Trends in Nosocomial Pneumonia in Surgical Patients as We Approach the 21st Century: A Prospective

Crabtree, Traves D.; Gleason, Thomas G.
August 1999
American Surgeon;Aug1999, Vol. 65 Issue 8, p706
Academic Journal
To compare outcome and prognostic factors of pneumonia in surgical patients, we prospectively studied all episodes of nosocomial infection at all sites in 1997 on the surgical services at a single hospital. Pneumonia accounted for 74 of 287 episodes of infection. The crude mortality for pneumonia was 31.1 versus 12.2 per cent for all other infections (P < 0.001). Pneumonia patients had a higher severity of illness compared with those with infections at other sites (18.7 +/- 0.8 vs 14.0 +/- 0.5; P < 0.001). Crude mortality remained higher in pneumonia patients when compared with an infected control group matched for severity of illness and age (31% vs 15%; P = 0.02). Staphylococcus aureus (15%) was the most common isolate, followed by Pseudomonas aeruginosa (9%). Resistant Gram-positive cocci accounted for 7 per cent of all isolates but was associated with a 60 per cent mortality vs 28 per cent with other organisms (not significant; P = 0.1). The Acute Physiology and Chronic Health Evaluation (APACHE) II score for patients with resistant Grampositive cocci was 22 +/- 1 versus 18 - 1 with other organisms (P = 0.03). Nonsurvivors of pneumonia were older (58 +/- 2 vs 51 +/- 3; P = 0.03), had a higher APACHE II score (23 +/- 1 vs 17 +/1; P < 0.001), and were diagnosed later in their hospital course (18 +/- 4 days vs 11 +/- 1; P = 0.05) compared with survivors. Pneumonia-associated mortality in surgical patients remains high compared with other infections even when correcting for differences in severity of illness. Although resistant Gram-positive cocci appear to be increasing in frequency, they may represent markers of severe illness rather than true pathogens. Increasing age, severity of illness, and length of stay before diagnosis were all associated with a worse prognosis.


Related Articles

  • New guidelines are out for nosocomical pneumonia.  // Brown University Long-Term Care Quality Advisor;05/12/97, Vol. 9 Issue 9, p2 

    Reports that the Epidemiology Program Office of the Centers for Disease Control and Prevention (CDC) published `Guidelines for Prevention of Nosocomial Pneumonia.' Who the guideline is aimed at; Some of the issues found in the guideline; Reference made to `The Morbidity and Mortality Weekly'...

  • Pharmacokinetics and Pharmacodynamics of Continuous and Intermittent Ceftazidime during the Treatment of Nosocomial Pneumonia. Nicolau, D.P.; McNabb, J.; Lacy, M.K.; Li, J.; Quintiliani, R.; Nightingale, C.H. // Clinical Drug Investigation;1999, Vol. 18 Issue 2, p133 

    Objective: This study aimed too compare the pharmacokinetic and pharmacodynamic profile of intermittent and continuously infused ceftazidime in patients with nosocomial pneumonia. Design and Setting: Prospective, randomised study set in a large community-teaching hospital. Interventions:...

  • healthcare-associated pneumonia.  // Taber's Cyclopedic Medical Dictionary (2009);2009, Issue 21, p1015 

    A definition of the medical term "healthcare-associated pneumonia," which refers to nosocomial pneumonia that is contracted during hospital stay, is presented.

  • Clinical Microbiology: Recombination turns one clade into two. Kåhrström, Christina Tobin // Nature Reviews Microbiology;May2014, Vol. 12 Issue 5, p313 

    The article reports on the study that illustrates the importance of the clinical isolates of carbapenem-resistant Klebsiella pneumoniae that belong to multilocus sequence type 258 (ST258) as nosocomial pathogens.

  • Preventing nosocomial pneumonia. Carroll, Patricia; Moore, Amy Slugg // RN;Jun98, Vol. 61 Issue 6, p44 

    Focuses on nosocomial pneumonia and how this disease can be treated. Percentage which the fatality rates ranges in this disease; Medical advice offered in the treatment of this disease; Utilization of ventilator circuits along with a heated wire; Education of patients with this disease;...

  • Medical microbiology.  // Clinical & Investigative Medicine;Aug97 Supplement, Vol. 20, pS55 

    Presents an abstract of the research manuscript `Direct evidence for nosocomial person-to-person transmission of intermediate level penicillin resistant Streptococcus pneumoniae,' by N. Cimolai and C. Trombley.

  • ERRATUM.  // Clinical Infectious Diseases;11/1/2010, Vol. 51 Issue 9, p1114 

    A correction to the article concerning the design of clinical trials for antibacterial drugs for hospital-acquired pneumonia and ventilator-associated pneumonia that was published in the August 1, 2010 is presented.

  • Outbreak of a Multiresistant Klebsiella pneumoniae Strain in an Intensive Care Unit: Antibiotic... Asensio, Angel; Oliver, Antonio; Gonzalez-Diego, Paulino; Baquero, Fernando; Perez-Diaz, Jose Claudio; Ros, Purificacion; Cobo, Javier; Palacios, Margarita; Lasheras, Dolores; Canton, Rafael // Clinical Infectious Diseases;1/1/2000, Vol. 30 Issue 1, p55 

    Describes a nosocomial infectious outbreak caused by multiresistant Klebsiella pneumoniae (MRKP) through a study of a sample of two groups of pediatric intensive care unit patients at a hospital in Madrid, Spain. Evidence of patterns that were indistinguishable from each other; Evidence that...

  • Risk Factors for Late-Onset Nosocomial Pneumonia Caused by Stenotrophomonas maltophilia in Critically Ill Trauma Patients. Hanes, Scott D.; Demirkan, Kutay; Tolley, Elizabeth; Boucher, Bradley A.; Croce, Martin A.; Wood, G. Christopher; Fabian, Timothy C. // Clinical Infectious Diseases;8/1/2002, Vol. 35 Issue 3, p228 

    Patients with nosocomial pneumonia caused by Stenotrophomonas maltophilia often receive inadequate empiric antibiotic therapy, potentially increasing mortality. Knowledge of the risk factors associated with S. maltophilia pneumonia may better guide the selection of empiric antibiotic therapy....


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics