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, eiprofloxacin 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. (C) 2001 Published by Elsevier Science B.V. and International Society of Chemotherapy. All rights reserved.