Epidemiology, Treatment, and Prevention of Nosocomial Bacterial Pneumonia

Shio-Shin Jean; Yin-Chun Chang; Wei-Cheng Lin; Wen-Sen Lee; Po-Ren Hsueh; Chin-Wan Hsu

doi:10.3390/jcm9010275

Epidemiology, Treatment, and Prevention of Nosocomial Bacterial Pneumonia

J Clin Med. 2020 Jan 19;9(1):275. doi: 10.3390/jcm9010275.

Authors

Shio-Shin Jean^{1

2}, Yin-Chun Chang³, Wei-Cheng Lin³, Wen-Sen Lee^{4

5}, Po-Ren Hsueh^{6

7}, Chin-Wan Hsu^{1

2}

Affiliations

¹ Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan.
² Department of Emergency Medicine, Department of Emergency and Critical Care Medicine, Wan Fang Hospital, Taipei Medicine University, Taipei 110, Taiwan.
³ Division of Thoracic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei 110, Taiwan.
⁴ Division of Infectious Diseases, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 110, Taiwan.
⁵ Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan.
⁶ Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 100, Taiwan.
⁷ Department Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 100, Taiwan.

Abstract

Septicaemia likely results in high case-fatality rates in the present multidrug-resistant (MDR) era. Amongst them are hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), two frequent fatal septicaemic entities amongst hospitalised patients. We reviewed the PubMed database to identify the common organisms implicated in HAP/VAP, to explore the respective risk factors, and to find the appropriate antibiotic choice. Apart from methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa, extended-spectrum β-lactamase-producing Enterobacteriaceae spp., MDR or extensively drug-resistant (XDR)-Acinetobacter baumannii complex spp., followed by Stenotrophomonas maltophilia, Chryseobacterium indologenes, and Elizabethkingia meningoseptica are ranked as the top Gram-negative bacteria (GNB) implicated in HAP/VAP. Carbapenem-resistant Enterobacteriaceae notably emerged as an important concern in HAP/VAP. The above-mentioned pathogens have respective risk factors involved in their acquisition. In the present XDR era, tigecycline, colistin, and ceftazidime-avibactam are antibiotics effective against the Klebsiella pneumoniae carbapenemase and oxacillinase producers amongst the Enterobacteriaceae isolates implicated in HAP/VAP. Antibiotic combination regimens are recommended in the treatment of MDR/XDR-P. aeruginosa or A. baumannii complex isolates. Some special patient populations need prolonged courses (>7-day) and/or a combination regimen of antibiotic therapy. Implementation of an antibiotic stewardship policy and the measures recommended by the United States (US) Institute for Healthcare were shown to decrease the incidence rates of HAP/VAP substantially.

Keywords: Acinetobacter baumannii complex species; Pseudomonas aeruginosa; antibiotic combination; carbapenemase; ceftazidime-avibactam; extended-spectrum β-lactamase-producing Enterobacteriaceae species; extensively drug-resistant; hospital-acquired pneumonia; methicillin-resistant Staphylococcus aureus; ventilator-associated pneumonia.

Publication types

Review