Frequency of Nosocomial Pneumonia in ICUs of Hospitals of Hamadan University of Medical Sciences

Document Type : Original Article(s)

Authors

1 Associate Professor, Department of Internal Medicine, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran

2 General Practitioner, Department of Tuberculosis and Respiratory Diseases Research, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran

3 Assistant Professor, Department of Infectious Diseases, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran

4 Assistant Professor, Department of Biostatistics and Epidemiology, School of Health, Hamadan University of Medical Sciences, Hamadan, Iran

Abstract

Background: Nosocomial pneumonia is the most prevalent causes of hospital-acquired infection in intensive Care Units (ICU). The purpose of this research was to detect the frequency and predisposing factors of nosocomial pneumonia in ICUs of hospitals of Hamadan University of medical sciences.Methods: In this cross sectional study, 353 patients that were hospitalized in ICUs of Hamadan hospitals (Besat and Ekbatan) were investigated. In the case of nosocomial pneumonia some variables including connecting until affection, the period of hospitalization in ICU until affection will were recorded for these patients. χ2 test and Fisher exact test were used for data analysis.Findings: 36 people (10.2%) of hospitalized patients in ICUs were affected to nosocomial pneumonia. The average age of studying patients was 51.2 ± 21.9 years old, in which the most affected people (28%) were older than 65 years old. 44.5% of patients with nosocomial pneumonia were affected about 2-5 days after hospitalization in ICU. 66.5% of these patients (24 patients) had ventilator associated pneumonia(VAP) after connecting to ventilation device.Conclusion: Considering to frequency and predispose of nosocomial pneumonia in this study, it's necessary to pay more attention to the patients whom are exposed to hospital–acquired infections. It is also recommended that all unnecessary intervening actions for the patients in ICU should be avoided. In the case of necessity for mechanical ventilation and for reducing the onset of pneumonia, it is necessary to consider all sanitary actions.

Keywords


  1. Kasper DL, Braunwald E, Fauci A, Hauser S, Longo D, Jameson J. Harrison's Principles of Internal Medicine. 17th ed. New York: McGraw-Hill; 2008.
  2. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005; 171(4): 388-416.
  3. Tablan OC, Anderson LJ, Arden NH, Breiman RF, Butler JC, McNeil MM. Guideline for prevention of nosocomial pneumonia. The Hospital Infection Control Practices Advisory Committee, Centers for Disease Control and Prevention. Am J Infect Control 1994; 22(4): 247-92.
  4. Vincent JL, Bihari DJ, Suter PM, Bruining HA, White J, Nicolas-Chanoin MH, et al. The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA 1995; 274(8): 639-44.
  5. Trivedi TH, Shejale SB, Yeolekar ME. Nosocomial pneumonia in medical intensive care unit. J Assoc Physicians India 2000; 48(11): 1070-3.
  6. Marsh B, Hone R, White M, Phelan D, Fabry J. European Nosocomial Infection Survey: analysis of Irish data. Irish Intensive Care Nosocomial Pneumonia Survey Group. Ir Med J 1996; 89(3): 96-8.
  7. Chung KI, Lim TH, Koh YS, Song JH, Kim WS, Choi JM, et al. Nosocomial pneumonia in medico-surgical intensive care unit. J Korean Med Sci 1992; 7(3): 241-51.
  8. Denys D, Martens P, Mullie A, Lust P. Incidence of nosocomial pneumonia in ICU patients. Acta Anaesthesiol Belg 1993; 44(3): 111-8.
  9. Merchant M, Karnad DR, Kanbur AA. Incidence of nosocomial pneumonia in a medical intensive care unit and general medical ward patients in a public hospital in Bombay, India. J Hosp Infect 1998; 39(2): 143-8.
  10. Wiblin R. Nosocomial pneumonia . In: Wenzel R, editor. Prevention and Control of Nosocomial Infections.Baltimore: Williams and Wilkins; 1997. p. 807.
  11. Hoffken G, Niederman MS. Nosocomial pneumonia: the importance of a de-escalating strategy for antibiotic treatment of pneumonia in the ICU. Chest 2002; 122(6): 2183-96.
  12. Wagenlehner FM, Naber KG. Hospital-acquired urinary tract infections. J Hosp Infect 2000; 46(3): 171-81.
  13. Safdar N, Crnich CJ, Maki DG. The pathogenesis of ventilator-associated pneumonia: its relevance to developing effective strategies for prevention. Respir Care 2005; 50(6): 725-39.
  14. Rello J, Ollendorf DA, Oster G, Vera-Llonch M, Bellm L, Redman R, et al. Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Chest 2002; 122(6): 2115-21.
  15. Fridkin SK, Welbel SF, Weinstein RA. Magnitude and prevention of nosocomial infections in the intensive care unit. Infect Dis Clin North Am 1997; 11(2): 479-96.
  16. Nassaji M, Mousavi Sh, Ghorbani R. Incidence of Nosocomial pneumonia in patients older than 15 years old in ICUs Semnan University of Medical Sciences. J Semnan University Medical Sciences 2003; 5(1-2): 87-92.
  17. Cook DJ, Walter SD, Cook RJ, Griffith LE, Guyatt GH, Leasa D, et al. Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Intern Med 1998; 129(6): 433-40.
  18. Kollef MH. Ventilator-associated pneumonia. A multivariate analysis. JAMA 1993; 270(16): 1965-70.
  19. Coplin WM, Pierson DJ, Cooley KD, Newell DW, Rubenfeld GD. Implications of extubation delay in brain-injured patients meeting standard weaning criteria. Am J Respir Crit Care Med 2000; 161(5): 1530-6.
  20. Mandell GL, Dolin R, Bennetts JE. Principles and Practice of Infectious Diseases Mandell GL. 5th ed. Philadelphia: Churchill Livingstone; 2000. p. 3020-6.
  21. Goldman L, Bennett JC. Cecil Textbook of Medicine. 21th ed. Philadelphia: Saunders; 2000. p. 1558.
  22. Rosenthal VD, Guzman S, Orellano PW. Nosocomial infections in medical-surgical intensive care units in Argentina: attributable mortality and length of stay. Am J Infect Control 2003; 31(5): 291-5.
  23. Craven DE, Steger KA. Nosocomial pneumonia in mechanically ventilated adult patients: epidemiology and prevention in 1996. Semin Respir Infect 1996; 11(1): 32-53.