Hospital-acquired pneumonia epidemiology and demographics
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]
Overview
The epidemiology of health-care-associated pneumonia varies considerably according to the type of health-care setting. Nosocomial pneumonia has been the second most common hospital-associated infection after that of the urinary tract. The primary risk factor for the development of hospital-associated bacterial pneumonia is mechanical ventilation. In long-term care facilities such as nursing homes, pneumonia is the first or second most common infection (after those of the urinary tract) acquired by patients, and accounts for 13-48% of all nursing home-associated infections. [1]
Epidemiology and Demographics
- Pneumonia has accounted for approximately 20% of all hospital-associated infections and 27% and 24% of all infections acquired in the medical intensive-care unit (ICU) and coronary care unit, respectively. [2]
Incidence
- The incidence of HAP is 5-15 cases per 1 000 hospital admissions. [3]
- The incidence of VAP is 6 to 20 times more than in patients without mechanical support.
| Age | Females | Males |
|---|---|---|
| 18-44 years | 5% | 4% |
| 45-64 years | 14% | 13% |
| ≥ 65 years | 34% | 30% |
| Total | 53% | 47% |
| Table adapted from 2009–2011 National Medicare Patient Safety Monitoring System [4] | ||
Mortality
- HAP and VAP are nosocomial infections with a high mortality in contrast with other nosocomial infections.
- This higher mortality rate is associated with MDR pathogens.
Age
- HAP is more commonly reported in patients > 65 years, probably due to the fact that this age population is more commonly hospitalized.
Gender
- There is no predominance in gender, although some data reports a higher incidence among females.
Ventilator-associated Pneumonia
- VAP occurs in up to 25% of all people who require mechanical ventilation.
- VAP can develop at any time during ventilation, but occurs more often in the first few days after intubation.
- This is because the intubation process itself contributes to the development of VAP.
- VAP occurring early after intubation typically involves fewer resistant organisms and is thus associated with a more favorable outcome.
- Because respiratory failure requiring mechanical ventilation is itself associated with a high mortality, determination of the exact contribution of VAP to mortality has been difficult.
- As of 2006, estimates range from 33% to 50% death in patients who develop VAP.
- Mortality is more likely when VAP is associated with certain microorganisms (Pseudomonas, Acinetobacter), blood stream infections, and ineffective initial antibiotics.
- VAP is especially common in people who have acute respiratory distress syndrome (ARDS).
References
- ↑ "CDC GUIDELINES FOR PREVENTING HEALTH-CARE-ASSOCIATED PNEUMONIA, 2003" (PDF).
- ↑ Magill, Shelley S.; Edwards, Jonathan R.; Bamberg, Wendy; Beldavs, Zintars G.; Dumyati, Ghinwa; Kainer, Marion A.; Lynfield, Ruth; Maloney, Meghan; McAllister-Hollod, Laura; Nadle, Joelle; Ray, Susan M.; Thompson, Deborah L.; Wilson, Lucy E.; Fridkin, Scott K. (2014). "Multistate Point-Prevalence Survey of Health Care–Associated Infections". New England Journal of Medicine. 370 (13): 1198–1208. doi:10.1056/NEJMoa1306801. ISSN 0028-4793.
- ↑ "Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and Healthcare-associated Pneumonia". American Journal of Respiratory and Critical Care Medicine. 171 (4): 388–416. 2005. doi:10.1164/rccm.200405-644ST. ISSN 1073-449X.
- ↑ Eckenrode, Sheila; Bakullari, Anila; Metersky, Mark L.; Wang, Yun; Pandolfi, Michelle M.; Galusha, Deron; Jaser, Lisa; Eldridge, Noel (2014). "The Association between Age, Sex, and Hospital-Acquired Infection Rates: Results from the 2009–2011 National Medicare Patient Safety Monitoring System". Infection Control and Hospital Epidemiology. 35 (S3): S3–S9. doi:10.1086/677831. ISSN 0899-823X.