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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Tuesday, April 17, 2012

Neumonía nosocomial

Nosocomial Pneumonia

From: The Hospitalist, Supplement: Hospital Medicine and Infectious Diseases, by Scott A. Flanders, MD University of Michigan, Ann Arbor, MI

"Nosocomial pneumonia (NP) is the leading cause of mortality among patients who die from hospital-acquired infections. Defined as pneumonia occurring 48 hours or more after hospital admission, NP also includes the subset of ventilator-associated pneumonia (VAP), defined as pneumonia developing 48 to 72 hours after initiation of mechanical ventilation. The incidence of NP is between 5 and 15 cases per 1000 hospital admissions. Healthcare-associated pneumonia (HCAP), part of the continuum of NP, describes an increasingly common proportion of pneumonia developing outside the hospital (Table I) (1). Typically afflicting people in a nursing home or assisted living setting, these patients are at risk for antibiotic-resistant-organisms and should be approached similarly to cases of nosocomial pneumonia rather than community-acquired pneumonia. Most of the data informing our diagnostic and treatment decisions about NP come from studies performed in mechanically ventilated patients and are extrapolated to make recommendations for non-ventilated patients. Mortality attributable to NP is debated, but may be as high as 30%. The presence of nosocomial pneumonia increases hospital length of stay an average of 7–10 days, and in the case of VAP, is estimated to cost between $10,000 and $40,000 per case"