Hospital-acquired pneumonia in critically ill patients. Risk factors analysis. Antibiotic resistance

Cocu Simona¹, R. Hagău², Dana Fărăian¹, R. Florea¹, Natalia Hagău²

¹ Spitalul Clinic Judeţean de Urgenţă Cluj
² Universitatea de Medicină şi Farmacie „Iuliu Haţieganu” Cluj-Napoca

Abstract

Aims. The purpose of this study was to investigate the predisposing factors to nosocomial pneumonia and the risk factors for mortality, as well as to identify the ”high-risk” microorganisms and their resistance to antibiotics.
Material and method. It is a retrospective epidemiological study which was conducted over 12 months, in a 21-bed intensive care unit, where medical and surgical patients are admitted. In a case-control study a univariate and multivariate analysis of the risk factors for nosocomial pneumonia was performed, as well as the analysis of the factors which increase the mortality rate in the nosocomial pneumonia group. The identification of the microorganisms was done with Biomerieux MiniAPI, whereas the sensitivity to antibiotics was performed using the diffusimetric method, Biomerieux MiniAPI gallery ATB STAPH, ATB G5, ATB PSE.
Results. A total of 1051 patients were admitted to the intensive care unit during the study period, 39 of these developed nosocomial pneumonia. The significant predisposing risk factors for nosocomial pneumonia resulting from multivariate analysis were: pulmonary aspiration, oro-tracheal intubation and more than 7 days stay in the intensive care unit. The significant factors which increase the mortality rate in nosocomial pneumonia were: APACHE II score > 30, chronic pulmonary disease and pulmonary aspiration. The incriminated microorganisms were Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter and Klebsiella. 69% of the Staphylococcus aureus infections were MRSA infections and 86% of the Klebsiella infections were ESBL. Both Pseudomonas and Acinetobacter acquired resistance to antipseudomonas penicilline, aminoglicoside and carbapenem.
Conclusion. The analysis of the predisposing factors for the nosocomial pneumonia can be used for developing a protocol of reducing the time-dependent factors. The identification of microorganisms involved in nosocomial pneumonia and their resistance to antibiotics is important for the first choice antibiotic therapy.

Key words: nosocomial infection, nosocomial pneumonia, ventilated acquired pneumonia, antibiotic resistance

Pneumonia nosocomială la pacienţii critici. Analiza factorilor de risc. Rezistenţa la antibiotice