Pneumonia nosocomiala

1. Pneumonia nosocomiala = pneumonia de spital, dobindita ca urmare a spitalizarii, “hospital-acquired pneumonia”

2. Pneumonia nosocomiala2 • = pneumonia ce apare la mai mult de 48 ore de la internare, cu excluderea oricarei infectii care era in perioada de incubare in momentul internarii • 5-10 cazuri/1000 internari, de 6-20 de ori mai mult la bolnavii ventilati mecanic • a doua cauza de infectie nosocomiala in SUA • creste durata spitalizarii in medie cu 7-9 zile/pacient

3. Pneumonia nosocomiala3 • Mortalitate de pina la 70%, dar nu intregime atribuabila infectiei! • Insa! - mortalitatea atribuabila infectiei creste cind exista bacteriemie sau cind agentul etiologic este Pseudomonas aeruginosa sau Acinetobacter

4. Pneumonia nosocomiala4 Tratamentul se bazeaza de: 1. evaluarea severitatii bolii 2. prezenta de factori de risc pentru un anume microb 3. momentul aparitiei si tratamentele anterioare (ex: infectia cu microbi meticilino-rezistenti este mai probabila daca bolnavul a primit antibiotice inaintea debutului pneumoniei)

5. PN- tratamentul antibiotic • Tratamentul initial este, prin necesitate, empiric! • Monoterapie sau combinatii de antibiotice? • Ce mecanism bactericid? • Ce concentratii pulmonare? • Cit timp?

6. Pneumonia nosocomiala: concluzii Many patients with presumed nosocomial pneumonia probably have infiltrates on the chest radiograph, fever, and leukocytosis resulting from noninfectious causes. Because of the high mortality and morbidity associated with nosocomial pneumonias, however, most clinicians treat such patients with a 2-week empiric trial of antibiotics. Before therapy is initiated, the clinician should rule out other causes of pulmonary infiltrates, fever, and leukocytosis that mimic a nosocomial pneumonia (e.g., pre-existing interstitial lung disease, primary or metastatic lung carcinomas, pulmonary emboli, pulmonary drug reactions, pulmonary hemorrhage, collagen vascular disease affecting the lungs, or congestive heart failure). If these disorders can be eliminated from diagnostic consideration, a 2-week trial of empiric monotherapy is indicated. The clinician should treat cases of presumed nosocomial pneumonia as if P. aeruginosa were the pathogen. Although P. aeruginosa is not the most common cause of nosocomial pneumonia, it is the most virulent pulmonary pathogen associated with nosocomial pneumonia. Coverage directed against P. aeruginosa is effective against all other aerobic gram-negative bacillary pathogens causing hospital-acquired pneumonia. The clinician should select an antibiotic for empiric monotherapy that is highly effective against P. aeruginosa, has a good side-effect profile, has a low resistance potential, and is relatively inexpensive in terms of its cost to the institution. Cunha BA, Med Clin North Am 2001; 85: 79-114