Nosocomial pneumonia in the critically ill: product of aspiration or translocation?
OBJECTIVE
To examine the possibility that nosocomial pneumonias might be caused by the translocation of enteric bacteria and their toxins.


METHODS
Prospectively collected previous database was examined by logistic regression analysis.


METHODS
University medical center.


METHODS
Sixty-two ICU patients.


RESULTS
The best stand-alone predictors for nosocomial pneumonia were bleeding from stress ulceration (p less than .001), the severity of illness present (p less than .001), and intramucosal acidosis in the stomach (p = .023), a metabolic indication of mucosal ischemia. Mechanical ventilation (p = .038) and the administration of antacids/cimetidine (p = .054) were also of stand-alone predictive value, but did not significantly improve the best predictive model for nosocomial pneumonia derived from the severity of illness present and the intramucosal pH in the stomach.


CONCLUSIONS
The findings are consistent with the hypothesis that ischemic mucosal injury and its associated translocation of enteric bacteria and toxins might be more important in the pathogenesis of nosocomial pneumonia in the critically ill than the aspiration of contaminated nasopharyngeal secretions.
Fiddian-Green
R G
RG
Department of Surgery, University of Massachusetts Medical Center, Worcester 01655.
Baker
S
S
D003428:Cross Infection / Q000209:etiology* / Q000382:microbiology; D005750:Gastric Juice; D005753:Gastric Mucosa / Q000098:blood supply / Q000382:microbiology*; D006471:Gastrointestinal Hemorrhage / Q000150:complications; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007511:Ischemia / Q000150:complications; D016015:Logistic Models; D011014:Pneumonia / Q000209:etiology* / Q000382:microbiology; D011015:Pneumonia, Aspiration / Q000209:etiology*; D011446:Prospective Studies; D013276:Stomach Ulcer / Q000150:complications* / Q000209:etiology; D013312:Stress, Physiological / Q000150:complications*