Indian Journal of Respiratory Care

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VOLUME 1 , ISSUE 2 ( July-December, 2012 ) > List of Articles


Nosocomial pneumonia

HM Krishna

Keywords : Nosocomial pneumonia, hospital-acquired pneumonia, ventilator-associated pneumonia

Citation Information : Krishna H. Nosocomial pneumonia. Indian J Respir Care 2012; 1 (2):94-100.

DOI: 10.5005/ijrc-1-1-94

License: NA

Published Online: 01-12-2022

Copyright Statement:  NA


Nosocomial pneumonia encompasses hospital-acquired pneumonia, healthcare-associated pneumonia and ventilator-associated pneumonia. It is a major infectious problem in the hospitals. Though predominantly caused by endogenous bacteria colonised in the oropharynx and stomach, polymicrobial aetiology is not uncommon. The problem with multidrug resistant strains has been increasing. Hospital environment, equipment and staff are the sources, fomites and carriers of this infection from patient to patient. Diagnosis of nosocomial pneumonia has been simplified by the guidelines. Preventive measures to reduce the incidence of nosocomial pneumonia are simple, effective and economical. They just need to be followed. Empirical antibiotic therapy and de-escalation measures form the back bone of the treatment of nosocomial pneumonia.

  1. American Thoracic Society. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005; 171:388–416.
  2. Masterton RG, Galloway A, French G, et al. Guidelines for the management of hospital-acquired pneumonia in the UK: Report of the working Party on hospital-acquired pneumonia of the British Society for Antimicrobial Chemotherapy. Journal of Antimicrobial Chemotherapy 2008; 62:5–34.
  3. Alcon A, Fabregas N, Torres A. Hospital-acquired pneumonia: etiologic considerations. Infect Dis Clin N Am 2003; 17:679–95.
  4. Kieninger AN, Lipsett PA. Hospital –acquired pneumonia: pathophysiology, diagnosis, and treatment. Surg Clin N Am 2009; 89:439–61.
  5. Pugin J, Auckenthaler R, Mili N, Janssens JP, Lew PD, Suter PM. Diagnosis of ventilatorassociated pneumonia by bacteriologic analysis of bronchoscopic and nonbronchoscopic “blind” bronchoalveolar lavage fluid. Am Rev Respir Dis 1991; 143:1121–9.
  6. Singh N, Rogers P, Atwood CW, Wagener MM, Yu VL. Short-course empiric antibiotic therapy for patients with pulmonary infiltrates in the intensive care unit: a proposed solution for indiscriminate antibiotic prescription. Am J Respir Crit Care Med 2000; 162:505–11.
  7. Craven DE, Palladino R, McQuillen DP. Healthcareassociated pneumonia in adults: management principles to improve outcomes. Infect Dis Clin N Am 2004; 18:939–62.
  8. Ibrahim EH, Mehringer L, Prentice D, et al.. Early versus late enteral feeding of mechanically ventilated patients: results of a clinical trial. J Parenter Enteral Nutr 2002; 26:174–181.
  9. Craven DE, Driks MR. Nosocomial pneumonia in the intubated patient. Semin Respir Infect 1987; 2:20– 33.
  10. Scolapio JS. Decreasing aspiration risk with enteral feeding. Gastrointest Endoscopy Clin N Am 2007; 17:711–6.
  11. Metheny NA. Strategies to prevent aspirationrelated pneumonia in tube-fed patients. Respir Care Clin 2006; 12:603–17.
  12. Bonten JM. Prevention of hospital-acquired pneumonia: European perspective. Infect Dis Clin N Am 2003; 17:773–84.
  13. Grap MJ, Munro CL. Preventing ventilatorassociated pneumonia: evidence-based care. Crit Care Nurs Clin N Am 2004; 16: 349– 58.
  14. Cook D, Guyatt G, Marshall J, et al. Canadian Critical Care Trials Group. A comparison of sucralfate and ranitidine for the prevention of upper gastrointestinal bleeding in patients requiring mechanical ventilation. N Engl J Med 1998; 338:791–7.
  15. Griffiths J, Barber VS, Morgan L, Young JD. Systematic review and meta-analysis of studies of the timing of tracheostomy in adult patients undergoing artificial ventilation. BMJ 2005; 330:1243–6.
  16. Blot F, Similowski T, Trouillet JL, et al. Early tracheotomy versus prolonged endotracheal intubation in unselected severely ill ICU patients. Intensive Care Med 2008; 34:1779–87.
  17. Durbin CG Jr, Perkins MP, Moores LK. Should tracheostomy be performed as early as 72 hours in patients requiring prolonged mechanical ventilation? Respir Care 2010; 55:76–87.
  18. AARC Evidence-Based Clinical Practice Guidelines. Care of the ventilator circuit and its relation to ventilator-associated pneumonia. Respir Care 2003; 48:869-79.
  19. Ricard JD, Boyer A, Dreyfuss D. The effect of humidification on the incidence of ventilatorassociated pneumonia. Respir Care Clin 2006; 12:263–73.
  20. Siempos II, Dimopoulos G, Falagas ME. Metaanalyses on the prevention and treatment of respiratory tract infections. Infect Dis Clin N Am 2009; 23:331–53.
  21. Hijazi M, Al-Ansari M. Therapy for ventilatorassociated pneumonia: what works, what doesn’t. Respir Care Clin 2004; 10:341–58.
  22. Diaz E, Ulldemolins M, Lisboa T, Rello J. Management of ventilator-associated pneumonia. Infect Dis Clin N Am 2009; 23:521–33.
  23. Fagon JY, Chastre J. Antimicrobial treatment of hospital-acquired pneumonia. Clin Chest Med 2005; 26:97–104.
  24. Masterton RG. Antibiotic de-escalation. Crit Care Clin 2011; 27: 149–62.
  25. Berwick DM, Calkins DR, McCannon CJ, Hackbarth AD. The 100,000 lives campaign: setting a goal and a deadline for improving health care quality. JAMA 2006; 295:324–7.
  26. Rello J, Lode H, Cornaglia G, Masterton R, and the VAP Care Bundle Contributors. A European care bundle for prevention of ventilator associated pneumonia. Intensive Care Med 2010; 36:773–80.
  27. Lorente L, Blot S, Rello J. New issues and controversies in the prevention of ventilatorassociated pneumonia. Am J Respir Crit Care Med 2010; 182:870–6.
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