Hospital-acquired pneumonia epidemiology and demographics: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Hospital-acquired pneumonia}} | {{Hospital-acquired pneumonia}} | ||
{{CMG}}; {{AE}} {{AL}} | |||
==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. <ref> {{cite web|url=http://www.cdc.gov/hicpac/pdf/guidelines/HApneu2003guidelines.pdf |title=CDC GUIDELINES FOR PREVENTING HEALTH-CARE-ASSOCIATED PNEUMONIA, 2003}}</ref> | |||
==Epidemiology and Demographics== | ==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. <ref name="MagillEdwards2014">{{cite journal|last1=Magill|first1=Shelley S.|last2=Edwards|first2=Jonathan R.|last3=Bamberg|first3=Wendy|last4=Beldavs|first4=Zintars G.|last5=Dumyati|first5=Ghinwa|last6=Kainer|first6=Marion A.|last7=Lynfield|first7=Ruth|last8=Maloney|first8=Meghan|last9=McAllister-Hollod|first9=Laura|last10=Nadle|first10=Joelle|last11=Ray|first11=Susan M.|last12=Thompson|first12=Deborah L.|last13=Wilson|first13=Lucy E.|last14=Fridkin|first14=Scott K.|title=Multistate Point-Prevalence Survey of Health Care–Associated Infections|journal=New England Journal of Medicine|volume=370|issue=13|year=2014|pages=1198–1208|issn=0028-4793|doi=10.1056/NEJMoa1306801}}</ref> | ||
* | |||
===Incidence=== | |||
=== | *The incidence of HAP is 5-15 cases per 1 000 hospital admissions. <ref>{{cite journal|title=Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and Healthcare-associated Pneumonia|journal=American Journal of Respiratory and Critical Care Medicine|volume=171|issue=4|year=2005|pages=388–416|issn=1073-449X|doi=10.1164/rccm.200405-644ST}}</ref> | ||
* | *The incidence of VAP is 6 to 20 times more than in patients without mechanical support. | ||
{| style="border: 0px; font-size: 85%; margin: 3px; width:380px; float:right" align=center | |||
|valign=top| | |||
|+ | |||
! style="background: #4479BA; color:#FFF; width: 200px;" | Age | |||
! style="background: #4479BA; color:#FFF; width: 200px;" | Females | |||
! style="background: #4479BA; color:#FFF; width: 200px;" | Males | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | 18-44 years | |||
| style="padding: 5px 5px; background: #F5F5F5;" | 5% | |||
| style="padding: 5px 5px; background: #F5F5F5;" | 4% | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | 45-64 years | |||
| style="padding: 5px 5px; background: #F5F5F5;" | 14% | |||
| style="padding: 5px 5px; background: #F5F5F5;" | 13% | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | ≥ 65 years | |||
| style="padding: 5px 5px; background: #F5F5F5;" | 34% | |||
| style="padding: 5px 5px; background: #F5F5F5;" | 30% | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | Total | |||
| style="padding: 5px 5px; background: #F5F5F5;" | 53% | |||
| style="padding: 5px 5px; background: #F5F5F5;" | 47% | |||
|- | |||
| style="padding: 5px 5px; background: #F5F5F5;" colspan=3 | <small>Table adapted from 2009–2011 National Medicare Patient Safety Monitoring System <ref name="EckenrodeBakullari2014">{{cite journal|last1=Eckenrode|first1=Sheila|last2=Bakullari|first2=Anila|last3=Metersky|first3=Mark L.|last4=Wang|first4=Yun|last5=Pandolfi|first5=Michelle M.|last6=Galusha|first6=Deron|last7=Jaser|first7=Lisa|last8=Eldridge|first8=Noel|title=The Association between Age, Sex, and Hospital-Acquired Infection Rates: Results from the 2009–2011 National Medicare Patient Safety Monitoring System|journal=Infection Control and Hospital Epidemiology|volume=35|issue=S3|year=2014|pages=S3–S9|issn=0899823X|doi=10.1086/677831}}</ref></small> | |||
|} | |||
===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=== | ===Age=== | ||
* | *HAP is more commonly reported in patients > 65 years, probably due to the fact that this age population is more commonly hospitalized. | ||
===Gender=== | ===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''), [[Bacteremia|blood stream infections]], and ineffective initial antibiotics. | |||
*VAP is especially common in people who have [[acute respiratory distress syndrome]] (ARDS). | |||
==References== | ==References== | ||
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[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Pulmonology]] | [[Category:Pulmonology]] | ||
[[Category: | [[Category:Pneumonia]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
Latest revision as of 18:02, 18 September 2017
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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.