Nosocomial pneumonia: pathogens, treatment and prevention

Nosocomial pneumonia is an acute infectious process that occurs in the body under the influence of the active vital activity of pathogenic bacteria. The characteristic features of the disease is the defeat of the respiratory tract of the pulmonary department with internal accumulation of a large volume of fluid. Exudate subsequently seeps through the cells and penetrates into the kidney tissue.

Updated national recommendations for nosocomial pneumonia

Since 2014, the Respiratory Society has presented clinical recommendations to the world . They are based on the algorithm of diagnosis and therapy in situations where it is suspected that the patient is progressing to nosocomial pneumonia. National recommendations were developed by specialists, practicing physicians, to help medical personnel who encounter acute respiratory infections.

In short, the algorithm consists of four points.

1. Determine the need for hospitalization of the patient. A positive decision is made if the patient has a clearly expressed respiratory insufficiency, there is a decrease in perfusion of tissues, acute autointoxication, impaired consciousness, unstable blood pressure. For placement in a hospital it is enough to determine at least one symptom.
2. Determine the cause of the disease. To do this, the patient is assigned a number of laboratory studies of biological materials: culture of blood from the vein, sputum bacillus, rapid test for the determination of bacterial antigenyura.
3. Determination of the duration of treatment. Provided that the disease is of bacterial origin, but the true cause is not established, the therapy is carried out for ten days. With various complications or extrapulmonary localization of the focus, the therapeutic course can be up to 21 days.
4. Necessary measures of inpatient stay. In severe condition, patients need respiratory or non-invasive ventilation.

Preventive measures are also prescribed in national recommendations. The most effective is the vaccination against influenza and pneumococcus, prescribed mainly to patients with chronic pneumonia and people of the older age group.

Features of Community-acquired Pneumonia

Community-acquired nosocomial pneumonia has another common name - out-of-hospital. The disease is caused by an infection of bacterial etiology. The main path of infection is the environment. Accordingly, the definition will read as follows: the inflammatory lesion of the pulmonary department, received by airborne droplets, while the patient had no contact with the carriers of infection in medical institutions.

Community-acquired and nosocomial pneumonia of bacterial origin is more often diagnosed in patients with reduced immunity, when the body is not able to withstand pathogenic microorganisms (pneumococci, hemophilic rod, Klebsiella). They penetrate into the lung cavity through the nasopharynx.

The risk group includes children of younger age group and patients with chronic pathologies of the lungs. In this case, the causative agent is Staphylococcus aureus.

Community-acquired nosocomial pneumonia: principles of classification of the disease

To develop the right treatment, pneumonia is classified according to the following parameters:

• Disease, not accompanied by a decrease in the protective function of the body;
• A disease that has arisen against a background of low immunity;
• A disease that occurred in the acute stage of AIDS;
• A disease formed in conjunction with other diseases.

As a rule, the diagnosis is confirmed in patients who have a problem in the form of reduced immunity against the background of oncology or hematology. Also at risk are patients who have been taking high-dose glucocorticosteroids for a long time. Also, there are situations when the disease occurs in patients with chronic immune pathologies.

In addition, a separate category includes this type of pneumonia, aspiration.

Doctors say that at the moment in the mechanism of origin of any type of aspiration pneumonia there are foreign bodies, when they get into the disease develops.

Features of nosocomial pneumonia

In this concept, physicians invest such a state of the patient when the inflammatory process in the pulmonary department manifests itself approximately 72 hours after infection. The danger is that nosocomial nosocomial pneumonia has a complicated course and most often ends in a lethal outcome. This is due to the fact that bacteria living within the walls of a medical institution are resistant to most medical drugs, so it is very difficult to pick up the right antibiotic from the first.

Intrahospital Nosocomial Pneumonia: Principles of Classification of Disease

Priority nosocomial pneumonia hospital type is classified at the stage of infection:

1. Early stage - in the first five days of the patient's stay in the hospital, obvious signs of the disease begin to appear.
2. The late stage - the manifestation of the symptoms is prolonged for more than five days.

Depending on the etiology of the development of the disease, three types are distinguished:

1. Aspiration nosocomial pneumonia.
2. Postoperative.
3. Fan-associated.

It is worth noting that the presented classification by type is conditional, and in most cases pneumonia is diagnosed in a mixed form. This, in turn, significantly burdens the patient's condition and reduces the chances of recovery.

Aspiration

The presented form of the disease is the most common. When the infected mucus of the nasopharynx enters the pulmonary department, self-infection occurs.

The nasopharyngeal fluid is an ideal place for feeding pathogenic bacteria, therefore, getting into the lungs, microorganisms begin to multiply actively, which contributes to the development of aspiration pneumonia.

Postoperative

The presented type of pneumonia is diagnosed in 18 clinical cases out of 100 and is found exclusively in patients who underwent surgery.

In this case, the infection occurs in the same way as in aspiration pneumonia, only the gastric secret is added to the nasopharyngeal fluid, which is no less dangerous. Also, do not exclude the infection of the patient with medical instruments and apparatus. Through a probe or catheter, the infection can easily spread to the lower respiratory tract.

Ventilator-associated

It is diagnosed in patients who have been under prolonged exposure to artificial ventilation. A safe period is not more than 72 hours of stay in this state, and then the risk of developing pneumonia increases every day.

Pathogens of Nosocomial Pneumonia

Nosocomial hospital pneumonia is more often caused by pneumococci. Such diagnoses range from 30 to 50 percent of all clinical cases.

The least aggressive bacteria are chlamydia, mycoplasma and legionella. Under their influence, pneumonia develops in no more than 30% of cases, but not less than 8%.

The least common is a disease that arose against the backdrop of active activity: hemophilic rods, Staphylococcus aureus, Klebsiella and enterobacteria.

Another causative agent of nosocomial pneumonia is influenza A and B, parainfluenza, adenovirus, respiratory syncytial virus.

The most frequent pathogens of nosocomial pneumonia aggressive type, capable of producing epidemic outbreaks - mycoplasma and legionella. In this case, in the first case, adolescents and young people up to 25 years are most often ill. And infection with legionella occurs through water, for example, in the public shower, pool and so on.

Methods of modern diagnostics

If the patient has a pneumonia of an out-of-hospital type, it is often diagnosed during medical examination. In each clinical case, for the convenience of monitoring the patient's condition and the symptoms of the disease, a separate card or medical history is established.

The phased outpatient diagnosis is as follows:

• Radiography of the chest - the method of radiation diagnosis, which in the pictures projects the state of the lungs in several planes. In the presence of dark, dense spots, the diagnosis is confirmed. Diagnosis is shown twice: at the beginning of treatment and after antibiotic therapy.

• Laboratory tests - the patient will need to donate blood for a general analysis and determination of the number of leukocytes, glucose and electrolytes.
• Microbiological studies - the analysis of pleural fluid and the coloring of the lower respiratory tract is performed, the presence of antigens in the urine is determined.

The results of these diagnostic procedures are sufficient to establish a definitive diagnosis and develop a treatment plan.

Recommendations for treatment of patients

Clinical recommendations for the treatment of nosocomial pneumonia are the primary purpose of a broad-based antibiotic.

After receiving the results of the examinations, it is within the competence of the doctor to change the prescription drug to a more effective one. The type of pathogenic microorganisms is taken as a basis.

Principles of therapy for patients with nosocomial pneumonia

Treatment of nosocomial pneumonia consists in the selection of the correct antibiotic, the regimen for its administration, the method of administration and dosage. This is only the attending physician. Also an integral part of therapy is the procedure for the sanitation of the respiratory tract (removal of the accumulated fluid).

An important point is finding the patient in a state of motor activity. It is necessary to perform respiratory gymnastics and small physical activities in the form of squats. Patients in serious condition are assisted by nurses. They are engaged in a regular change in the patient's position, which allows not to stagnate liquids in one place.

Prevent a recurrent disease will help prevent nosocomial pneumonia, which in detail will tell the doctor in charge.

Antibiotic therapy

Treatment aimed at combating bacteria has two types: purposeful and empirical. Initially, all patients undergo empiric-type treatment, and the directed one is assigned after the causative agent has been determined.

The most important conditions for recovery are:

1. Developing the right antibacterial treatment.
2. Reducing the use of antimicrobials.

To pick up antibacterial medicines, and also their dosage can only the attending physician, independent replacement of preparations is inadmissible.

Prognosis for recovery

Depending on the correctness of the selected drugs, the severity of the disease and the general condition of the patient, the outcome of treatment may be as follows: recovery, minor improvement in condition, ineffective therapy, relapse, death.

With nosocomial pneumonia, the likelihood of a lethal outcome is significantly higher than that of a community-acquired form.

Preventive measures

Prevention of nosocomial pneumonia is represented by a complex of medical and epidemiological measures:

• Timely treatment of concomitant diseases;
• Compliance with hygiene rules and norms;
• Reception of immunomodulating agents;
• vaccination.

It is very important to improve the patient's condition - to prevent relapse - to monitor compliance with simple rules: regular sanitation of the oral cavity, expectoration of the accumulated fluid, physical activity.