Hospital-Acquired Pneumonia in Critically Ill Patients

Topic Hospital-acquired pneumonia commonly develops after 48 hours of hospitalization and can be divided into non–ventilator-acquired and ventilator-acquired pneumonia. Prevention of non–ventilator-acquired pneumonia requires a multimodal approach. Implementation of oral care bundles can reduce the incidence of ventilator-acquired pneumonia, but the literature on oral care in other populations is limited. Clinical Relevance Use of noninvasive ventilation is increasing owing to positive outcomes. The incidence of non–ventilator-acquired pneumonia is higher in patients receiving noninvasive ventilation than in the general hospitalized population but remains lower than that of ventilator-acquired pneumonia. Non–ventilator-acquired pneumonia increases mortality risk and hospital length of stay. Purpose To familiarize nurses with the evidence regarding oral care in critically ill patients requiring noninvasive ventilation. Content Covered No standard of oral care exists for patients requiring noninvasive ventilation owing to variation in study findings, definitions, and methods. Oral care decreases the risk of hospital-acquired pneumonia and improves comfort. Nurses perform oral care less often for nonintubated patients, as it is perceived as primarily a comfort measure. The potential risks of oral care for patients receiving noninvasive ventilation have not been explored. Further research is warranted before this practice can be fully implemented. Conclusion Oral care is a common preventive measure for non–ventilator-acquired pneumonia and may improve comfort. Adherence to oral care is lower for patients not receiving mechanical ventilation. Further research is needed to identify a standard of care for oral hygiene for patients receiving noninvasive ventilation and assess the risk of adverse events.

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Comparative Analysis of the Host Response to Community-acquired and Hospital-acquired Pneumonia in Critically Ill Patients

American Journal of Respiratory and Critical Care Medicine ◽

10.1164/rccm.201602-0368oc ◽

2016 ◽

Vol 194 (11) ◽

pp. 1366-1374 ◽

Cited By ~ 24

Author(s):

Lonneke A. van Vught ◽

Brendon P. Scicluna ◽

Maryse A. Wiewel ◽

Arie J. Hoogendijk ◽

Peter M. C. Klein Klouwenberg ◽

...

Keyword(s):

Comparative Analysis ◽

Critically Ill ◽

Critically Ill Patients ◽

Host Response ◽

Hospital Acquired Pneumonia ◽

Hospital Acquired

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Predictive value of different scoring systems for critically ill patients with hospital acquired pneumonia

Egyptian Journal of Chest Diseases and Tuberculosis ◽

10.1016/j.ejcdt.2016.05.010 ◽

2016 ◽

Vol 65 (4) ◽

pp. 757-763 ◽

Cited By ~ 1

Author(s):

Tarek Hussein Al-Badawy ◽

Amr Mohamed Abouelela ◽

Marwa Abdel Gawad Abdel Kawi

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Predictive Value ◽

Scoring Systems ◽

Hospital Acquired Pneumonia ◽

Hospital Acquired

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

Seminars in Respiratory and Critical Care Medicine ◽

10.1055/s-0037-1602716 ◽

2017 ◽

Vol 38 (03) ◽

pp. 271-286 ◽

Cited By ~ 4

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.

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Predictive value of different scoring systems for critically ill patients with hospital acquired pneumonia

Intensive Care Medicine Experimental ◽

10.1186/2197-425x-3-s1-a345 ◽

2015 ◽

Vol 3 (S1) ◽

Cited By ~ 1

Author(s):

A Abouelela ◽

T Al-Badawy ◽

M Abdel Gawad

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Predictive Value ◽

Scoring Systems ◽

Hospital Acquired Pneumonia ◽

Hospital Acquired

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Inhalation with intravenous loading dose of colistin in critically ill patients with pneumonia caused by carbapenem-resistant gram-negative bacteria

Therapeutic Advances in Respiratory Disease ◽

10.1177/1753466619885529 ◽

2019 ◽

Vol 13 ◽

pp. 175346661988552 ◽

Cited By ~ 4

Author(s):

Junsu Choe ◽

You Min Sohn ◽

Suk Hyeon Jeong ◽

Hyo Jung Park ◽

Soo Jin Na ◽

...

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Gram Negative Bacteria ◽

Loading Dose ◽

Gram Negative ◽

Carbapenem Resistant ◽

Optimal Dosing ◽

Microbiological Outcome ◽

Hospital Acquired Pneumonia ◽

Hospital Acquired

Background: Despite the increasing use of colistin in clinical practice, the optimal dosing, and administration route have not been established. This study aimed to evaluate the clinical outcome and safety of intravenous (IV) colistin with a loading dose (LD) and adjunctive aerosolized (AS) colistin administration in critically ill patients with hospital-acquired pneumonia (HAP) or ventilator-associated pneumonia (VAP) caused by carbapenem-resistant gram-negative bacteria (CRGNB). Methods: We retrospectively reviewed 191 critically ill patients who received colistin for the treatment of HAP or VAP caused by CRGNB. Patients were divided into three groups: non-LD IV (patients received only IV colistin without LD), LD IV (patients received only IV colistin with LD), and AS–LD (patients received IV colistin with LD and adjunctive AS colistin). Results: There was no difference in clinical response between the three groups. However, the rate of microbiological eradication was significantly higher in the AS–LD group (60%) than in the non-LD IV (31%), and LD IV (33%) groups ( p = 0.010). Patients treated with adjunctive AS colistin in combination with LD IV had significantly lower 30-day mortality rates than patients treated with IV colistin alone ( p = 0.027). After adjusting for potential confounding factors, adjunctive AS colistin was still significantly associated with lower mortality (adjusted OR 0.338, CI 95% 0.132–0.864, p = 0.024). However, nephrotoxicity did not change according to the use of LD regimen and AS colistin administration ( p = 0.100). Conclusions: Adjunctive AS colistin in combination with IV colistin with LD was related to an improved 30-day mortality and microbiological outcome without an increase in nephrotoxicity in critically ill patients with HAP and VAP caused by CRGNB. The reviews of this paper are available via the supplemental material section.

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