Pneumonia nosocomiala

= pneumonia de spital, dobindita ca

urmare a spitalizarii, “hospital-
acquired pneumonia”
 Pneumonia nosocomiala 2

• = 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 nosocomiala 3

• 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 nosocomiala 4

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 2-
week 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