Hospital Acquired Pneumonia
Original Editors - Students from Glasgow Caledonian University's Cardiorespiratory Therapeutics Project.
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Definition/Description[edit | edit source]
Distinguishing between pneumonia and Hospital-acquired pneumonia
Pneumonia
“Pneumonia is an infection of the lung tissue. When a person has pneumonia the air sacs in their lungs become filled with microorganisms, fluid and inflammatory cells and their lungs are not able to work properly. Diagnosis of pneumonia is based on symptoms and signs of an acute lower respiratory tract infection, and can be confirmed by a chest X-ray showing new shadowing that is not due to any other cause (such as pulmonary oedema or infarction)."
(NICE clinical guidelines 2014)
Hospital-acquired pneumonia
"Hospital-acquired pneumonia is defined as pneumonia that occurs 48 hours or more after hospital admission and is not incubating at hospital admission. Early-onset (occurring within 4 days of admission) hospital-acquired pneumonia is usually caused by the same bacteria and viruses as community-acquired pneumonia and has a good prognosis. Late-onset (starting 5 days or more after admission) hospital-acquired pneumonia has a worse prognosis and is usually caused by micro-organisms that are acquired from the hospital environment. MRSA, Pseudomonas aeruginosa and other non-pseudomonal Gram-negative bacteria are the most common causes."
(NICE Hospital-acquired pneumonia caused by methicillin-resistant Staphylococcus aureus: telavancin. Published: 15 July 2014)
Epidemiology[edit | edit source]
“At any time 1.5% of hospital inpatients in England have a hospital-acquired respiratory infection, more than half of which are hospital-acquired pneumonia and are not associated with intubation. Hospital-acquired pneumonia is estimated to increase hospital stay by about 8 days and has a reported mortality rate that ranges from 30–70%. Variations in clinical management and outcome occur across the UK.”
(NICE guidelines 2014)
Ventilator-acquired pneumonia (VAP) has been studied more comprehensively than HAP. A clear reason for this is VAP is responsible for 86% of the HAP reported (Masterston).
The incidence rate of HAP is between 3 and 10 per 1000 hospital admissions (Kieninger, 2009, Stolbrink 2014)
Mortality rates from VAP are between 24 and 50% (Masterston) but it is reported to jump to 76% if it is caused my multi drug resistant pathogens (mastersotn) that are often linked to later stage pneumonia (> 5days in hospital). Although it is difficult to determine the exact cause of death in critically ill patients, which will cause discrepancies in any date, Liapikou reports that accurate antibiotics taken at the right time has shows to lower mortality rate for HAP.
The chance of infection is estimated to be 3%/day during the first 5 days of ventilation, followed by 2%/day up to day 10 of ventilation and there- after 1%/day.
(American Thoracic Society 2005)
Aetiology[edit | edit source]
The most common cause is an accumulation of bacteria, most ordinarily gram-negative bacilli and staphlycoccus aureus, which inhabit the oropharynx and upper airways in seriously ill and ventilated patients. A less common cause is seeding of the lung due to bacteremia; a bacterium that originates is the patients’ blood supply but if transferred to the lungs during gas exchange. Finally inhalation of bacterially contaminated aerosols which transport airborne particles containing Legionella sp, Aspergillus sp, or influenza virus, although this is a relative unfamiliar form of contracting hospitalized pneumonia.
Endotracheal intubation with mechanical ventilation poses the greatest overall risk. Ventilation Associated Pneumonia is a subcategory of hospitalized and contributes more than 85% of all cases, with pneumonia occurring in up to 27% of ventilated patients. Endotracheal intubation related bacteria embed themselves deep into the endotracheal tube cuff enabling them to avoid the body nature immune response while also providing a biofilm of protection from antibiotics.
In nonintubated patients, risk factors include previous antibiotic treatment, high gastric pH, resulting from cardiac, pulmonary, hepatic, or renal deficiencies. Major risk factors for postoperative pneumonia are patients older than 70, abdominal or thoracic surgery, and cardiorespiratory functional depletion.
Investigations[edit | edit source]
This may well include any investigations used to gain a diagnosis or that you might need to gain information about your patient assessment.
Clinical Manifestations[edit | edit source]
Clinical manifestations (the signs and symptoms your patient may well present to you on an examination) ensure you relate this back to the underlying pathophysiology.
Physiotherapy and Other Management[edit | edit source]
Physiotherapy and other management. Other health professionals will be treating your patient. What is their input?
Prevention[edit | edit source]
Brief consideration of how this pathology could be prevented and the physiotherapy role in health promotion in relation to prevention of disease or disease progression.
Resources
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add appropriate resources here
Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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