas E.

    2018-01-01

    Infectious disease was an important driver of historic declines and extirpations of bighorn sheep (Ovis canadensis) in North America and continues to impede population restoration and management. Domestic sheep have long been linked to pneumonia outbreaks in bighorn sheep and this association has now been confirmed in 13 captive commingling experiments. However, ecological and etiological complexities still hinder our understanding and control of the disease. We provide an overview of the current state of knowledge about the biology and management of respiratory disease in bighorn sheep and propose strategies for moving forward. Epizootic pneumonia in bighorn sheep is polymicrobial. Mycoplasma ovipneumoniae, a bacterium host-specific to Caprinae and commonly carried by healthy domestic sheep and goats appears to be a necessary primary agent. All-age epizootics following introduction of M. ovipneumoniae along with other pathogens into bighorn sheep populations are usually severe (median mortality 47%) but fatality rates vary widely, from 15 – 100%. Disease severity may be influenced by the strain of M. ovipneumoniae, by secondary bacterial and viral pathogens, and by factors affecting transmission and host immunity. Once introduced, M. ovipneumoniae can persist in bighorn sheep populations for decades. Carrier dams transmit the pathogen to their susceptible lambs, triggering fatal pneumonia outbreaks in nursery groups, which limits recruitment and slows or prevents population recovery. The result is that demographic costs of pathogen persistence often outweigh the impacts of the initial invasion and die-off. There is currently no effective vaccine or antibiotic for domestic or wild sheep and to date, no management actions have been successful in reducing morbidity, mortality, or disease spread once pathogen invasion has occurred. Molecular-based strain typing suggests that spillover of M. ovipneumoniae into bighorn sheep populations from domestic small ruminants

  19. Difference of clinical features in childhood Mycoplasma pneumoniae pneumonia

    Directory of Open Access Journals (Sweden)

    Kang Jin-Han

    2010-07-01

    Full Text Available Abstract Background M. pneumoniae pneumonia (MP has been reported in 10-40% of community-acquired pneumonia cases. We aimed to evaluate the difference of clinical features in children with MP, according to their age and chest radiographic patterns. Methods The diagnosis of MP was made by examinations at both admission and discharge and by two serologic tests: the indirect microparticle agglutinin assay (≥1:40 and the cold agglutinins titer (≥1:32. A total of 191 children with MP were grouped by age: ≤2 years of age (29 patients, 3-5 years of age (81 patients, and ≥6 years of age (81 patients. They were also grouped by pneumonia pattern: bronchopneumonia group (96 patients and segmental/lobar pneumonia group (95 patients. Results Eighty-six patients (45% were seroconverters, and the others showed increased antibody titers during hospitalization. Among the three age groups, the oldest children showed the longest duration of fever, highest C-reactive protein (CRP values, and the most severe pneumonia pattern. The patients with segmental/lobar pneumonia were older and had longer fever duration and lower white blood cell (WBC and lymphocyte counts, compared with those with bronchopneumonia. The patient group with the most severe pulmonary lesions had the most prolonged fever, highest CRP, highest rate of seroconverters, and lowest lymphocyte counts. Thrombocytosis was observed in 8% of patients at admission, but in 33% of patients at discharge. Conclusions In MP, older children had more prolonged fever and more severe pulmonary lesions. The severity of pulmonary lesions was associated with the absence of diagnostic IgM antibodies at presentation and lymphocyte count. Short-term paired IgM serologic test may be mandatory for early and definitive diagnosis of MP.

  20. Outbreak of Klebsiella pneumoniae carbapenemase-producing K pneumoniae: A systematic review.

    Science.gov (United States)

    Campos, Anaelís C; Albiero, James; Ecker, Alessandra B; Kuroda, Cristina M; Meirelles, Lívia E F; Polato, Angelita; Tognim, Maria C B; Wingeter, Márcia A; Teixeira, Jorge J V

    2016-11-01

    First detected in the United States in 1996, Klebsiella pneumoniae carbapenemase (KPC) has spread internationally among gram-negative bacteria, especially K pneumoniae. These microorganisms can cause serious infections in hospitalized patients, and there are few therapeutic options, culminating in increased mortality. The objective of this study was to describe the occurrence of outbreaks that were caused by KPC-producing K pneumoniae, emphasizing the interventions that were implemented to contain the outbreaks. PubMed, Web of Knowledge, and Literatura Latino Americana em Ciências da Saúde databases were searched for articles that were published between 2001 and 2012 according to the recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Of the 586 studies identified, 13 were selected for the final sample. Most studies showed that the containment of KPC outbreaks is possible in hospital settings through several actions, particularly use of surveillance cultures and the establishment of contact precautions. The results show that limiting the cross-transmission of these and other KPC-producing bacteria is possible in a hospital setting. However, such isolates need to be detected early with the aid of culture surveillance and contained early using appropriate actions immediately to prevent an outbreak. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  1. Shin’iseihaito (Xinyiqingfeitang Suppresses the Biofilm Formation of Streptococcus pneumoniae In Vitro

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    Masaaki Minami

    2017-01-01

    Full Text Available Streptococcus pneumoniae (S. pneumoniae is the important pathogen that causes otolaryngeal diseases such as sinusitis. S. pneumoniae frequently forms the biofilm to prevent severe circumstances such as antimicrobial agents. Shin’iseihaito (xinyiqingfeitang is a formula of Japanese traditional Kampo medicine that has 9 crude drugs and provides the medicinal usage for sinusitis. The objective of the present study is to reveal the mechanism of antibiofilm activity by Shin’iseihaito extract (SSHT. SSHT significantly inhibited the formation of biofilm from S. pneumoniae ATCC 49619 in dose- and time-dependent manners. SSHT also significantly suppressed the biofilm formation by other five different cps types of S. pneumoniae clinical isolates. We found that the extracts of 8 out of 9 components in Shin’iseihaito had the inhibitory effects of biofilm formation, and the extract of the root of Scutellaria baicalensis had the strongest effect among the ingredients of Shin’iseihaito. We found that the capsule of SSHT-treated S. pneumoniae was significantly thinner than that of the untreated group and that SSHT reduced the hydrophobicity of bacterial cell surface. Our results suggest that Shin’iseihaito may be a useful agent for the treatment of S. pneumoniae-induced sinusitis because of the inhibition of biofilm formation of S. pneumoniae.

  2. An Update on the Management Of Hospital-Acquired Pneumonia in the Elderly

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    Chao-Hsien Lee

    2008-12-01

    Full Text Available Pneumonia is the leading cause of infection-related death and represents the fifth cause of mortality in the elderly. There are several reported risk factors for acquiring pneumonia at an older age, such as alcoholism, lung and heart diseases, nursing home residence, and swallowing disorders. Hospital-acquired pneumonia (HAP is reviewed, with an emphasis on multidrug-resistant (MDR bacterial pathogens, such as Pseudomonas aeruginosa, Acinetobacter species, and methicillin-resistant Staphylococcus aureus. The clinical characteristics of pneumonia in the elderly differ substantially compared with younger patients, and the severity of the disease is strongly associated with increased age and age-related comorbid disorders. Streptococcus pneumoniae is the pathogen most frequently responsible for pneumonia in the elderly with early HAP without risk factors for MDR; enteric Gram-negative rods should be considered in nursing home-associated pneumonia, as well as anaerobes in patients with aspiration pneumonia. Special attention should be given to preventive measures such as vaccination, oral care, and nutrition. The management of HAP should be instituted early with: appropriate use of antibiotics in adequate doses; avoidance of excessive use of antibiotics by de-escalation of initial antibiotic therapy, based on microbiologic cultures and the clinical response of the patient; and reduction of the duration of treatment to the minimum effective period.

  3. [Mixed infections in children with Mycoplasma pneumoniae pneumonia].

    Science.gov (United States)

    Chen, Ling-ling; Cheng, Yun-gai; Chen, Zhi-min; Li, Shu-xian; Li, Xue-jing; Wang, Ying-shuo

    2012-03-01

    To investigate the incidence and clinical features of mixed infections in children with Mycoplasma pneumoniae (MP) pneumonia. A total of 201 cases diagnosed as MP pneumonia were investigated for mixed infections by sputum bacterial culture, respiratory virus antigen detection and serum Chlamydia pneumoniae antibody test. For those with the indications for bronchoscopy, we also did bronchoalveolar lavage and lavage bacterial culture. A high incidence (103/201, 51.2%) of mixed infections in children with MP pneumonia was revealed. The most frequent co-infected pathogen was Chlamydia pneumoniae (52, 25.9%), followed by viruses (29, 14.4%), and bacteria (22, 10.9%). Among viruses, respiratory syncytial virus was the most common (17, 8.5%), followed by adenovirus (6, 3.0%), parainfluenza virus type III (4, 2.0%) and influenza virus type B (2, 1.0%). Sputum bacterial culture was positive in 14/201 (7.0%) cases, Streptococcus pneumonia being most common (6, 3.0%). BALF culture yielded positive results in 11.6% (8/69), Streptococcus pneumonia was also common (5, 7.3%). Among 29 cases with MP and virus coinfection, 26 were younger than 3 years (89.7%), while for MP and Chlamydia pneumoniae coinfection, most of them were older than 3 years (40/52, 76.9%). Compared with non-mixed infections, those with mixed infections had longer fever duration (24.5% and 40.8% longer than 10 d), more frequently developed pleural effusion (11.2%, 23.3%) and large area of shadow in chest imaging (35.7%, 51.5%). White blood cell [(14.28 ± 4.99) × 10(9)/L], C-reactive protein (CRP) [69(32.5 - 99.5) mg/L] and neutrophil ratio in BALF [0.86 (0.63 - 0.91)] were much higher in children with mixed bacterial infections than that in non-mixed infections [(9.06 ± 3.47) × 10(9)/L, 3 (0 - 31.0) mg/L, 0.44 (0.03 - 0.88)]. But no significant difference was found in peripheral blood neutrophil proportion between mixed bacterial infections (0.38 ± 0.25) and non-mixed infections (0.51 ± 0.19). More than

  4. Pneumonia in neutropenic patients

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    Heussel, C.P. [Department of Radiology, Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz (Germany); Kauczor, H.U. [Department of Radiology, Division Innovative Cancer Diagnostics and Therapy, German Cancer Research Centre, Heidelberg (Germany); Ullmann, A.J. [Department of Medicine, Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz (Germany)

    2004-02-01

    Radiologists have a special role in the management of neutropenic patients. The appropriate investigational technique, frequently targeted differential diagnosis, and the special needs of these patients, need to be understood. Early detection of a focus is the major goal in febrile neutropenic patients. As pneumonia is the most common focus, chest imaging is a special radiological task. The sensitivity of chest X-ray, especially in supine position, is known to be low; therefore, the very sensitive high-resolution CT (HRCT) became gold standard in neutropenic hosts and will probably be replaced by thin-section multislice CT (MSCT) in the near future. Costs of high-resolution CT are low in comparison to antibiotics. An infiltrate needs to be localised, so that a physician can utilise this information as a guidance for invasive procedures for further microbiological work-up. The radiological characterisation of infiltrates gives a first and rapid hint to differentiate between different sorts of infectious (typical bacterial, atypical bacterial, fungal) and non-infectious aetiologies. Follow-up investigations need careful interpretation according to disease and concomitant treatment. Due to an increased incidence of fungal infiltrates even with appropriate therapy, follow-up of an infiltrate must use further parameters in addition to lesion size. Temporary exclusion of infectious involvement of the lung with high accuracy remains of special interest for clinicians. (orig.)

  5. Idiopathic Acute Eosinophilic Pneumonia

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    Kuan-Ting Liu

    2006-07-01

    Full Text Available Idiopathic acute eosinophilic pneumonia (IAEP is a rare disease but of clinical importance because of its good prognosis if treated promptly and appropriately. The etiology remains unknown and the temporal relationship between IAEP and a history of resent onset of cigarette smoking has been described. We report a typical case of a 21-year-old male with recent onset of smoking, who presented with acute febrile hypoxemic respiratory failure. High-resolution chest computed tomography scan revealed patchy ground glass opacity and ill-defined nodules, diffuse interlobar and interlobular septal thickening, and bilateral small amount of pleural effusion, which mimicked congestive heart failure except that the heart size was within normal limits. Bronchoalveolar lavage (BAL was performed soon after the patient was admitted and remarkable eosinophilia was noted in BAL fluid. Clinical condition and chest radiographs improved dramatically after cor-ticosteroid treatment. Because effective treatment and prompt institution of therapy can obviate unnecessary morbidity and mortality, IAEP should be kept in mind when treating patients presenting with diffuse parenchymal lung disease and acute respiratory failure. In that case, BAL is valuable and should be performed as soon as possible.

  6. Does This Child Have Pneumonia?: The Rational Clinical Examination Systematic Review.

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    Shah, Sonal N; Bachur, Richard G; Simel, David L; Neuman, Mark I

    2017-08-01

    Pneumonia is a leading cause of morbidity and mortality in children. It is important to identify the clinical symptoms and physical examination findings associated with pneumonia to improve timely diagnosis, prevent significant morbidity, and limit antibiotic overuse. To systematically review the accuracy of symptoms and physical examination findings in identifying children with radiographic pneumonia. MEDLINE and Embase (1956 to May 2017) were searched, along with reference lists from retrieved articles, to identify diagnostic studies of pediatric pneumonia across a broad age range that had to include children younger than age 5 years (although some studies enrolled children up to age 19 years); 3644 unique articles were identified, of which 23 met inclusion criteria. Two authors independently abstracted raw data and assessed methodological quality. A third author resolved disputes. Likelihood ratios (LRs), sensitivity, and specificity were calculated for individual symptoms and physical examination findings for the diagnosis of pneumonia. An infiltrate on chest radiograph was considered the reference standard for the diagnosis of pneumonia. Twenty-three prospective cohort studies of children (N = 13 833) with possible pneumonia were included (8 from North America), with a range of 78 to 2829 patients per study. The prevalence of radiographic pneumonia in North American studies was 19% (95% CI, 11%-31%) and 37% (95% CI, 26%-50%) outside of North America. No single symptom was strongly associated with pneumonia; however, the presence of chest pain in 2 studies that included adolescents was associated with pneumonia (LR, 1.5-5.5; sensitivity, 8%-14%; specificity, 94%-97%). Vital sign abnormalities such as fever (temperature >37.5°C [LR range, 1.7-1.8]; sensitivity, 80%-92%; specificity, 47%-54%) and tachypnea (respiratory rate >40 breaths/min; LR, 1.5 [95% CI, 1.3-1.7]; sensitivity, 79%; specificity, 51%) were not strongly associated with pneumonia diagnosis

  7. Pneumonia in Immunocompromised People

    Science.gov (United States)

    ... cells, and fever. Alternative preventive drug treatments are dapsone , atovaquone , and pentamidine (which can be taken as ... In This Article Generic Name Select Brand Names dapsone ACZONE trimethoprim No US brand name atovaquone MEPRON ...

  8. Pneumoniae in immunocompromised patients; Pneumonien bei Immunsuppression

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    Jacobi, Volkmar; Lehnert, Thomas; Thalhammer, Axel [Klinikum der Johann-Wolfgang-Goethe-Univ. (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie

    2009-12-15

    Due to the large surface area, heat, high humidity and high oxygen supply in the lung makes an ideal environment for the propagation of germs. The purpose of the immune system is to establish and maintain the balance between saprophytes and immune defense so as to depress and ultimately kill germs as they infiltrate the body. This usually is achieved by the use of a highly complex immune system. It is a perfect combination of non-specific, cellular and humoral immune mechanisms with very specific immune cells and antibodies, which are specialized on particular pathogens. The specific defenses potentiate the effect of the nonspecific defense in a large extent so as to prevent re-infection and ultimately eliminate recognized pathogens. The causes of immune deficiency can be related to either the cellular or humoral level and affect both the specific and nonspecific defenses. There is a different excitation spectrum depending on the type of immune deficiency. Immune deficiency can prevalently cause complications in the course of infections, decelerate the healing and allow the occurrence of rare pathogens. In particular, the radiological characteristics of typical and atypical pneumonia in immunocompromised patients will be discussed. Particular emphasis is placed on the appearance of bacterial infections, mycobacterioses, PCP, CMV, and laid fungual pneumonia. Even it is not possible to identify certain pathogens radiologically, it is often possible to narrow the spectrum of germs causing pulmonary infections significantly by comparing with other pulmonary complications such as lymphoma or kaposisarcomas. (orig.)

  9. Intubation-associated pneumonia: An integrative review.

    Science.gov (United States)

    Sousa, Ana Sabrina; Ferrito, Cândida; Paiva, José Artur

    2018-02-01

    This article aims to characterise intubation-associated pneumonia regarding its diagnosis, causes, risk factors, consequences and incidence. Integrative literature review using database Pubmed and B-on and webpages of organisations dedicated to this area of study. The research took place between May and July 2015. After selection of the articles, according to established criteria, their quality was assessed and 17 documents were included. Evidence has demonstrated that intubation associated pneumonia has a multifactorial aetiology and one of its main causes is micro-aspiration of gastric and oropharynx contents. Risk factors can be internal or external. The diagnostic criteria are based on clinical, radiological and microbiological data, established by several organisations, including the European Centres for Disease Control and Prevention, which are, however, still not accurate. In recent years, there has been a downward trend in the incidence in Europe. Nevertheless, it continues to have significant economic impact, as well as affecting health and human lives. Several European countries are committed to addressing this phenomenon through infection control and microbial resistance programmes; however there is a much to be done in order to minimise its effects. The lack of consensus in the literature regarding diagnosis criteria, risk factors and incidence rates is a limitation of this study. Copyright © 2017 Elsevier Ltd. All rights reserved.

  10. Oral health disparities in older adults: oral bacteria, inflammation, and aspiration pneumonia.

    Science.gov (United States)

    Scannapieco, Frank A; Shay, Kenneth

    2014-10-01

    Poor oral hygiene has been suggested to be a risk factor for aspiration pneumonia in the institutionalized and disabled elderly. Control of oral biofilm formation in these populations reduces the numbers of potential respiratory pathogens in the oral secretions, which in turn reduces the risk for pneumonia. Together with other preventive measures, improved oral hygiene helps to control lower respiratory infections in frail elderly hospital and nursing home patients. Copyright © 2014 Elsevier Inc. All rights reserved.

  11. [Cough syncope caused by a possible Chlamydia pneumoniae pneumonia].

    Science.gov (United States)

    Cinotti, R; Moubarak, G; Gervais, R; Mabo, P

    2009-09-01

    We report the case of a 61-year-old man who presented with coughing fits followed by sinus pauses and syncope. Cardiac and neurological diagnostic work-up was negative and the patient was considered to have cough syncope. As this occurred within the context of febrile pneumonia, an infectious disease was suspected but diagnostic work-up only revealed an increase of antibodies against Chlamydia pneumoniae. The responsibility of this agent is discussed. Clinical recovery was obtained with the prescription of antitussive medication.

  12. Community-Acquired Pneumonia in Children Caused by Pneumococci of MLSB- and M-Phenotype: Clinical Cases

    Directory of Open Access Journals (Sweden)

    Natalya A. Ilenkova

    2017-01-01

    Full Text Available The key to effective treatment of a bacterial infection is a rapid and proper selection of antimicrobial therapy. WHO and UNICEF developed the Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD aimed to elimination of the preventable causes of child death by 2025 by optimizing diagnosis and treatment. The main pneumonia agents are fastidious microorganisms that require special nutrient media and cultivation conditions that are absent in many laboratories. Due to low effectiveness of the etiological diagnosis, the choice of antibiotic therapy for pneumonia in the practice of a pediatrician is usually empirical. The article describes clinical cases of community-acquired pneumonia in children caused by strains of Streptococcus pneumoniae with a multiple antibiotic resistance. The above experience can be used by pediatricians in everyday practice.

  13. Pneumonia: update on diagnosis and management

    OpenAIRE

    Hoare, Zara; Lim, Wei Shen

    2006-01-01

    Prompt diagnosis and management of community acquired pneumonia saves lives. This article summarises the latest key recommendations in the management of pneumonia and is intended for junior doctors managing this common condition

  14. Childhood pneumonia and vitamin A

    Directory of Open Access Journals (Sweden)

    Farhad Heidarian

    2014-04-01

    Full Text Available One of the major causes of mortality in children younger than 5 years old is acute lower respiratory tract infections (ALRI. ALRI clinical features are cough, tachypnea, fever, coryza, chest retraction, crackles and wheeze. Increased white blood cell count with left shift might happen in pneumonia. C-reactive protein (CRP and erythrocyte sedimentation rate (ESR might rise in children with respiratory tract infections. Vitamin A deficiency is associated with severe childhood infections. The effect of vitamin A supplementation in childhood pneumonia depends on the prevalence and the level of vitamin A deficiency in the population. Some studies confirmed that retinol levels were significantly higher after recovery from acute pneumonia compared to acute phase. But there were no significant association between serum retinol level and the clinical manifestation.

  15. Chest physiotherapy in primary pneumonia.

    Science.gov (United States)

    Britton, S; Bejstedt, M; Vedin, L

    1985-01-01

    One hundred and seventy one patients with primary pneumonia entered a single blind, placebo controlled trial of physiotherapy. Treatment was allocated at random, physiotherapy consisting of postural drainage, external help with breathing, percussion, and vibration and the controls receiving advice on expectoration, deep breathing, and how to exercise to avoid thrombosis. Principles of pharmaceutical management were the same in the two groups. There was no objective evidence that daily physiotherapy helped during the acute phase of the disease. On the contrary, in younger patients, smokers, and patients with interstitial pneumonia physiotherapy appeared to prolong the duration of fever as well as the hospital stay. It is concluded that chest physiotherapy is at best useless in patients with primary infectious pneumonia. PMID:3924221

  16. Anti-alpha-hemolysin monoclonal antibodies mediate protection against Staphylococcus aureus pneumonia.

    Science.gov (United States)

    Ragle, Brook E; Bubeck Wardenburg, Juliane

    2009-07-01

    Staphylococcus aureus pneumonia is one of the most common invasive diseases caused by this human pathogen. S. aureus alpha-hemolysin, a pore-forming cytotoxin, is an essential virulence factor in the pathogenesis of pneumonia. Vaccine-based targeting of this toxin provides protection against lethal staphylococcal pneumonia in a murine model system, suggesting that a monoclonal antibody-based therapy may likewise prove to be efficacious for prevention and treatment of this disease. We report the generation of two distinct anti-alpha-hemolysin monoclonal antibodies that antagonize toxin activity, preventing human lung cell injury in vitro and protecting experimental animals against lethal S. aureus pneumonia. Each of these two monoclonal antibodies recognized an epitope within the first 50 amino acid residues of the mature toxin and blocked the formation of a stable alpha-hemolysin oligomer on the target cell surface. Active immunization with the first 50 amino acids of the toxin also conferred protection against S. aureus pneumonia. Together, these data reveal passive and active immunization strategies for prevention or therapy of staphylococcal pneumonia and highlight the potential role that a critical epitope may play in defining human susceptibility to this deadly disease.

  17. Common childhood kidney diseases in Uganda and their prevention.

    African Journals Online (AJOL)

    2016-03-10

    Mar 10, 2016 ... Sustained sensitization of the masses on malaria preven- tion should be possible as a primary preventive measure for AKI. Pneumonia, on the other hand is preventable, at least partly through Streptococcus pneumoniae and Haemophi- lus type B vaccination. Ensuring adequate child nutrition through ...

  18. Enterobacter Asburiae Pneumonia with Cavitation

    Energy Technology Data Exchange (ETDEWEB)

    Cha, Seung Woo; Heo, Jeong Nam; Park, Choong Ki [Dept. of Radiology, Hanyang University College of Medicine, Guri Hospital, Guri (Korea, Republic of); Choi, Yo Won; Jeon, Seok Chol [Dept. of Radiology, Hanyang University College of Medicine, Seoul Hospital, Seoul (Korea, Republic of)

    2013-03-15

    Enterobacter species have increasingly been identified as pathogens over the past several decades. These bacterial species have become more important because most are resistant to cephalothin and cefoxitin, and can produce extended-spectrum {beta}-lactamase. Enterobacter asburiae (E. asburiae) is a gram-negative rod of the family Enterobacteriaceae, named in 1986. Since then, there has been only one clinical report of E. asburiae pneumonia. We report a case of E. asburiae pneumonia with cavitation and compare it with the previous case.

  19. Pneumonia in Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Vinay Joshi

    2008-01-01

    Full Text Available No large data based, or randomized controlled studies are available in reference to pneumonia in ICU especially in adult population, in India. Moreover the types of ICU infrastructure, sterilization& disinfection protocols, empirical antibiotics and antibiotics policy are standardized in the country. Hence this review article has mainly utilized available literature from developed countries. This review article briefly discusses the definition of various pneumonia, epidemiology, causative organism, patho-genesis, risk factors, diagnostic strategies and management modalities. By this article, authors hope that a certain guidelines or standardization of protocols in India will be formulated.

  20. Social and practical representations in pneumonia associated to ventilation mechanics

    OpenAIRE

    Giovane Mendieta I; Amparo E. Cristancho M

    2009-01-01

    Objective: To identify the practice and social representations of the respiratory therapists, on the strategies of prevention of pneumonia associated to mechanical ventilation, of the unit intensive care of the Kennedy Hospital. Methodology:Qualitative inquiry, descriptive and explanatory character, the population, respiratorys therapist of the unit’s intensives cares, with a sample of captive type for convenience, conformed by seventeen respiratorys therapists who were applied a semistructu...

  1. [Early identification of refractory Mycoplasma pneumoniae pneumonia in children].

    Science.gov (United States)

    Wang, Zhen; Li, Ya-Chun; Chen, Lu

    2015-11-01

    To investigate the clinical indicators for early identification of refractory Mycoplasma pneumoniae pneumonia (RMPP) in children. The clinical data of 142 children with Mycoplasma pneumoniae pneumonia (MPP) between January 2014 and June 2015 were retrospectively studied. Among the 142 children, there were 32 cases of RMPP and 110 cases of non-refractory MPP. The clinical data were compared between the RMPP and non-refractory MPP groups. The percentage of school-age children in the RMPP group was higher than in the non-refractory MPP group (Prefractory MPP group (Prefractory MPP children (Prefractory MPP children (Prefractory MPP group (P40 mg/L and ESR>30 mm/h+LDH>300 IU/L than the non-refractory MPP group (P<0.05). RMPP is common in school-age children. Consolidation of lung on chest X-Ray, pleural effusion and increased levels of CRP and ESR+LDH may be helpful to early identification of RMPP in children.

  2. Effectiveness of a dental care intervention in the prevention of lower respiratory tract nosocomial infections among intensive care patients: a randomized clinical trial.

    Science.gov (United States)

    Bellissimo-Rodrigues, Wanessa T; Menegueti, Mayra G; Gaspar, Gilberto G; Nicolini, Edson A; Auxiliadora-Martins, Maria; Basile-Filho, Anibal; Martinez, Roberto; Bellissimo-Rodrigues, Fernando

    2014-11-01

    To evaluate whether dental treatment may enhance oral antisepsis, thus preventing more effectively lower respiratory tract infections (LRTIs) among critically ill patients. Observer-blind randomized clinical trial. General intensive care unit (ICU) for adult patients. We analyzed data from 254 adult patients who stayed for at least 48 hours in the ICU. Patients were randomized by means of rolling dice. The experimental group (n = 127) had access to dental care provided by a dental surgeon, 4-5 times a week. Besides routine oral hygiene, care also included teeth brushing, tongue scraping, removal of calculus, atraumatic restorative treatment of caries, and tooth extraction. The control group (n = 127) had access to routine oral hygiene only, which included the use of chlorhexidine as a mouth rinse, which was performed by the ICU nurse staff. The primary study outcome was the LRTI incidence, which was 8.7% in the experimental group and 18.1% in the control group (adjusted relative risk [RR], 0.44 [95% confidence interval (CI), 0.20-0.96]; P = .04). Ventilator-associated pneumonia rates per 1,000 ventilator-days were 16.5 (95% CI, 9.8-29.5) in the control group and 7.6 (95% CI, 3.3-15.0) in the experimental group (P Dental treatment was safe and effective in the prevention of LRTI among critically ill patients who were expected to stay at least 48 hours in the ICU. Brazilian Clinical Trials Registry, affiliated with the World Health Organization's International Clinical Trial Registry Platform: U1111-1152-2671.

  3. Dysphagia and aspiration pneumonia in patients with Alzheimer's disease.

    Science.gov (United States)

    Kalia, Madhu

    2003-10-01

    Dysphagia and aspiration pneumonia are the 2 most serious medical conditions seen in late-stage Alzheimer's disease (AD) patients. Pseudobulbar dysphagia is associated with weight loss, which is not always prevented by optimizing the management of the dysphagia. Failure of basic homeostatic mechanisms appears to play an important role in the nutritional status of these patients. Aspiration pneumonia is the most common cause of death in end-stage AD. The primary problems that predispose to aspiration pneumonia include a reduced level of consciousness, dysphagia, loss of the gag reflex, periodontal disease, and the mechanical effects of inserting various tubes into the respiratory and gastrointestinal tracts. The bacterial flora involved include the indigenous oral flora (among which aerobes predominate) and, in the hospital or nursing home setting, nosocomially acquired pathogens such as Staphylococcus aureus and various aerobic and facultative gram-negative bacilli that may colonize in patients. In addition to treatment with antibiotics, adequate symptomatic treatment of AD patients with pneumonia is a priority in order to relieve suffering.

  4. Prevalence of Pseudomonas aeruginosa and antimicrobial-resistant Pseudomonas aeruginosa in patients with pneumonia in mainland China: a systematic review and meta-analysis.

    Science.gov (United States)

    Ding, Chengyi; Yang, Zhirong; Wang, Jing; Liu, Xinran; Cao, Yu; Pan, Yuting; Han, Lizhong; Zhan, Siyan

    2016-08-01

    To estimate the prevalence of Pseudomonas aeruginosa and antimicrobial-resistant P. aeruginosa in ventilator-associated pneumonia (VAP), hospital-acquired pneumonia (HAP), and community-acquired pneumonia (CAP) in mainland China. Meta-analyses of 50 studies published from 2010 to 2014 were conducted, followed by pre-defined subgroup analyses and meta-regressions. P. aeruginosa accounted for 19.4% (95% confidence interval (CI) 17.6-21.2%) of all isolates in VAP, which was similar to the proportion in HAP of 17.8% (95% CI 14.6-21.6%), but significantly greater than the proportion in CAP of 7.7% (15/195, presistance to agents recommended for the initial management of VAP, with a high level of resistance to gentamicin (51.1%, 95% CI 37.7-64.4%) and a low level of resistance to amikacin (22.5%, 95% CI 14.3-33.6%). The prevalence of P. aeruginosa isolates resistant to agents recommended for the treatment of HAP ranged from 22.2% (95% CI 13.8-33.6%) for amikacin to 50.0% (95% CI 30.2-69.8%) for cefoperazone. P. aeruginosa was highly prevalent among patients with VAP and HAP in mainland China. The initial empirical treatment of these patients remains challenging because of the strikingly high prevalence of antimicrobial resistance. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  5. Danger Signs of Childhood Pneumonia: Caregiver Awareness and Care Seeking Behavior in a Developing Country

    Directory of Open Access Journals (Sweden)

    Ikenna K. Ndu

    2015-01-01

    Full Text Available Background. Efforts to reduce child mortality especially in Africa must as a necessity aim to decrease mortality due to pneumonia. To achieve this, preventive strategies such as expanding vaccination coverage are key. However once a child develops pneumonia prompt treatment which is essential to survival is dependent on mothers and caregiver recognition of the symptoms and danger signs of pneumonia. Methods. This community based cross-sectional study enrolled four hundred and sixty-six caregivers in Enugu state. It aimed to determine knowledge of caregivers about danger signs of pneumonia and the sociodemographic factors that influence knowledge and care seeking behaviour of caregivers. Results. There is poor knowledge of the aetiology and danger signs of pneumonia among caregivers. Higher maternal educational attainment and residence in semiurban area were significantly associated with knowledge of aetiology, danger signs, and vaccination of their children against pneumonia. Fast breathing and difficulty in breathing were the commonest known and experienced WHO recognized danger signs while fever was the commonest perceived danger sign among caregivers. Conclusion. Knowledge of danger signs and health seeking behaviour among caregivers is inadequate. There is need for intensified public and hospital based interventions targeted at mothers to improve their knowledge about pneumonia.

  6. Intrapartum colonization with Streptococcus pneumoniae, early-onset sepsis and deficient specific neonatal immune responses.

    Science.gov (United States)

    Faust, Kirstin; Demmert, Martin; Bendiks, Meike; Göpel, Wolfgang; Herting, Egbert; Härtel, Christoph

    2012-03-01

    Intrapartum colonization with Streptococcus pneumoniae (S. pneumoniae) is a rare but important risk factor for severe courses of early-onset sepsis (EOS) in the newborn, as underlined in the case of a preterm infant born after 32 weeks of gestation described here. One potential explanation could be an immature immune response of the neonate to S. pneumoniae, however, immunological data in term and preterm infants are scarce. To determine the neonatal immune responses to S. pneumoniae, flow-cytometry analysis of the cytokine production by CD14+ cells was performed after full pathogen stimulation with S. pneumoniae (serotype 18C, derived from an EOS case described here) of cord blood of 10 term (37-41 gestational weeks) and 6 preterm (31-32 gestational weeks) neonates, compared to peripheral venous blood samples of 10 healthy adults in vitro. Neonatal cytokine responses of term and preterm infants to S. pneumoniae are diminished compared to adults. The quantities of cytokine expression were comparable to immune responses induced by other important gram-positive pathogens of EOS such as Streptococcus agalacticae. Severe courses of EOS with S. pneumoniae may be attributed to remarkable deficiencies of the specific neonatal immune response. To protect the neonate from invasive pneumococcal disease, maternal immunization may be an important prevention strategy, as protective antibodies can be transferred through the placenta and vaccination of pregnant women may reduce colonization.

  7. [Noninfectious differential diagnoses of pneumonia].

    Science.gov (United States)

    Wielandner, A; Agarwal, P; Toelly, A; Bardach, C

    2017-01-01

    In patients with a clinical suspicion of pneumonia, typical clinical and laboratory features along with the detection of infiltrates on chest X‑ray are as a rule considered diagnostic and therapy is immediately initiated; however, studies have shown that in up to 5% of patients with an initial suspicion of pneumonia, another noninfectious pulmonary disease was the underlying cause. Early recognition and differentiation of diseases mimicking pneumonia are prerequisites for an adequate therapy. The aim of this review is to present the important noninfectious differential diagnoses of pneumonia and to provide the reader with tools for a systematic diagnostic approach. A literature search was carried out. As alterations in the lungs often result in similar imaging appearances and a differentiation between transudates, exsudates, blood and cells is not feasible by chest X‑ray or CT, a systematic approach is essential to make an appropriate diagnosis. Hence, consideration of the temporal course, predominant pattern, distribution of findings, additional findings and clinical presentation are indispensable.

  8. Wegener granulomatosis masquerading as pneumonia.

    Science.gov (United States)

    Theodorou, D J; Theodorou, S J; Mpougias, K; Mastora, M; Stefanaki, S; Akritidis, N C

    2010-01-01

    We report a case of an elderly patient with a limited form of Wegener granulomatosis, which simulated the clinical and imaging features of organizing pneumonia. Here we call attention to this atypical case presentation that eloquently illustrates the many faces of Wegener granulomatosis.

  9. Childhood Pneumonia Screener: a concept

    Directory of Open Access Journals (Sweden)

    Jukka Räsänen

    2014-06-01

    Full Text Available Childhood pneumonia continues to be the number one cause of death in children under five years of age in developing countries. In addition to mortality, pneumonia constitutes an enormous economic and social burden because late diagnosis is associated with high cost of treatment and often leads to chronic health problems. There are several bottlenecks in developing countries in the case flow of a child with lung infection: 1 recognising the symptoms as a reason to seek care, 2 getting the patient to a first-tier health facility, 3 scarcity of trained healthcare personnel who can diagnose the condition and its severity, 4 access to a second-tier facility in severe cases. These factors are commonly present in rural areas but even in more urban settings, access to a physician is often delayed. The Childhood Pneumonia Screener project aims at bridging the diagnostic gap using emerging technology. Mobile “smart” phone communication with several inexpensive dedicated sensors is proposed as a rapid data-collection and transmission unit that is connected to a central location where trained personnel assisted by sophisticated signal processing algorithms, evaluate the data and determine if the child is likely to have pneumonia and what the level and urgency of care should be.

  10. Epimorphin expression in interstitial pneumonia

    Directory of Open Access Journals (Sweden)

    Suga Moritaka

    2005-01-01

    Full Text Available Abstract Epimorphin modulates epithelial morphogenesis in embryonic mouse organs. We previously suggested that epimorphin contributes to repair of bleomycin-induced pulmonary fibrosis in mice via epithelium-mesenchyme interactions. To clarify the role of epimorphin in human lungs, we evaluated epimorphin expression and localization in normal lungs, lungs with nonspecific interstitial pneumonia (NSIP, and lungs with usual interstitial pneumonia (UIP; we also studied the effect of recombinant epimorphin on cultured human alveolar epithelial cells in vitro. Northern and Western blotting analyses revealed that epimorphin expression in NSIP samples were significantly higher than those in control lungs and lungs with UIP. Immunohistochemistry showed strong epimorphin expression in mesenchymal cells of early fibrotic lesions and localization of epimorphin protein on mesenchymal cells and extracellular matrix of early fibrotic lesions in the nonspecific interstitial pneumonia group. Double-labeled fluorescent images revealed expression of matrix metalloproteinase 2 in re-epithelialized cells overlying epimorphin-positive early fibrotic lesions. Immunohistochemistry and metalloproteinase activity assay demonstrated augmented expression of metalloproteinase induced by recombinant epimorphin in human alveolar epithelial cells. These findings suggest that epimorphin contributes to repair of pulmonary fibrosis in nonspecific interstitial pneumonia, perhaps partly by inducing expression of matrix metalloproteinase 2, which is an important proteolytic factor in lung remodeling.

  11. Chitinases in Pneumocystis carinii pneumonia

    Science.gov (United States)

    Villegas, Leah R.; Kottom, Theodore J.

    2014-01-01

    Pneumocystis pneumonia remains an important complication of immune suppression. The cell wall of Pneumocystis has been demonstrated to potently stimulate host inflammatory responses, with most studies focusing on β-glucan components of the Pneumocystis cell wall. In the current study, we have elaborated the potential role of chitins and chitinases in Pneumocystis pneumonia. We demonstrated differential host mammalian chitinase expression during Pneumocystis pneumonia. We further characterized a chitin synthase gene in Pneumocystis carinii termed Pcchs5, a gene with considerable homolog to the fungal chitin biosynthesis protein Chs5. We also observed the impact of chitinase digestion on Pneumocystis-induced host inflammatory responses by measuring TNFα release and mammalian chitinase expression by cultured lung epithelial and macrophage cells stimulated with Pneumocystis cell wall isolates in the presence and absence of exogenous chitinase digestion. These findings provide evidence supporting a chitin biosynthetic pathway in Pneumocystis organisms and that chitinases modulate inflammatory responses in lung cells. We further demonstrate lung expression of chitinase molecules during Pneumocystis pneumonia. PMID:22535444

  12. A Prospective One-Year Microbiologic Survey of Combined Pneumonia and Respiratory Failure.

    Science.gov (United States)

    Fisher, Kristen; Trupka, Tracy; Micek, Scott T; Juang, Paul; Kollef, Marin H

    2017-10-01

    Pneumonia and respiratory failure are common problems in the intensive care unit (ICU) setting, often occurring together. The relative prevalence of pneumonia types (community acquired, hospital acquired, ventilator associated) and causative pathogens is not well described in patients with respiratory failure. This was a prospective observational cohort study conducted in the medical ICU (34 beds) of Barnes-Jewish Hospital, an academic referral center of 1,300 beds from January 2016-December 2016. All patients who were prospectively adjudicated to have respiratory failure and pneumonia (RFP) regardless of pneumonia type were classified into one of four microbiologic categories: pathogen negative, antibiotic-susceptible pathogen (according to ceftriaxone susceptibility), antibiotic-resistant pathogen, and viruses. The primary outcomes assessed were the hospital mortality rate and inappropriate initial antibiotic therapy (IIAT) for non-viral pathogens. Among 364 consecutive patients with RFP, 63 (17.3%) had organisms that were antibiotic susceptible, 104 (28.6%) had antibiotic-resistant organisms, 118 (32.4%) were pathogen negative, and 79 (21.7%) had viral infections. For these categories, IIAT occurred in 3.2%, 21.2%, 0.8%, and 0, respectively (p < 0.001). Vasopressor-requiring shock was present in 61.9%, 72.1%, 68.6%, and 67.1%, respectively (p = 0.585), and the hospital mortality rates were 27.0%, 48.1%, 31.4%, and 36.7%, respectively (p = 0.020). Multivariable logistic regression analysis identified IIAT as an independent predictor of in-hospital death (adjusted odds ratio 5.28; 95% confidence interval 2.72-10.22; p = 0.012). Male gender, increasing Acute Physiology and Chronic Health Evaluation (APACHE) II scores, greater age, and the presence of shock also predicted death. Microbiologic categorization of patients with RFP suggests that antibiotic-resistant pathogens and viruses are associated with the highest mortality rates. Vasopressor

  13. Bidirectional Relationship between Cognitive Function and Pneumonia

    Science.gov (United States)

    Shah, Faraaz Ali; Pike, Francis; Alvarez, Karina; Angus, Derek; Newman, Anne B.; Lopez, Oscar; Tate, Judith; Kapur, Vishesh; Wilsdon, Anthony; Krishnan, Jerry A.; Hansel, Nadia; Au, David; Avdalovic, Mark; Fan, Vincent S.; Barr, R. Graham

    2013-01-01

    Rationale: Relationships between chronic health conditions and acute infections remain poorly understood. Preclinical studies suggest crosstalk between nervous and immune systems. Objectives: To determine bidirectional relationships between cognition and pneumonia. Methods: We conducted longitudinal analyses of a population-based cohort over 10 years. We determined whether changes in cognition increase risk of pneumonia hospitalization by trajectory analyses and joint modeling. We then determined whether pneumonia hospitalization increased risk of subsequent dementia using a Cox model with pneumonia as a time-varying covariate. Measurements and Main Results: Of the 5,888 participants, 639 (10.9%) were hospitalized with pneumonia at least once. Most participants had normal cognition before pneumonia. Three cognition trajectories were identified: no, minimal, and severe rapid decline. A greater proportion of participants hospitalized with pneumonia were on trajectories of minimal or severe decline before occurrence of pneumonia compared with those never hospitalized with pneumonia (proportion with no, minimal, and severe decline were 67.1%, 22.8%, and 10.0% vs. 76.0%, 19.3%, and 4.6% for participants with and without pneumonia, respectively; P pneumonia, even in those with normal cognition and physical function before pneumonia (β = −0.02; P pneumonia were subsequently at an increased risk of dementia (hazard ratio, 2.24 [95% confidence interval, 1.62–3.11]; P = 0.01). Associations were independent of demographics, health behaviors, other chronic conditions, and physical function. Bidirectional relationship did not vary based on severity of disease, and similar associations were noted for those with severe sepsis and other infections. Conclusions: A bidirectional relationship exists between pneumonia and cognition and may explain how a single episode of infection in well-appearing older individuals accelerates decline in chronic health conditions and loss of

  14. A health care-associated pneumonia case due to colistin resistant Acinetobacter baumannii

    Directory of Open Access Journals (Sweden)

    Siran Keske

    2014-09-01

    Full Text Available A 78 year old male was hospitalized in neurology clinic with a diagnosis of encephalopathy. On 13th day of imipenem treatment for ventilator-associated pneumonia (VAP, a new VAP episode was diagnosed based on physical examination, laboratory and radiological findings. Cefoperazone-sulbactam 2x2 gr/day IV was started empirically. In the 3rd day of treatment Acinetobacter baumannii was identified from endotracheal aspirate culture that was resistant to all other antibiotics including colistin except cefoperazone-sulbactam (intermediate and tigecycline (MIC: 4 mg/L, intermediate by VITEK and E-test. Tigecycline 2 x 50 mg (after loading dose of 100 mg IV, colistin IV 2 x 150 mg and colistin inhaler 2 x 75 mg were added to the cefoperazone-sulbactam 2 x 2 gr IV. Clinical findings were improved under this combination and completed to 14 days. The patient was discharged from hospital with neurological sequel after three months. This case has been presented to emphasize that colistin resistant Acinetobacter baumannii is becoming a problem for our country. J Microbiol Infect Dis 2014; 4(3: 111-113

  15. Epidemiology of Mycoplasma pneumoniae Infections in Japan and Therapeutic Strategies for Macrolide-resistant M. pneumoniae

    Directory of Open Access Journals (Sweden)

    Tsutomu eYamazaki

    2016-05-01

    Full Text Available Pneumonia caused by Mycoplasma pneumoniae (M. pneumoniae pneumonia is a major cause of community-acquired pneumonia worldwide. The surveillance of M. pneumoniae pneumonia is important for etiological and epidemiological studies of acute respiratory infections. In Japan, nation-wide surveillance of M. pneumoniae pneumonia has been conducted as a part of the National Epidemiological Surveillance of Infectious Diseases (NESID program. This surveillance started in 1981, and significant increases in the numbers of M. pneumoniae pneumonia patients were noted in 1984, 1988, 2006, 2010, 2011, 2012 and 2015. The epidemics in 2011 and 2012 were particularly widespread and motivated researchers to conduct detailed epidemiological studies, including genotyping and drug resistance analyses of M. pneumoniae isolates. The genotyping studies based on the p1 gene sequence suggested that the p1 gene type 1 lineage has been dominant in Japan since 2003, including the epidemic period during 2011-2012. However, more detailed p1 typing analysis is required to determine whether the type 2 lineages become more relevant after the dominance of the type 1 lineage. There has been extensive research interest in implications of the p1 gene types on the epidemiology of M. pneumoniae infections. Serological characterizations of sera from patients have provided a glimpse into these associations, showing the presence of type specific antibody in the patient sera. Another important epidemiological issue of M. pneumoniae pneumonia is the emergence of macrolide-resistant M. pneumoniae (MRMP. MRMPs were noted among clinical isolates in Japan after 2000. At present, the isolation rate of MRMPs from pediatric patients is estimated at 50–90% in Japan, depending on the specific location. In view of the situation, Japanese societies have issued guiding principles for treating M. pneumoniae pneumonia. In these guiding principles, macrolides are still recommended as the first-line drug

  16. [Pneumonia awareness year, 2004: scientific impact through publications in Archivos de Bronconeumología].

    Science.gov (United States)

    Rajas Naranjo, Olga; Aspa Marco, Javier

    2006-10-01

    Pneumonia is a common and potentially serious infectious disease. Morbidity and mortality rates continue to be high in spite of major advances and steady progress in diagnosis and treatment. The economic impact of the disease is also great. It is therefore necessary to enlist the public, primary care and emergency physicians, and public policy administrators to join forces to treat and prevent pneumonia for the common good. The annual incidence of pneumonia in the population over the age of 14 years is 1.6 to 2.6 episodes/1000 inhabitants. The mortality rate is 14.1 per 100,000 inhabitants, and the associated costs are 115 million euros annually. The RESPIRA Foundation and the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) declared 2004 to be pneumonia awareness year with the aim of coordinating efforts to raise awareness, distribute information, and foster debate.

  17. The Correlation Between Indoor Air Pollution with the Incident of Toddler’s Pneumonia

    Directory of Open Access Journals (Sweden)

    Ni Nyoman Dayu Mahalastri

    2014-09-01

    Full Text Available ABSTRACT Pneumonia is a serious health problem in the world, including in Indonesia. Based on the results of Riskesdas 2007, pneumonia was the second ranking cause of death in the proportion of children aged 1–4 years and is under the diarrhea which ranks first. Environmental factors or conditions of the house, especially the air quality in the house is said to be one of the factors that can trigger pneumonia in infants. This study was conducted to determine the correlation of indoor air quality factors with the incidence of toddler’s pneumonia. Type of this study is observational analytic and use case control design. The population of case group was all toddlers who become visitors Mojo Health Center in January 2014 until March 2014 and was diagnosed with pneumonia. While population of control group was all toddlers who become visitors Mojo Health Center in January 2014 until March 2014 and was diagnosed with diseases other than pneumonia. The number of respondents in this study were 60 respondents. The selection of the sample with simple random sampling method. The variables studied were cigarette smoke exposure in the house, size of ventilation and residential density. The results of the analysis using Epi Info StatCalc indicate that exposure to cigarette smoke in the house (OR = 4.00, size of ventilation (OR = 4.03, and residential density (OR = 4.38 has an correlation with incidence of toddler’s pneumonia. It is expected that the public can avoid air pollution in the house in order to prevent toddlers from pneumonia. Keywords: cigarette smoke, size of ventilation, residential density, air quality,                 toddler’s Pneumonia

  18. Factors Associated with Pneumonia-caused Death in Older Adults with Autopsy-confirmed Dementia.

    Science.gov (United States)

    Manabe, Toshie; Mizukami, Katsuyoshi; Akatsu, Hiroyasu; Hashizume, Yoshio; Ohkubo, Takayoshi; Kudo, Koichiro; Hizawa, Nobuyuki

    2017-01-01

    Objective A better understanding of risk factors for pneumonia-caused death may help to improve the clinical management of dementia. Methods A retrospective observational study was conducted by reviewing the medical charts and autopsy reports of 204 patients who were admitted to hospital, underwent a post-mortem examination, and who were neuropathologically diagnosed with dementia. The risk factors for pneumonia-caused death were examined both as underlying and immediate causes of death using logistic regression models. Results A high frequency of pneumonia-caused death was observed both in u