scholarly journals The Spectrum of Practice in the Diagnosis and Management of Pneumonia in Patients Requiring Mechanical Ventilation. Australian and New Zealand Practice in Intensive Care (ANZPIC II)

2005 ◽  
Vol 33 (1) ◽  
pp. 87-100 ◽  
Author(s):  
R. J. Boots ◽  
J. Lipman ◽  
R. Bellomo ◽  
D. Stephens ◽  
R. F. Heller
Keyword(s):  
Intensive Care ◽  
New Zealand ◽  
Antibiotic Prescription ◽  
Antibiotic Use ◽  
Community Acquired Pneumonia ◽  
Diagnostic Methods ◽  
Ventilator Associated Pneumonia ◽  
Third Generation ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

This study of ventilated patients investigated current clinical practice in 476 episodes of pneumonia (48% community-acquired pneumonia, 24% hospital-acquired pneumonia, 28% ventilator-associated pneumonia) using a prospective survey in 14 intensive care units (ICUs) within Australia and New Zealand. Diagnostic methods and confidence, disease severity, microbiology and antibiotic use were assessed. All pneumonia types had similar mortality (community-acquired pneumonia 33%, hospital-acquired pneumonia 37% and ventilator-associated pneumonia 24%, P=0.15) with no inter-hospital differences (P=0.08–0.91). Bronchoscopy was performed in 26%, its use predicted by admission hospital (one tertiary: OR 9.98, CI 95% 5.11–19.49, P<0.001; one regional: OR 6.29, CI 95% 3.24–12.20, P<0.001), clinical signs of consolidation (OR 3.72, CI 95% 2.09–6.62, P<0.001) and diagnostic confidence (OR 2.19, CI 95% 1.29–3.72, P=0.004). Bronchoscopy did not predict outcome (P=0.11) or appropriate antibiotic selection (P=0.69). Inappropriate antibiotic prescription was similar for all pneumonia types (11–13%, P=0.12) and hospitals (0–16%, P=0.25). Blood cultures were taken in 51% of cases. For community-acquired pneumonia, 70% received a third generation cephalosporin and 65% a macrolide. Third generation cephalosporins were less frequently used for mild infections (OR 0.38, CI 95% 0.16–0.90, P=0.03), hospital-acquired pneumonia (OR 0.40, CI 95% 0.23–0.72, P<0.01), ventilator-associated pneumonia (OR 0.04, CI 95% 0.02–0.13, P<0.001), suspected aspiration (OR 0.20, CI 95% 0.04–0.92, P=0.04), in one regional (OR 0.26, CI 95% 0.07–0.97, P=0.05) and one tertiary hospital (OR 0.14, CI 95% 0.03–0.73, P=0.02) but were more commonly used in older patients (OR 1.02, CI 95% 1.01–1.03, P=0.01). There is practice variability in bronchoscopy and antibiotic use for pneumonia in Australian and New Zealand ICUs without significant impact on patient outcome, as the prevalence of inappropriate antibiotic prescription is low. There are opportunities for improving microbiological diagnostic work-up for isolation of aetiological pathogens.

scholarly journals Disease Risk and Mortality Prediction in Intensive Care Patients with Pneumonia. Australian and New Zealand Practice in Intensive Care (ANZPIC II)

2005 ◽  
Vol 33 (1) ◽  
pp. 101-111 ◽  
Author(s):  
R. J. Boots ◽  
J. Lipman ◽  
R. Bellomo ◽  
D. Stephens ◽  
R. F. Heller
Keyword(s):  
Intensive Care ◽  
New Zealand ◽  
Clinical Signs ◽  
Community Acquired Pneumonia ◽  
Ventilator Associated Pneumonia ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

This study of ventilated patients investigated pneumonia risk factors and outcome predictors in 476 episodes of pneumonia (48% community-acquired pneumonia, 24% hospital-acquired pneumonia, 28% ventilator-associated pneumonia) using a prospective survey in 14 intensive care units within Australia and New Zealand. For community acquired pneumonia, mortality increased with immunosuppression (OR 5.32, CI 95% 1.58–17.99, P<0.01), clinical signs of consolidation (OR 2.43, CI 95% 1.09–5.44, P=0.03) and Sepsis-Related Organ Failure Assessment (SOFA) scores (OR 1.19, CI 95% 1.08–1.30, P<0.001) but improved if appropriate antibiotic changes were made within three days of intensive care unit admission (OR 0.42, CI 95% 0.20–0.86, P=0.02). For hospital-acquired pneumonia, immunosuppression (OR 6.98, CI 95% 1.16–42.2, P=0.03) and non-metastatic cancer (OR 3.78, CI 95% 1.20–11.93, P=0.02) were the principal mortality predictors. Alcoholism (OR 7.80, CI 95% 1.20–17.50, P<0.001), high SOFA scores (OR 1.44, CI 95% 1.20–1.75, P=0.001) and the isolation of “high risk” organisms including Pseudomonas aeruginosa, Acinetobacter spp, Stenotrophomonas spp and methicillin resistant Staphylococcus aureus (OR 4.79, CI 95% 1.43–16.03, P=0.01), were associated with increased mortality in ventilator-associated pneumonia. The use of non-invasive ventilation was independently protective against mortality for patients with community-acquired and hospital-acquired pneumonia (OR 0.35, CI 95% 0.18–0.68, P=0.002). Mortality was similar for patients requiring both invasive and non-invasive ventilation and non-invasive ventilation alone (21% compared with 20% respectively, P=0.56). Pneumonia risks and mortality predictors in Australian and New Zealand ICUs vary with pneumonia type. A history of alcoholism is a major risk factor for mortality in ventilator-associated pneumonia, greater in magnitude than the mortality effect of immunosuppression in hospital-acquired pneumonia or community-acquired pneumonia. Non-invasive ventilation is associated with reduced ICU mortality. Clinical signs of consolidation worsen, while rationalising antibiotic therapy within three days of ICU admission improves mortality for community-acquired pneumonia patients.

scholarly journals A Literature Review on Hospital-Acquired Pneumonia (HAP), Community-Acquired Pneumonia (CAP), and Ventilator-Associated Pneumonia (VAP)

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Pedram Bolboli Zade ◽  
Abbas Farahani ◽  
Mohammadreza Riyahi ◽  
Ali Laelabadi ◽  
Ali Salami Asl ◽  
...  
Keyword(s):  
Risk Factors ◽  
Community Acquired Pneumonia ◽  
Specific Information ◽  
Ventilator Associated Pneumonia ◽  
Artificial Airway ◽  
Control And Prevention ◽  
Hospital Acquired Pneumonia ◽  
And Gender ◽  
Hospital Acquired ◽  
Common Infection

: One of the most dangerous respiratory diseases is pneumonia, one of the ten leading causes of death globally. Hospital-acquired pneumonia (HAP) is a common infection in hospitals, which is the second most common nosocomial infection and causes inflammation parenchyma. In Community-acquired pneumonia (CAP), we have various risk factors, including age and gender, and also some specific risk factors. Ventilator-associated pneumonia (VAP) is one of the deadliest nosocomial infections. According to the Centers for Disease Control and Prevention, VAP is pneumonia that develops about 48 hours of an artificial airway. Bacterial, viral, parasitic, primordial, and other species can cause these diseases. We discuss bacterial factors. Our goal is to gather information about HAP, CAP, and VAP to give people specific information. In this study, these three issues have been examined together, but in similar studies, each of them has been examined separately, and our type of study will be more helpful in diagnosis and treatment.

scholarly journals Etiology, incidence and mortality in patients with ventilator-associated pneumonia in adult general surgery and cardiac surgery intensive care units in University Hospital Dubrava

2020 ◽  
Vol 39 (4) ◽  
pp. 124-128
Author(s):  
Andrea Karin ◽  
Andrej Šribar ◽  
Marko Pražetina ◽  
Katerina Bakran ◽  
Jasminka Peršec
Keyword(s):  
Cardiac Surgery ◽  
Intensive Care ◽  
Intensive Care Units ◽  
General Surgery ◽  
University Hospital ◽  
Ventilator Associated Pneumonia ◽  
Timely Initiation ◽  
Incidence And Mortality ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

Ventilator-associated pneumonia (VAP) and hospital acquired pneumonia (HAP) strongly contribute to morbidity and mortality in intensive care units. Hospital acquired pneumonia (HAP) is pneumonia occurring 48 hours upon admission and appears not to be incubating at the time of admission. Ventilator-associated pneumonia (VAP) is a type of HAP developing in intubated patients after more than 48 hours upon mechanical ventilation. HAP and VAP are common and serious complications present in hospitalized patients. Since the diagnosis of VAP and HAP are rarely documented, we wanted to assess the incidence of VAP in General Surgery and Cardiac Surgery Intensive Care Units in 2018 and analyse the patients and procedures related factors. Patients intubated and ventilated more than 96 hours during 2018 were included. Our findings have shown that incidence of VAP in two analysed ICUs in UH Dubrava is in line with VAP incidence found in literature due to successful preventive strategies and timely initiation of antimicrobial therapy and other adjunctive procedures.

Pharmacokinetic/Pharmacodynamics-Optimized Antimicrobial Therapy in Patients with Hospital-Acquired Pneumonia/Ventilator-Associated Pneumonia

2017 ◽  
Vol 38 (03) ◽  
pp. 271-286 ◽  
Author(s):  
Helmi Sulaiman ◽  
Mohd Abdul-Aziz ◽  
Jason Roberts
Keyword(s):  
Intensive Care ◽  
Antimicrobial Resistance ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Therapeutic Drug ◽  
Ventilator Associated Pneumonia ◽  
Physiological Changes ◽  
Significant Morbidity ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

AbstractHospital-acquired pneumonia and ventilator-associated pneumonia continue to cause significant morbidity and mortality. With increasing rates of antimicrobial resistance, the importance of optimizing antibiotic treatment is key to maximize treatment outcomes. This is especially important in critically ill patients in intensive care units, in whom the infection is usually caused by less susceptible organisms. In addition, the marked physiological changes that can occur in these patients can cause serious changes in antibiotic pharmacokinetics which in turn alter the attainment of therapeutic drug exposures. This article reviews the various aspects of the pharmacokinetic changes that can occur in the critically ill patients, the barriers to achieving therapeutic drug exposures in pneumonia for systemically delivered antibiotics, the optimization for commonly used antibiotics in hospital- and ventilator-associated pneumonia, the agents that should be avoided in the treatment regimen, as well as the use of adjunctive therapy in the form of nebulized antibiotics.

Hospital-Acquired Pneumonia in the Intensive Care Units of Polish Hospitals

2006 ◽  
Vol 27 (7) ◽  
pp. 784-786
Author(s):  
Jadwiga Wójkowska-Mach ◽  
Małgorzata Bulanda ◽  
Anna Różańska ◽  
Piotr Kochan ◽  
Piotr B. Heczko
Keyword(s):  
Escherichia Coli ◽  
Intensive Care ◽  
Mortality Rate ◽  
Intensive Care Units ◽  
Artificial Ventilation ◽  
Ventilator Associated Pneumonia ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired ◽  
Epidemiological Characteristics ◽  
Overall Mortality

We analyzed the epidemiological characteristics of pneumonia in intensive care units of Polish hospitals. Among 11,587 patients, there were 191 cases of hospital-acquired pneumonia (HAP). The incidence of HAP was 5.6%, and that of ventilator-associated pneumonia (VAP) was 17.9%. The overall mortality rate was 12.6%, and the mortality rate for patients who received artificial ventilation was 15.0%. The predominant organisms causing HAP and VAP were Pseudomonas aeruginosa and Escherichia coli, and 21.1% of Staphylococcus aureus isolates were resistant to methicillin.

Hospital-Acquired Pneumonia in the Intensive Care Units of Polish Hospitals

2006 ◽  
Vol 27 (7) ◽  
pp. 784-786 ◽  
Author(s):  
Jadwiga Wójkowska-Mach ◽  
Małgorzata Bulanda ◽  
Anna Różańska ◽  
Piotr Kochan ◽  
Piotr B. Heczko
Keyword(s):  
Escherichia Coli ◽  
Intensive Care ◽  
Mortality Rate ◽  
Intensive Care Units ◽  
Artificial Ventilation ◽  
Ventilator Associated Pneumonia ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired ◽  
Epidemiological Characteristics ◽  
Overall Mortality

We analyzed the epidemiological characteristics of pneumonia in intensive care units of Polish hospitals. Among 11,587 patients, there were 191 cases of hospital-acquired pneumonia (HAP). The incidence of HAP was 5.6%, and that of ventilator-associated pneumonia (VAP) was 17.9%. The overall mortality rate was 12.6%, and the mortality rate for patients who received artificial ventilation was 15.0%. The predominant organisms causing HAP and VAP were Pseudomonas aeruginosa and Escherichia coli, and 21.1% of Staphylococcus aureus isolates were resistant to methicillin.

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