Nosocomial pneumonia is an acute infectious process that occurs in the body under the influence of the active life of pathogenic bacteria. Characteristic features of the disease are damage to the respiratory tract of the pulmonary region with internal accumulation of a large volume of fluid. Exudate subsequently seeps through the cells and enters the renal tissue.
Updated national guidelines for nosocomial pneumonia
Since 2014, the Respiratory Society has submitted clinical recommendations to the world . They are based on the algorithm of diagnosis and therapy in situations where there is a suspicion that the patient is progressing nosocomial pneumonia. National recommendations have been developed by specialists, medical practitioners, to help medical workers who have experienced acute respiratory infections.
In short, the algorithm consists of four points.
- Determination of the need for hospitalization of the patient. A positive decision is made if the patient has pronounced respiratory failure, there is a decrease in tissue perfusion, acute autointoxication, impaired consciousness, unstable blood pressure. The definition of at least one symptom is sufficient for placement in a hospital.
- Determining the cause of the disease. For this, a series of laboratory studies of biological materials is prescribed to the patient: cultural blood culture from a vein, bacterial culture of sputum, a speed test to determine bacterial antigenuria.
- Determination of the duration of treatment. Provided that the disease is of bacterial origin, but the true cause has not been established, therapy is carried out for ten days. With various complications or extrapulmonary localization of the focus, the therapeutic course can be up to 21 days.
- Necessary measures of inpatient stay. In serious condition, patients need respiration or non-invasive ventilation.
Also, national recommendations spell out preventive measures. The most effective is vaccination against influenza and pneumococcus, prescribed mainly to patients with chronic pneumonia and people of an older age group.
Features of community-acquired pneumonia
Community-acquired nosocomial pneumonia has another common name - community-acquired. The disease is caused by an infection of bacterial etiology. The main route of infection is the environment. Accordingly, the definition will be as follows: an inflammatory lesion of the pulmonary region obtained by airborne droplets, while the patient had no previous contact with carriers of infection in medical institutions.
Community-acquired and nosocomial pneumonia of bacterial origin is more often diagnosed in patients with reduced immunity, when the body is not able to withstand pathogens (pneumococci, hemophilic bacillus, Klebsiella). They enter the lung cavity through the nasopharynx.
The risk group includes children of a younger age group and patients with chronic lung pathologies. In this case, the causative agent is Staphylococcus aureus.
Community-acquired nosocomial pneumonia: principles for classifying a disease
To develop the right treatment, pneumonia is usually classified according to the following parameters:
- a disease that is not accompanied by a decrease in the protective function of the body;
- a disease that arose against a background of reduced immunity;
- a disease that arose in the acute stage of AIDS;
- a disease formed in conjunction with other diseases.
As a rule, the diagnosis is confirmed in patients who have a problem in the form of reduced immunity against the background of oncology or hematology. Also, patients who take high-dose glucocorticosteroids for a long time fall into the risk group. There are also situations when the disease occurs in patients with chronic immune pathologies.
In addition, this type of pneumonia is referred to as aspiration.
Doctors note that at the moment, foreign bodies are present in the mechanism of nucleation of any type of aspiration pneumonia , when they enter the disease develops.
Features of nosocomial pneumonia
Doctors put this condition of the patient in this concept, when the inflammatory process in the pulmonary section appears approximately 72 hours after infection. The danger lies in the fact that nosocomial nosocomial pneumonia has a complicated course and most often results in death. This is due to the fact that the bacteria that live in the walls of a medical institution are resistant to most medications, so it is very difficult to choose the right antibiotic the first time.
Nosocomial nosocomial pneumonia: principles for classifying a disease
Nosocomial pneumonia of the hospital type is primarily classified according to the stage of infection:
- The early stage - in the first five days of the patient being in stationary conditions, obvious signs of the disease begin to appear.
- Late stage - the manifestation of symptoms is delayed by more than five days.
Depending on the etiology of the development of the disease, three types are distinguished:
- Aspiration nosocomial pneumonia.
- Postoperative.
- Fan-associated.
It is worth noting that the presented classification by species is conditional, and in most cases pneumonia is diagnosed in a mixed form. This, in turn, significantly aggravates the patient's condition and reduces the chances of recovery.
Aspiration
The presented form of the disease is the most common. When infected nasopharyngeal mucus enters the pulmonary region, self-infection of the body occurs.
Nasopharyngeal fluid is an ideal place for feeding pathogenic bacteria, therefore, once in the lungs, microorganisms begin to multiply actively, which contributes to the development of aspiration pneumonia.
Postoperative
The presented type of pneumonia is diagnosed in 18 clinical cases out of 100 and occurs exclusively in patients who have undergone surgical intervention.
In this case, infection occurs in the same way as with aspiration pneumonia, only gastric secretion is added to the nasopharyngeal fluid, which is no less dangerous. Also, do not exclude the infection of the patient with medical instruments and devices. Through a tube or catheter, the infection can easily spread to the lower respiratory tract.
Fan-associated
It is diagnosed in patients who are for a long time in conditions of mechanical ventilation. A safe period is not more than 72 hours in such a condition, and then every day the risk of developing pneumonia increases.
The causative agents of nosocomial pneumonia
Nosocomial hospital pneumonia is often caused by pneumococci. Such diagnoses make up from 30 to 50 percent of all clinical cases.
The least aggressive bacteria are chlamydia, mycoplasma and legionella. Under their influence, pneumonia develops in no more than 30% of cases, but not less than 8%.
Least of all you can meet a disease that has arisen against the background of vigorous activity: hemophilic bacillus, Staphylococcus aureus, Klebsiella and enterobacteria.
Another causative agent of nosocomial pneumonia is influenza A and B viruses, parainfluenza, adenovirus, respiratory syncytial virus.
The most common causative agents of aggressive nosocomial pneumonia, which can cause epidemic outbreaks, are mycoplasma and legionella. Moreover, in the first case, adolescents and young people under 25 years old are most often sick. And Legionella infection occurs through water, for example, in a public shower, pool, and more.
Methods of modern diagnostics
If the patient has pneumonia of the out-of-hospital type, I often diagnose it with a medical examination. In each clinical case, for convenience of monitoring the patient's condition and the symptoms of the disease, a separate card or medical history is created.
A phased outpatient diagnosis looks like this:
- Chest x-ray is a method of radiation diagnosis, which in the pictures projects the condition of the lungs in several planes. In the presence of dark, dense spots, the diagnosis is confirmed. Diagnosis is shown twice: at the beginning of treatment and after antibiotic therapy.
- Laboratory studies - the patient will need to donate blood for a general analysis and determination of the number of white blood cells, glucose and electrolytes.
- Microbiological studies - an analysis of pleural fluid and coloration of the lower respiratory tract is performed, the presence of antigens in the urine is determined.
The results of these diagnostic procedures are enough to make a final diagnosis and develop a treatment plan.
Recommendations for the treatment of patients
Clinical recommendations for the treatment of nosocomial pneumonia consist in the primary appointment of a broad-spectrum antibiotic.
After obtaining the results of examinations in the competence of the doctor, change the previously prescribed drug to a more effective one. The basis is the type of pathogenic microorganisms.
Principles of treatment of patients with nosocomial pneumonia
Treatment of nosocomial pneumonia consists in the selection of the correct antibiotic, its administration schedule, route of administration and dosage. Only the attending physician is engaged in this. Also an integral part of therapy is the procedure of sanitation of the respiratory tract (removal of accumulated fluid).
An important point is the patient is in a state of physical activity. You should perform breathing exercises and small physical activities in the form of squats. Serious patients are assisted by nurses. They are engaged in a regular change of position of the patient, which allows not to stagnate fluid in one place.
Prevention of recurrence of the disease will help the prevention of nosocomial pneumonia, which will be described in detail by the attending physician.
Antibiotic therapy
Treatment aimed at combating bacteria has two types: targeted and empirical. Initially, all patients undergo treatment of an empirical type, and the direction is prescribed after determining the causative agent of the disease.
The most important conditions for recovery are:
- Developing the right antibacterial treatment.
- Reducing the use of antimicrobials.
Only the attending physician can choose antibacterial medicines, as well as their dosage, self-medication replacement is unacceptable.
Prognosis for recovery
Depending on the correctness of the selected drugs, the severity of the disease and the general condition of the patient, the outcome of treatment may be as follows: recovery, slight improvement, treatment failure, relapse, death.
With nosocomial pneumonia, the likelihood of death is significantly higher than with community-acquired form.
Preventative measures
Prevention of nosocomial pneumonia is represented by a complex of medical and epidemiological measures:
- timely treatment of concomitant diseases;
- compliance with hygiene rules and standards;
- reception of immunomodulating agents;
- vaccination.
It is very important when improving the patient's condition - to prevent relapse - to monitor compliance with simple rules: regular sanitation of the oral cavity, expectoration of accumulated fluid, physical activity.