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Hospital-Acquired Pneumonia

2001; Elsevier BV; Volume: 119; Issue: 2 Linguagem: Inglês

10.1378/chest.119.2_suppl.373s

1931-3543

Joseph P. Lynch,

Antibiotic Resistance in Bacteria

Pneumonia complicates hospitalization in 0.5 to 2.0% of patients and is associated with considerable morbidity and mortality. Risk factors for hospital-acquired pneumonia (HAP) include mechanical ventilation for > 48 h, residence in an ICU, duration of ICU or hospital stay, severity of underlying illness, and presence of comorbidities. Pseudomonas aeruginosa , Staphylococcus aureus , and Enterobacter are the most common causes of HAP. Nearly half of HAP cases are polymicrobial. In patients receiving mechanical ventilation, P aeruginosa , Acinetobacter, methicillin-resistant S aureus , and other antibiotic-resistant bacteria assume increasing importance. Optimal therapy for HAP should take into account severity of illness, demographics, specific pathogens involved, and risk factors for antimicrobial resistance. When P aeruginosa is implicated, monotherapy, even with broad-spectrum antibiotics, is associated with rapid evolution of resistance and a high rate of clinical failures. For pseudomonal HAP, we advise combination therapy with an antipseudomonal β-lactam plus an aminoglycoside or a fluoroquinolone ( eg , ciprofloxacin).