Pneumonia is a common medical problem encountered in clinical practice and it is the leading cause of fatal infectious disease worldwide. Pneumonia is diagnosed by the presence of new lung infiltrates in the presence of evidence of infection like new onset fever, purulent sputum, leucocytosis and fall in oxygen saturation¹.

Hospital acquired pneumonia (HAP)or nosocomial pneumonia is the second most common hospital acquired infection and is the leading cause of death among hospital acquired infections². It is defined as pneumonia that occurs 48 hours or more after admission and did not appear to be incubating at the time of admission. Ventilator associated pneumonia is pneumonia that develops more than 48 to 72 hours after endotracheal intubation^3,4. The most common pathogens causing HAP are gram negative bacilli such as Pseudomonas aeruginosa and Acinetobacter spp, and gram-positive organisms like methicillin resistant Staphylococcus aureus^5,6. Hospital acquired pneumonia considerably increases the morbidity, mortality, length and cost of hospital stay. So, efforts should be made to prevent hospital acquired infections, the best possible way to reduce in hospital morbidity and mortality

References

1.      Cunha BA. Pneumonia Essentials. 3rd ed. Royal Oak, Michigan: Physicians Press; 2010

2.      Hoffken G, Niederman MS. Nosocomial pneumonia: the importance of a de-escalating strategy for antibiotic treatment of pneumonia in the ICU. Chest. 2002;122:2183–2196. doi: 10.1378/chest.122.6.2183

3.      American Thoracic Society and the Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005 Feb 15. 171(4):388-416.

4.      Kalil AC, Metersky ML, Klompas M, et al. Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis 2016;

5.      Jones RN. Microbial etiologies of hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia. Clin Infect Dis 2010; 51 Suppl 1:S81.

6.      Sievert DM, Ricks P, Edwards JR, et al. Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009-2010. Infect Control Hosp Epidemiol 2013; 34:1.

7.      Celis RTorres A, Gatell JM, Almela M, Rodríguez-Roisin R, Agustí-Vidal A: Nosocomial pneumonia. A multivariate analysis of risk and prognosis, Chest. 1988 Feb;93(2):318-24.

8.      See comment in PubMed Commons belowBlot S, Koulenti D, Dimopoulos G, Martin C, Komnos A, Krueger WA, Spina G, Armaganidis A, Rello J; EU-VAP Study Investigators. Prevalence, risk factors, and mortality for ventilator-associated pneumonia in middle-aged, old, and very old critically ill patients. Crit Care Med. 2014 Mar;42(3):601-9. 

Dr Suraj KP

Professor, Department of Pulmonary Medicine

Government Medical College, Kozhikode