Nosocomial pneumonia: importance of recognition of aetiological agents to define an appropriate initial empirical therapy

Int J Antimicrob Agents. 2001 Feb;17(2):147-50. doi: 10.1016/s0924-8579(00)00316-2.

Abstract

Of the 16,024 patients hospitalized from January 1995 to October 1997, 397 (2.4%) acquired nosocomial pneumonia and the aetiological agent was defined in 101 (25%). About 82% developed late onset pneumonia (>7 days of hospitalization). The site of isolation of microorganisms was bronchoalveolar lavage (BAL) (49%), blood culture (39%), pleural effusion (10%) and (2%) pulmonary tissue. Gram-negative bacteria were responsible for 54% of infections. Staphylococcus aureus (34%) was the most frequent microorganism isolated followed by Acinetobacter baumannii (29%) and Pseudomonas aeruginosa and Klebsiella pneumoniae, responsible for 7% of nosocomial pneumonia. Monotherapy gave good cover for early onset pneumonia, but not for late onset pneumonia. Based on our selection criteria, ciprofloxacin was the best monotherapy for early (50%) and late (31%) onset pneumonia. Vancomycin plus ciprofloxacin gave cover of 85% of early and 64% of late onset pneumonia. Monotherapy with ciprofloxacin and also combination therapy of ciprofloxacin plus vancomycin may be good options as initial empirical therapy for nosocomial pneumonia.

MeSH terms

  • Anti-Bacterial Agents / therapeutic use*
  • Bacteria / drug effects
  • Bacteria / isolation & purification*
  • Blood / microbiology
  • Bronchoalveolar Lavage Fluid / microbiology
  • Ciprofloxacin / therapeutic use
  • Cross Infection / drug therapy
  • Cross Infection / microbiology*
  • Drug Therapy, Combination / therapeutic use*
  • Humans
  • Lung / microbiology
  • Pleural Effusion / microbiology
  • Pneumonia, Bacterial / drug therapy
  • Pneumonia, Bacterial / microbiology*
  • Vancomycin / therapeutic use

Substances

  • Anti-Bacterial Agents
  • Ciprofloxacin
  • Vancomycin