Nosocomial refers to a
disease coming from a hospital. Pneumonia refers to an
infection in one or both lungs. Bacteria, viruses, and fungi cause it. The
infection causes inflammation in the air sacs in your lungs, which are called
alveoli. The alveoli fill with fluid or pus, making it difficult to breathe. Therefore,
nosocomial pneumonia refers to Hospital- acquired pneumonia that has been
contracted by a patient in at least 48-72 hours after being admitted in a
hospital.
This disease is the most common cause of death among nosocomial infections
and is the primary cause of death in intensive care units. Ventilator-associated pneumonia (VAP) represents a significant sub-set of HAP occurring in intensive care units (ICUs) and is defined as pneumonia that occurs more than 48 to 72 hours after tracheal intubation and is thought to affect 10% to 20% patients receiving mechanical ventilation for more than 48 hours
The incidence of hospital-acquired pneumonia (HAP)
is not well studied outside the intensive care unit, but estimates range from
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Common pathogens of HAP
These include; aerobic gram-negative bacilli
(e.g. Pseudomonas aeruginosa, Escherichia coli, Klebsiella
pneumoniae, Enterobacter spp, Acinetobacter spp)
and gram-positive cocci (e.g., Staphylococcus aureus, which
includes methicillin-resistant S. aureus, Streptococcus spp).
Symptoms may include
cough, expectoration, a rise in
body temperature, chest pain or dyspnea. Signs include fever, tachypnea,
consolidations or crackles.
According
to Eman
Shebl; Peter G. Gulick, Bacteriologic Evaluation of this disease can be done by; Blind tracheobronchial aspiration (TBAS), Bronchoscopy with
bronchoalveolar lavage (BAL)
and Protected specimen brush (PSB). All respiratory tract samples should
be sent for microscopic analysis and culture.
Microscopic Analysis
The microscopic
analysis includes the analysis of polymorphonuclear leukocytes and a gram
stain. The microscopy can be helpful in determining a possible pathogen and
the antibiotic selection until the results of the culture are available. The
presence of abundant neutrophils and the bacterial morphology may suggest a
likely pathogen.
Quantitative Cultures
Diagnostic thresholds include:
- Endotracheal aspirates 1,000,000 colony forming units (CFU)/mL
- Bronchoscopic- or mini-BAL 10,000 CFU/mL
- PSB 1000 CFU/mL
New Molecular Diagnostic Tests
New molecular diagnostic
tests like multiplex polymerase chain reaction assay, which detects an
array of respiratory bacterial pathogens and many antibiotic resistance genes,
offer the advantage of rapid identification of pathogens and resistance patterns
for rapid choosing the antibiotic regimens.
Treatment
Treatment of this disease is highly dependent on the study of drug resistance
and sustability and it’s only done by specialists in the hospitals
