Nosocomial pneumonia: importance of recognition of aetiological agents to define an appropriate initial empirical therapy.
Of the 16,024 patients hospitalized from January 1995 to October 1997, 397 (2.4%) acquired nosocomial pneumonia and the aetiological agent was defined in 101 (25%). About 82% developed late onset pneumonia (>7 days of hospitalization). The site of isolation of microorganisms was bronchoalveolar lavage (BAL) (49%), blood culture (39%), pleural effusion (10%) and (2%) pulmonary tissue. Gram-negative bacteria were responsible for 54% of infections. Staphylococcus aureus (34%) was the most frequent microorganism isolated followed by Acinetobacter baumannii (29%) and Pseudomonas aeruginosa and Klebsiella pneumoniae, responsible for 7% of nosocomial pneumonia. Monotherapy gave good cover for early onset pneumonia, but not for late onset pneumonia. Based on our selection criteria, ciprofloxacin was the best monotherapy for early (50%) and late (31%) onset pneumonia. Vancomycin plus ciprofloxacin gave cover of 85% of early and 64% of late onset pneumonia. Monotherapy with ciprofloxacin and also combination therapy of ciprofloxacin plus vancomycin may be good options as initial empirical therapy for nosocomial pneumonia.
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Nosocomial Infection Control Group, Hospital das Clínicas, University of São Paulo, HC-FMUSP, Avenida Dr Eneas Carvalho de Aguiar 255, SP, São Paulo, Brazil. gcih@hcnet.usp.br
Newbaer
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Santos
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Basso
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Soares
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Levin
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D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001419:Bacteria / Q000187:drug effects / Q000302:isolation & purification*; D001769:Blood / Q000382:microbiology; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D002939:Ciprofloxacin / Q000627:therapeutic use; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology*; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D006801:Humans; D008168:Lung / Q000382:microbiology; D010996:Pleural Effusion / Q000382:microbiology; D018410:Pneumonia, Bacterial / Q000188:drug therapy / Q000382:microbiology*; D014640:Vancomycin / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin; D014640:Vancomycin