Medicus, Vol. 25 No. 1 Pneumonije, 2016.
Review article
Hospital Pneumonia
Hrvoje Puretić
Ervin Žuljević
Marko Jakopović
Abstract
Three types of hospital pneumonia are recognised by the 2005 American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) guidelines: Hospital-acquired pneumonia (HAP), Ventilator-associated pneumonia (VAP) and healthcare-associated pneumonia (HCAP). Among all the hospital-acquired infections HAP is responsible for highest mortality rate. The stay in intensive care units increases the risk of pneumonia. Infection develops through microaspiration of bacteria from colonized oropharyngeal tract and may be polymicrobial and caused by multidrug resistant (MDR) pathogens. MDR is defined as resistance of bacteria to two or more antibiotics ordinarily used to treat this microorganism. MDR infection is expected in patients with certain risk factors: recent antibiotic use, recent or prolonged hospital stay, comorbidity, critical illness and exposure to local microbial flora. Besides clinical features (sudden onset fever, purulent tracheobronchial secretions, respiratory deterioration), the diagnosis of HAP, VAP and HCAP is made upon reliable microbiologic sampling and culture analysis in relation to the chest radiograph findings of new or progressive infiltrate. Considering a high mortality rate, the treatment of suspected HAP, VAP and HCAP should not be delayed and empiric broad spectrum antibiotic should be instituted. Empiric antibiotic monotherapy (beta-lactams or fluoroquinolones) is used in the absence of known risk factors for MDR infection. When MDR infection is suspected, empiric combination of drugs is the choice. Tailoring the broad spectrum therapy after susceptibility tests (de-escalation) and shortening the therapy duration reduces the risk of additional drug-resistance, toxicity of combination therapy and in-hospital mortality.
Keywords
HAP; VAP; HCAP; MDR pathogens; antibiotic therapy
Hrčak ID:
161766
URI
Publication date:
13.7.2016.
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