Incidence, risk factors and prognosis of nosocomial pneumonia in adult patients admitted in the intensive care unit

authors:

avatar Mojtaba Soltani , avatar Mohammad Nassaji , avatar Raheb Ghorbani ORCID , *


how to cite: Soltani M, Nassaji M, Ghorbani R. Incidence, risk factors and prognosis of nosocomial pneumonia in adult patients admitted in the intensive care unit. koomesh. 2021;23(1):e153242. 

Abstract

Introduction: Hospital acquired pneumonia (HAP) is the second most commonly reported hospital infection and the most common infection in the intensive care unit (ICU). Identification of risk factors and determinants of prognosis in the occurrence of HAP and ways of prevention can be effective in reducing the incidence and mortality of these infections. In this way, we investigated, the incidence of HAP, its prognostic risk factors in adult patients admitted in intensive care unit of the Kosar Hospital in Semnan, Iran. Materials and Methods: In this cross-sectional study, 283 patients over 18 years of age hospitalized in intensive care units of Kosar Hospital, Semnan, Iran during the period of 2018 years with the inclusion criteria for pneumonia were studied. Patients who were infected with infectious diseases at the time of admission to ICU and Patients who died or were discharged before 48 hours were excluded. Results: 59% of patients were male. The mean ± SD age of the patients was 64.3 ±20.0 (18 to 96 years). 8.5% had abdominal surgery, 6.7% chest surgery, 27.2% diabetes and 38.9% had high blood pressure.15.9% ( 95%CI :11.7-20.1%) were infected with pneumonia. Interestingly, Pneumonia was not associated with age, abdominal surgery, chest surgery, diabetes, and high blood pressure. The duration of having a nasogastric tube (P

References

  • 1.

    Prevention of hospital-acquired infections: A practical guide. 2nd edition. WHO/CDS/CSR/EPH/2002/12. Available at http://www.who.int/emc.

  • 2.

    Behzadnia S, Davoudi A, Rezai MS, Ahangarkani F. Nosocomial infections in pediatric population and antibiotic resistance of the causative organisms in North of Iran. Iran Red Crescent Med J 2014; 16: e14562. (Persian).

  • 3.

    Martin-Loeches, Rodriguez AH, Torres A. New guidelines for hospital-acquired pneumonia/ventilator-associated pneumonia: USA vs. Eur Curr Opin Crit Care 2018; 24: 347-352.

  • 4.

    Barbier F, Andremont A, Wolff M, Bouadma L. Hospital-acquired pneumonia and ventilator-associated pneumonia: recent advances in epidemiology and management. Curr Opin Pulm Med 2013; 19: 216-228.

  • 5.

    Bassetti M, Righi E, Vena A, Graziano E, Russo A, Peghin M. Risk stratification and treatment of ICU-acquired pneumonia caused by multidrug- resistant/extensively drug-resistant/pandrug-resistant bacteria. Curr Opin Crit Care 2018; 24: 385-393.

  • 6.

    Mandell LA, Wunderink RG. Pneumonia. In: Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameon JL, Loscalzo J, editors. Harrisons's Principles of Internal Medicine. 19th ed. USA: McGraw-Hill; 2015; p: 803-813.

  • 7.

    Zhu J, Zhang X, Shi G , Yi K, Tan X . Atrial fibrillation is an independent risk factor for hospital-acquired pneumonia. PLoS One 2015; 10: e0131782.

  • 8.

    Khan HA, Baig FK, Mehboob R. Nosocomial infections: Epidemiology, prevention, control and surveillance. Asian Pacific J Tropic Biomed 2017; 7: 478-482.

  • 9.

    Mandell GL, Bennett JE, Dolin R. Mandell, Douglas, and Bennett's principles and practice of infectious diseases: Churchill Livingstone/Elsevier; 2020; p: 3577-3578.

  • 10.

    Ashraf M, Ostrosky-Zeichner L. Ventilator-associated pneumonia: a review. Hosp Pract 2012; 40: 93-105.

  • 11.

    Nassaji M, Mosavi S, Ghorbani R. Incidences of nosocomial pneumonia in patients above 15 years in intensive care units of university hospital in Semnan. Koomesh 2004; 5: 89-94. (Persian).

  • 12.

    Nadi E , Nekouii B, Mobin A, Nekouii A, Moghim Beigi A. Frequency of nosocomial pneumonia in ICUs of hospitals of Hamadan university of medical sciences. J Isfahan Med Sch 2011; 29: 1255-1262. (Persian).

  • 13.

    Salehifar E, Abedi S, Mirzaei E, Kalhor Sh, Eslami G, Ala Sh, Alyali M, Sharifpour A. Profile of microorganisms involved in nosocomial pneumonia and their antimicrobial resistance pattern in intensive care units of Imam Khomeini hospital, Sari 2011-2012. J Mazand Univ Med Sci 2013; 23: 151-162 (Persian).

  • 14.

    Denys D, Martens P, Mullie A, Lust P. Incidence of nosocomial pneumonia in ICU patients. Acta Anaesth Belg 1993; 44: 111-118.

  • 15.

    Marsh B, Hone R, White M, Phelan D, Fabry J. European nosocomial infection survey: analysis of Irish data. Irish intensive care nosocomial pneumonia survey group. Ir Med J 1996; 89: 96-98.

  • 16.

    Trivedi TH, Shejale SB, Yeolekar ME. Nosocomial pneumonia in medical intensive care unit. J Assoc Physicians India 2000; 48: 1070-1073.

  • 17.

    Diling Wu, Chenfang Wu, Siye Zhang, Yanjun Zhong. Risk factors of ventilator-associated pneumonia in critically III patients. Front Pharmacol 2019; 10: 482.

  • 18.

    Erbay H, Yalcin AN, Serin S, Turgut H, Tomatir E, Cetin B, Zencir M. Nosocomial infections in intensive care unit in a Turkish university hospital: a 2-year survey. Intensive Care Med 2003; 29: 1482-1488.

  • 19.

    Nobahar M, Razavi MR, Malek F, Ghorbani R. Incidence of ventilator-associated pneumonia in intensive care units and its relationship with risk factors. RJMS 2016; 22: 134-145 (Persian).

  • 20.

    Ranjbar H, Jafari S, Kamrani F, Alavi Majd H, Yaghmaei F, Asgari A. Effect of Chlorhexidine gluconate oral rinse on late onset ventilator associated pneumonia prevention and its interaction with severity of the illness. Iran J Crit Care Nurs 2010; 3: 81-86 (Persian).

  • 21.

    Chao YF, Chen YY, Wang KW, Lee RP, Tsai H. Removal of oral secretion prior to position change can reduce the incidence of ventilator-associated pneumonia for adult ICU patients: a clinical controlled trial study. J Clin Nurs 2009; 18: 22-28.

  • 22.

    Bercault N, Boulain T. Mortality rate attributable to ventilator-associated nosocomial pneumonia in an adult intensive care unit: a prospective case-control study. Crit Care Med 2001; 29: 2303-2309.

  • 23.

    Rouz A, Cottereau A, Nseir S. Chronic obstructive pulmonary disease and the risk for ventilator-associated pneumonia. Curr Opin Crit Care 2014; 20: 525-531.

  • 24.

    Koulenti D, Lisboa T, Brun-Buisson C, Krueger W, Macor A, Sole-Violan J, et al. Spectrum of practice in the diagnosis of nosocomial pneumonia in patients requiring mechanical ventilation in European intensive care units. Crit Care Med 2009; 37: 2360-2368.##.