Nosocomial pneumonia definition, risk factors, diagnosis & treatment

In this article , we are going to discuss Nosocomial pneumonia regarding its causes , predisposing factors , manifestations , diagnostic investigations and management (treatment) .

Definition of Nosocomial pneumonia ? 

It is a hospital acquired pneumonia in a patient who has been admitted for more than 48 hours. The mortality is 30% .
Nosocomial pneumonia

Factors predisposing to nosocomial pneumonia

(1) Reduced host defences:
• Reduced immune defences (e.g corticosteroid treatment, D.M, malignancy).

• Postoperative reduced cough reflex and disordered mucociliary clearance
(anaesthetic agents).
(2) Aspiration of nasopharyngeal or gastric secretions:
• Reduced conscious level.
• Nasogastric intubation.
• Esophageal achalasia or severe gastro-esophageal reflux.

(3) Bacteria introduced into lower respiratory tract:
• Endotracheal intubation.
• Tracheostomy
• lntected ventilators, nebulisers, bronchoscopes.
(4) Bacteraemia :
• Abdominal sepsis.
• I.V cannula infection.
organism : Mostly Gm - ve ( Klebsiella , Pseudomonas )
Others, pneumococci - staph aureus (MRSA) - anaerobic arganisms

• There is high rate of colonization of the nasophorynx of hospital patients with Gram negative bacteria, together with the poor host defences and general inability of the severely ill or semiconscious patients to clear upper airway and respiratory tract secretions.

• Residence in the hospital predisposes patients to skin and mucosal colonization by microbial flora different from that found in ambulatory patients.
• Antimicrobials given to prevent or treat infection may predispose patients to colonization and subsequent infection by hospital flora.
• Failure to observe appropriate infection control measures may permit the dissemination of hospital flora.

 Clinical picture and investigations:

• The clinical features and investigations are very similar to community acquired pneumonia.
• In patients who develops acute bronchopneumonia there is initially symptoms of acute bronchitis followed by fever and dyspnea. Pleural pain is uncommon.
• Early, the signs are those of acute bronchitis followed by crepitations.
• There is neutrophil leucocytosis with mottled opacities in both lung fields mainly in lower lung zones.

How to prevent Nosocomial pneumonia ?

how to prevent hospital-acquired pneumonia

Treatment of nosocomial pneumonia

• Third generation cephalosporin e.g (cefotaxime) plus an aminoglycoside e.g (gentamicin).
• Aspiration pneumonia treated by co-amoxiclav (augmentin) 1.2 gm/8 hrs plus metronidazole 500 mg/8 hrs.
• Physiotherapy, O2 therapy, fluid support

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