nosocomial pneumonia

Hospital Acquired Pneumonia (HAP) or nosocomial pneumonia is an infection caused mainly by gram-negative bacteria. Carbapenems and cephalosporins/cephalosporin siderophores are effective for infections caused by gram-negative bacteria.

To compare the effectiveness of antibiotics from the Carbapenem group (meropenem) compared to the cephalosporin/cephalosporin siderophore group in HAP infections caused by gram-negative bacteria.

  Sources of article searches used Cochrane and PubMed, which were then selected by the PICO method with a population of adult HAP patients, with comparator cephalosporins/cephalosporin siderophores that have clinical improvement outcomes with parameters of microbiological response and death, the flow chart PRISMA described it.

A total of 7 articles comprehensively discussed the effectiveness of cephalosporins/siderophore cephalosporins and meropenem against Klebsiella pneumonia, Pseudomonas aeruginosa, and Escherichia coli. The clinical recovery of patients after administering these two antibiotics showed high therapeutic effectiveness and could reduce mortality. Ceftazidime-avibactam, ceftolozane-tazobactam, and cefiderocol are new antibiotics that are effective for HAP. Meropenem at high doses can offset the efficacy of the three antibiotic combinations and minimize antibiotic resistance.

  meropenem and cephalosporins/siderophore cephalosporins have similar effectiveness as therapy for gram-negative infections in HAP.

 Lower respiratory tract infections (LRTIs) are prevalent diseases and a major cause of referral to primary healthcare centers. The present study aimed to identify the bacterial etiology of LRTIs to determine the trend changes within the past three decades and help ascertain the new scenarios of empirical LRTI therapy in Turkey.

Data Sources:

 This systematic review was conducted by searching various electronic databases based on specified criteria. In total, 2,670 articles were identified, which had been published during 1990 - 2020 and could be potentially used, and 46 scientific studies that met the eligibility criteria were selected for the review.

 The most frequently isolated bacteria in the reviewed studies were Acinetobacter spp. (31.68%), P. aeruginosa (16.59%), H. influenzae (14.30%), and S. pneumoniae (13.80%). Data analysis also indicated that the most frequent reports of LRTI agents were in Aegean region in Turkey during 2014-2020.

 This systematic review reflected the changes in LRTI agents over the past three decades in Turkey. Knowledge of the frequency of LRTI bacterial agents specific to each country could help healthcare professionals in reporting laboratory results and prescribing/selecting the most effective antibiotics for the treatment of the disease.

Hospital-acquired pneumonia (HAP) prevalence is related to patients’ population and diagnostic methods. HAP incidence is reported in different studies from 9% to 46%. The current study aimed at evaluating the etiology of HAP in patients admitted to intensive care units (ICUs).
The patients admitted to ICU of Imam Reza hospital (a tertiary care and teaching hospital in Mashhad, Northeast of Iran) were evaluated for HAP based on the following criteria: fever, leukocytosis, purulent discharge, new radiologic findings, changes in O2 saturation, and ventilator setting. Blood and endotracheal aspirates cultures were performed for all patients. Demographic characteristics were recorded in a checklist.
Among the 88 adult patients enrolled in the current study, the most frequent radiologic finding was patchy infiltration in chest X-ray (71.6%). Mean age of the patients was 58 ± 20.1 years; mean hospital stay was 63 ± 40.8 days; mean interval between hospitalization and pneumonia development was 20.9 ± 16.8 days; and 41 patients (46.6%) died. Acinetobacter spp. were the most frequent microorganisms in purulent discharge and methicillin-resistant Staphylococcus aureus (MRSA) were the main bacteria isolated from blood culture.
Early diagnosis and appropriate antibiotic therapy can decrease HAP mortality and morbidity. The current study findings revealed that Acinetobacter app. were the most frequent cause of HAP in ICU patients in the studied center, which should be considered at the time of diagnosis and empirical antibiotics administration. Appropriate infection control and preventive measures should also be taken in ICUs to prevent HAP, especially against those caused by Acinetobacter spp.

Nosocomial pneumonia is a prevalent complication in patients admitted to intensive care units (ICU). Endotracheal suction is used in cleaning the airways of secretions in patients under mechanical ventilation. Performing suction accurately is of great importance to prevent ventilation associated pneumonia. The purpose of this study was to compare the effect of open versus closed tracheal suction on the incidence of VAP.
This was a clinical trial study performed on 86 intubated patients in ICU. Patients of control group (n=43) underwent conventional open suction and case group (n=43) closed suction. After 72 hours, patients were assessed regarding VAP using clinical pulmonary infection score (CPIS).
There was no significant difference regarding age (p=0.15) and gender (p=0.33) between the two groups. The incidence of ventilator associated pneumonia was significantly lower in closed method compared to the open method (p=0.016).
Closed tracheal suction compared to the open method was associated with lower incidence of VAP in patients of ICU.