A study of the etiologies and treatment of nosocomial pneumonia in a community-based teaching hospital.
OBJECTIVE
To compare the frequency of the pathogens of nosocomial pneumonia in a community-based teaching hospital to the frequencies previously published, and to evaluate recommendations for the therapy of nosocomial pneumonia in this setting.


METHODS
Retrospective review of prospectively acquired data accrued during 9 randomized single-blinded and 4 single-agent investigational antibiotic studies for the therapy of pneumonia in hospitalized patients between 1981 and 1989.


METHODS
The study was performed at a university affiliated, community-based teaching Department of Veterans Affairs Medical Center.


METHODS
Patients were hospitalized on the acute medical/surgical and intermediate medicine wards. Informed consent was obtained prior to enrolling patients into the respective antimicrobial studies. Pneumonia was documented radiographically and clinically for each patient.


RESULTS
Two hundred thirty-one episodes of nosocomial pneumonia were treated. Overall, 51% of pneumonias were caused by Streptococcus pneumoniae or Hemophilus influenzae with or without other organisms that were not gram-negative bacilli. Gram-negative bacilli, with or without other organisms, accounted for only 26% of all nosocomial pneumonias. Overall, monotherapy with a cephalosporin (usually a broad-spectrum agent) was equally efficacious compared with combination therapy (87% versus 81%, respectively). Cure rates for nosocomial pneumonias from gram-negative bacilli treated with these 2 therapies also were similar (70% versus 60%, respectively).


CONCLUSIONS
In nontertiary care settings, gram-negative bacilli may cause fewer episodes of nosocomial pneumonia (26% in this study) than noted by previously published reports, which indicated that these organisms account for 50% of nosocomial pneumonias. Further, S pneumoniae and H influenzae may account etiologically for many of these nosocomial pneumonias. Monotherapy with an extended-spectrum cephalosporin may be more appropriate than combined treatment with a beta-lactam and an aminoglycoside in a nontertiary care setting, thereby reducing potential toxicity in an older, hospitalized patient population.
Schleupner
C J
CJ
University of Virginia School of Medicine, Department of Veterans Affairs Medical Center, Salem, VA.
Cobb
D K
DK
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002511:Cephalosporins / Q000627:therapeutic use; D003428:Cross Infection / Q000188:drug therapy* / Q000382:microbiology*; D005260:Female; D006192:Haemophilus Infections / Q000188:drug therapy / Q000382:microbiology; D006193:Haemophilus influenzae; D006744:Hospital Bed Capacity, 100 to 299; D006764:Hospitals, Community; D006784:Hospitals, Teaching; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000188:drug therapy / Q000382:microbiology; D011014:Pneumonia / Q000188:drug therapy* / Q000382:microbiology*; D012189:Retrospective Studies; D016037:Single-Blind Method; D014768:Virginia
D002511:Cephalosporins