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Mortality as an Outcome in Hospital-Acquired Pneumonia

Published online by Cambridge University Press:  02 January 2015

Jordi Rello  and
Jordi Valles
Jordi Rello*
Affiliation:
Intensive Care Department, Hospital de Sabadell, Sabadell, Barcelona, Spain
Jordi Valles
Affiliation:
Intensive Care Department, Hospital de Sabadell, Sabadell, Barcelona, Spain
*
Intensive Care Department, Hospital de Sabadell, Parc Tauli s/n, E08208 Sabadell, Barcelona, Spain; e-mail jrello@siberia.chpt.es
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Abstract

The most common route of entry of pathogens into the lung in patients managed in the intensive-care unit is aspiration of contaminated oropharyngeal secretions or gastric contents. In intubated patients, the risk of this type of infection is particularly high. Knowledge of specific risk factors for specific microorganisms, along with the origin of acquisition (primary endogenous, secondary endogenous, or exogenous), will permit a more rational and effective method of prevention. Attributable mortality is highly dependent on the institution of a correct initial antibiotic choice, as well as the interaction between the virulence of the pathogen responsible and host defenses. However, survival in these patients is determined primarily by the degree of severity at the time of pneumonia diagnosis and the response to initial therapy. As a consequence, the number of preventable deaths is likely to be much smaller than the total. Therapy requires both supportive and specific measures. When diagnostic information becomes available, it permits the rescue of some patients with inadequate therapy or simplifies the spectrum of the empirical therapy. Initial antibiotic choice should be based on expected etiologic pathogens, while knowledge of local microbial epidemiology and susceptibility patterns is crucial.

Type
Readers' Forum
Information
Infection Control & Hospital Epidemiology , Volume 19 , Issue 10 , October 1998 , pp. 795 - 797
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1998

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