Hospital-acquired pneumonia in nonintensive care unit wards

Aim: To determine the incidence, risk factors, etiology, and antibiotic susceptibility of hospital-acquired pneumonia(HAP) in nonintensive care units (non-ICU) and nonintubated adult patients.Materials and methods: A prospective surveillance study was performed from January 2006 through December 2007 in the medical and surgical wards of the Izmir Teaching and Research Hospital. Results: During the study period, data on 57,133 patients with a total of 413,515 patient-days were analyzed. A total of106 HAP episodes occurred in 99 patients. The infection rate per 100 patients and per 1000 patient-days was found tobe 0.2% and 0.3%, respectively. HAP episodes were detected mostly in medical wards (66%). The mean age of patients was 58.6 ± 15.9 and 73% of the patients were male. The most common intrinsic and extrinsic risk factors observed in patients with HAP, according to the first episode, were cardiovascular disease (47%), central nervous system disease(41%), malignancy (40%), hospitalization longer than 5 days (91%), antibiotic therapy (81%), previous endotracheal intubation (40%), nasogastric tubes (38%), and H2 receptor antagonist/antiacid (37%). Moreover, 109 microorganisms were isolated from 84% of HAP episodes. Overall, the most frequently isolated pathogens from HAP episodes were Klebsiella pneumoniae (23%), Escherichia coli (21%), and Staphylococcus aureus (18%). These were mostly multidrug-resistant. The crude mortality was found to be 25%.Conclusion: Surveillance of HAP in non-ICU and nonintubated adult patients provides valuable guidance for empirical antimicrobial therapy and infection control measures for some wards.