Hospital-Acquired Pneumonia in Neurosurgical Clinic: Local Epidemiologic Characteristics
Background. Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are recognized as important causes of morbidity and mortality among neurosurgical patients. Successful management of HAP and VAP should rely upon detailed knowledge of specific epidemiological pattern in a given medical facility. The study was aimed to evaluate epidemiological features of HAP in one of the leading neurosurgical centers in the southern Ukraine. Methods. A retrospective (2006–2011) analysis of 4,528 medical records including 115 cases complicated with HAP was performed. Results. HAP was diagnosed in 2.5 % (n = 115) of neurosurgical patients on record. VAP accounted for 77.4 % (n = 89) of HAP cases. Fatal outcome and recovery were registered for 41.7 and 37.4 % of HAP patients, respectively. Bacteriological analysis of sputum and tracheal aspirate (n = 484) was performed in 66 % of patients with HAP. Most commonly isolated pathogen, Pseudomonas aeruginosa (26.4 %), exhibited increased resistance to antipseudomonal drugs, namely ciprofloxacin (98 %), ceftazidime (97 %), gentamicin (96 %), cefepime (95 %) and amikacin (92 %).Conclusions. Overall, increased mortality and high incidence of HAP, low bacteriologic coverage of HAP cases and excessive antimicrobial resistance of P.aeruginosa were revealed. The results should be utilized to remove shortcomings in local practice of HAP treatment and microbiologic testing in the neurosurgical center. They also may be helpful for improvement of relevant protocols of medical care in other surgical facilities.
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Barbier F., Andremont A., Wolff M., Bouadma L. Hospital-acquired pneumonia and ventilator-associated pneumonia: recent advances in epidemiology and management // Curr. Opin. Pulm. Med. — 2013. — 19(3). — 216-28.
Chawla R. Epidemiology, etiology, and diagnosis of hospital-acquired pneumonia and ventilator-associated pneumonia in Asian countries // Am. J. Infect. Control. — 2008. — 36(4 Suppl.). — S93-100.
Rello J., Ulldemolins M., Lisboa T. et al. Determinants of prescription and choice of empirical therapy for hospital-acquired and ventilator-associated pneumonia // Eur. Respir. J. — 2011. — 37(6). — 1332-9.
American Thoracic Society and Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and health care-associated pneumonia // Am. J. Respir. Crit. Care Med. — 2005. — 171. — 388-416.
Guleria Rand Madan K. Pulmonary complications in neurosurgical patients // Indian. J. Neurosurg. — 2012. — 1(2). — 175-80.
Sogame L.C., Vidotto M.C., Jardim J.R., Faresin S.M. Incidence and risk factors for postoperative pulmonary complications in elective intracranial surgery // J. Neurosurg. — 2008. — 109(2). — 222-7.
Niederman M.S. Nosocomial and Ventilator-Associated Pneumonia. VAP: approach to therapy // Eur. Respir. Mon. — 2011. — 53. — 36-47.
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