From the Guidelines
Hospital-acquired infections, including nosocomial pneumonia, should be diagnosed and treated promptly with appropriate antibiotics, taking into account local microbiologic data and the patient's risk factors for multidrug-resistant pathogens, as recommended by the 2017 European Respiratory Society guidelines 1. The diagnosis of nosocomial infection involves identifying the causative pathogen and assessing the patient's risk factors for infection. According to the 2017 European Respiratory Society guidelines 1, hospital-acquired pneumonia (HAP) is an infection of the pulmonary parenchyma caused by pathogens that are present in hospital settings. The guidelines recommend collecting lower respiratory tract cultures from all patients before antibiotic therapy, but emphasize that collection of cultures should not delay the initiation of therapy in critically ill patients. Some key points to consider in the diagnosis and treatment of nosocomial infections include:
- Identifying the causative pathogen and assessing the patient's risk factors for infection
- Collecting lower respiratory tract cultures from all patients before antibiotic therapy
- Using appropriate antibiotics, taking into account local microbiologic data and the patient's risk factors for multidrug-resistant pathogens
- Implementing comprehensive infection control programs, including proper hand hygiene, use of personal protective equipment, and environmental cleaning and disinfection The 2017 European Respiratory Society guidelines 1 provide recommendations for the management of HAP and ventilator-associated pneumonia (VAP), including the use of broad-spectrum antibiotics in patients with late-onset pneumonia or other risk factors for infection with multidrug-resistant pathogens. The guidelines also emphasize the importance of de-escalation of initial antibiotic therapy, based on microbiologic cultures and the clinical response of the patient, and shortening the duration of therapy to the minimum effective period. In terms of treatment, the 2005 American Thoracic Society guidelines 1 recommend using either "semiquantitative" or "quantitative" culture data to manage patients with HAP. The guidelines also emphasize the importance of taking local microbiologic data into account when adapting treatment recommendations to any specific clinical setting. However, the 2017 European Respiratory Society guidelines 1 are more recent and provide more comprehensive recommendations for the management of HAP and VAP.
From the Research
Diagnosis of Nosocomial Infections
- Hospital-acquired infections (HAIs) can be diagnosed through clinical, hematological, and microbiological evaluation 2
- Identification of the causative bacterial agents of HAI from different clinical samples is crucial for diagnosis 3
- Surveillance strategies designed according to the specific needs of the institution are key elements of a good infection control management within healthcare institutions 4
Treatment of Nosocomial Infections
- Treatment protocols for HAIs should be designed based on the resistance pattern of organisms isolated from hospital-acquired infections 2
- Empirical antibiotics protocol, such as tigecycline with carbapenem like meropenem and vancomycin, may be prescribed for patients with HAIs, especially those with cirrhosis 2
- De-escalation is advised after the culture sensitivity report is obtained 2
- Antimicrobial susceptibility patterns of the identified organisms should guide the treatment of HAIs 3
Prevention of Nosocomial Infections
- Infection control practices, such as hand hygiene, isolation precautions, environmental cleaning, antimicrobial bathing, and prevention of ventilator-associated pneumonia, are paramount in avoiding HAIs 5
- Structured interventions, such as the introduction of bundles of infection control measures or checklists, can increase compliance with infection control measures and decrease nosocomial infection rates 4
- Efforts specific to each of the most common infections, such as surgical site infections, intravascular line-associated infections, pneumonia, catheter-associated urinary tract infections, and C. difficile infection, are necessary to prevent HAIs 6