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A Study of the Etiologies and Treatment of Nosocomial Pneumonia in a Community-Based Teaching Hospital

Published online by Cambridge University Press:  21 June 2016

Charles J. Schleupner  and
David K Cobb
Charles J. Schleupner*
Affiliation:
University of Virginia School of Medicine, Infectious Diseases Section, Department of Veterans Affairs Medical Center, Salem, Virginia
David K Cobb
Affiliation:
Program in Infectious Diseases, University of Virginia Affiliated Hospitals Salem, Virginia
*
Infectious Diseases Section (111L), VA Medical Center, Salem, VA 24153
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Abstract

Objective:

To compare the frequency of the pathogens of nosocomial pneumonia in a community-based teaching hospital to the frequencies previously published, and to evaluate recommendations for the therapy of nosocomial pneumonia in this setting.

Design:

Retrospective review of prospectively acquired data accrued during 9 randomized single-blinded and 4 single-agent investigational antibiotic studies for the therapy of pneumonia in hospitalized patients between 1981 and 1989.

Setting:

The study was performed at a university affiliated, community-based teaching Department of Veterans Affairs Medical Center.

Patients:

Patients were hospitalized on the acute medical/surgical and intermediate medicine wards. Informed consent was obtained prior to enrolling patients into the respective antimicrobial studies. Pneumonia was documented radiographicahy and clinically for each patient.

Results:

Two hundred thirty-one episodes of nosocomial pneumonia were treated. Overall, 51% of pneumonias were caused by Streptococcus pneumoniae or Hemophilus influenzae with or without other organisms that were not gram-negative bacilli. Gram-negative bacilli, with or without other organisms, accounted for only 26% of all nosocomial pneumonias. Overall, monotherapy with a cephalosporin (usually a broad-spectrum agent) was equally efficacious compared with combination therapy (87% versus 81%, respectively). Cure rates for nosocomial pneumonias from gram-negative bacilli treated with these 2 therapies also were similar (70% versus 60%, respectively).

Conclusions:

In nontertiary care settings, gram-negative bacilli may cause fewer episodes of nosocomial pneumonia (26% in this study) than noted by previously published reports, which indicated that these organisms account for 50% of nosocomial pneumonias. Further, S pneumoniae and H influenzae may account etiologicahy for many of these nosocomial pneumonias. Monotherapy with an extended-spectrum cephalosporin may be more appropriate than combined treatment with a b-lactam and an aminoglycoside in a nontertiary care setting, thereby reducing potential toxicity in an older, hospitalized patient population.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 13 , Issue 9 , September 1992 , pp. 515 - 525
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1992

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