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Pneumonia nosocomiala

= pneumonia de spital, dobindita ca


urmare a spitalizarii, hospitalacquired pneumonia

Pneumonia nosocomiala2
= pneumonia ce apare la mai mult de 48 ore de la
internare, cu excluderea oricarei infectii care era in
perioada de incubare in momentul internarii
5-10 cazuri/1000 internari, de 6-20 de ori mai mult
la bolnavii ventilati mecanic
a doua cauza de infectie nosocomiala in SUA
creste durata spitalizarii in medie cu 7-9
zile/pacient

Pneumonia nosocomiala3
Mortalitate de pina la 70%, dar nu intregime
atribuabila infectiei!
Insa! - mortalitatea atribuabila infectiei
creste cind exista bacteriemie sau cind
agentul etiologic este Pseudomonas
aeruginosa sau Acinetobacter

Pneumonia nosocomiala4
Tratamentul se bazeaza de:
1. evaluarea severitatii bolii
2. prezenta de factori de risc pentru un anume
microb
3. momentul aparitiei si tratamentele
anterioare (ex: infectia cu microbi meticilino-rezistenti
este mai probabila daca bolnavul a primit antibiotice
inaintea debutului pneumoniei)

PN- tratamentul antibiotic


Tratamentul initial este, prin necesitate,
empiric!
Monoterapie sau combinatii de antibiotice?
Ce mecanism bactericid?
Ce concentratii pulmonare?
Cit timp?

Pneumonia nosocomiala: concluzii


Many patients with presumed nosocomial pneumonia probably have infiltrates
on the chest radiograph, fever, and leukocytosis resulting from noninfectious
causes. Because of the high mortality and morbidity associated with nosocomial
pneumonias, however, most clinicians treat such patients with a 2-week empiric
trial of antibiotics. Before therapy is initiated, the clinician should rule out other
causes of pulmonary infiltrates, fever, and leukocytosis that mimic a nosocomial
pneumonia (e.g., pre-existing interstitial lung disease, primary or metastatic lung
carcinomas, pulmonary emboli, pulmonary drug reactions, pulmonary
hemorrhage, collagen vascular disease affecting the lungs, or congestive heart
failure). If these disorders can be eliminated from diagnostic consideration, a 2week trial of empiric monotherapy is indicated. The clinician should treat cases of
presumed nosocomial pneumonia as if P. aeruginosa were the pathogen. Although
P. aeruginosa is not the most common cause of nosocomial pneumonia, it is the
most virulent pulmonary pathogen associated with nosocomial pneumonia.
Coverage directed against P. aeruginosa is effective against all other aerobic
gram-negative bacillary pathogens causing hospital-acquired pneumonia. The
clinician should select an antibiotic for empiric monotherapy that is highly
effective against P. aeruginosa, has a good side-effect profile, has a low resistance
potential, and is relatively inexpensive in terms of its cost to the institution.
Cunha BA, Med Clin North Am 2001; 85: 79-114