Spectrum of practice in the diagnosis of nosocomial pneumonia in patients requiring mechanical ventilation in European intensive care units

Introduction. Pneumonia is the most frequent nosocomial infection in intensive care units. The reported frequency varies with definition, the type of hospital or intensive care units and the population of patients. The incidence ranges from 6.8-27%. Objective. The objective of this study was to determine the frequency, risk factors and mortality of nosocomial pneumonia in intensive care patients. Methods. We analyzed retrospectively and prospectively the collected data of 180 patients with central nervous system infections who needed to stay in the intensive care unit for more than 48 hours. This study was conducted from 2003 to 2009 at the Clinical Centre of Kragujevac. Results. During the study period, 54 (30%) patients developed nosocomial pneumonia. The time to develop pneumonia was 10?6 days. We found that the following risk factors for the development of nosocomial pneumonia were statistically significant: age, Glasgow Coma Scale (GCS) score <9, mechanical ventilation, duration of mechanical ventilation, tracheostomy, presence of nasogastric tube and enteral feeding. The most commonly isolated pathogens were Klebsiella-Enterobacter spp. (33.3%), Pseudomonas aeruginosa (24.1%), Acinetobacter spp. (16.6%) and Staphylococcus aureus (25.9%). Conclusion. Nosocomial pneumonia is the major cause of morbidity and mortality of patients with central nervous system infections. Patients on mechanical ventilation are particularly at a high risk. The mortality rate of patients with nosocomial pneumonia was 54.4% and it was five times higher than in patients without pneumonia.

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Oral care and nosocomial pneumonia: a systematic review

Einstein (São Paulo) ◽

10.1590/s1679-45082015rw2980 ◽

2015 ◽

Vol 13 (2) ◽

pp. 290-296 ◽

Cited By ~ 12

Author(s):

Maria Carolina Nunes Vilela ◽

Gustavo Zanna Ferreira ◽

Paulo Sérgio da Silva Santos ◽

Nathalie Pepe Medeiros de Rezende

Keyword(s):

Systematic Review ◽

Intensive Care ◽

Intensive Care Units ◽

Nosocomial Pneumonia ◽

Oral Hygiene ◽

Oral Care ◽

Control Group ◽

Level Of Evidence ◽

Grade Of Recommendation ◽

Minimal Bias

To perform a systematic review of the literature on the control of oral biofilms and the incidence of nosocomial pneumonia, in addition to assessing and classifying studies as to the grade of recommendation and level of evidence. The review was based on PubMed, LILACS, and Scopus databases, from January 1st, 2000 until December 31st, 2012. Studies evaluating oral hygiene care related to nosocomial infections in patients hospitalized in intensive care units were selected according to the inclusion criteria. Full published articles available in English, Spanish, or Portuguese, which approached chemical or mechanical oral hygiene techniques in preventing pneumonia, interventions performed, and their results were included. After analysis, the articles were classified according to level of evidence and grade of recommendation according to the criteria of the Oxford Centre for Evidence-Based Medicine. A total of 297 abstracts were found, 14 of which were full articles that met our criteria. Most articles included a study group with chlorhexidine users and a control group with placebo users for oral hygiene in the prevention of pneumonia. All articles were classified as B in the level of evidence, and 12 articles were classified as 2B and two articles as 2C in grade of recommendation. It was observed that the control of oral biofilm reduces the incidence of nosocomial pneumonia, but the fact that most articles had an intermediate grade of recommendation makes clear the need to conduct randomized controlled trials with minimal bias to establish future guidelines for oral hygiene in intensive care units.

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Diagnosis and Treatment of Nosocomial Pneumonia in Patients in Intensive Care Units

Clinical Infectious Diseases ◽

10.1093/clind/21.supplement_3.s226 ◽

1995 ◽

Vol 21 (Supplement_3) ◽

pp. S226-S237 ◽

Cited By ~ 48

Author(s):

Jean Chastre ◽

Jean-Yves Fagon ◽

Jean Louis Trouillet

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Nosocomial Pneumonia ◽

Diagnosis And Treatment

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Mucormycosis: A Black Fungus- Post Covid Complications

Journal of Regenerative Biology and Medicine ◽

10.37191/mapsci-2582-385x-3(4)-078 ◽

2021 ◽

Author(s):

Prithiv Kumar KR

Keyword(s):

Mechanical Ventilation ◽

T Cells ◽

Intensive Care ◽

Fungal Infection ◽

Intensive Care Units ◽

Respiratory System ◽

Cd8 T Cells ◽

Transmitted Disease ◽

Global Pandemic

Human to human transmitted disease is the game of coronavirus disease (COVID-19) transmission and it had been declared an emergency global pandemic that caused major disastrous in the respiratory system to more than five million people and killing more than half a billion deaths across the globe. Besides lower acute respiratory syndrome, there is damage to the alveolar with severe inflammatory exudation. COVID-19 patients often have lower immunosuppressive CD4+ T and CD8+ T cells and most patients in intensive care units (ICU) need mechanical ventilation, hence longer stay in hospitals. These patients have been discovered to develop fungal co-infections. COVID-19 patients develop what is known as mucormycosis a black fungal infection that is deadly leading to loss of sight and hearing and eventually death. This chapter will focus on mucormycosis, a black fungus caused during post covid complications.

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Candidemia in an intensive care unit

Medicina ◽

10.3390/medicina45050044 ◽

2008 ◽

Vol 45 (5) ◽

pp. 351

Author(s):

Dalia Adukauskienė ◽

Aida Kinderytė ◽

Asta Dambrauskienė ◽

Astra Vitkauskienė

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Risk Factor ◽

Intensive Care ◽

Urinary Bladder ◽

Intensive Care Units ◽

Severe Disease ◽

Candida Spp ◽

Lethal Outcome ◽

Bladder Catheter

Candidemia is becoming more actual because of better survival of even critically ill patients, wide use of antimicrobials, and increased numbers of invasive procedures and manipulations. Diagnosis of candidemia remains complicated, and costs of treatment and mortality rates are increasing. Objective. To evaluate the pathogens of candidemia, risk factors and their influence on outcome. Material and methods. Data of 41 patients with positive blood culture for Candida spp., who were treated in the intensive care units at the Hospital of Kaunas University of Medicine, were analyzed retrospectively. Results. Candidemia was caused by Candida albicans (C. albicans) in 48.8% (n=20) of patients and by non-albicans Candida in 51.2% (n=21) of patients. The main cause of candidemia was C. albicans in 2004 (83.3%, n=5), but in 2005 (63.6%, n=7), in 2006 (57.1%, n=4), and in 2007 (52.9%, n=9), the main cause was non-albicans Candida spp. The number of candidemia cases caused by C. albicans was decreased in 2005, 2006, and 2007 as compared with 2004, and the number of candidemia caused by non-albicans Candida spp. was decreased, respectively (P<0.05). More than 65% (n=34) of patients had severe disease (P<0.05). Lethal outcome was recorded in 58.5% of patients with candidemia. Mechanical ventilation was used in 76.9% (n=20) and urinary bladder catheter in 72.1% (n=19) of non-survivors and in 23.1% (n=6) and 26.9% (n=7) of survivors, respectively (P<0.05). Conclusions. There is an increase in the prevalence of candidemia in the intensive care units during the 4-year period; half of candidemia cases were caused by non-albicans Candida spp., and patients with candidemia caused by non-albicans Candida spp. are at higher risk of mortality. Therefore, for the empirical treatment of septic conditions in an intensive care unit, when invasive fungal infection is suspected, we recommend using an antifungal agent of non-azole class until a pathogen of candidemia is determined. Severe disease is evaluated as a risk factor for candidemia. Patients with oncological diseases are at significantly higher risk for candidemia caused by non-albicans Candida spp. Use of mechanical ventilation and urinary bladder catheter is a risk factor for lethal outcome.

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