NOSOCOMIAL PNEUMONIA IN THE MEDICAL AND SURGICAL PATIENT - RISK-FACTORS AND PRIMARY MANAGEMENT

Pneumonia is the third most common type of nosocomial infection, trailing only urinary tract and surgical wound infection, and is a deadly type of nosocomial infection. Recent series have reported mortality rates of 28% to 37%,(50) and in one group of 200 patients who died in the hospital, nosocomial pneumonia directly caused or contributed to 16% of the deaths.(16) In addition to death, nosocomial pneumonias cause considerable morbidity, add an average of 5 days to the hospital stay of surviving patients, and add billions of dollars to health care costs. About 300,000 patients each year develop a nosocomial pneumonia in the United States, a number that is likely to increase given the aging of the American population and the ability of medicine to keep severely ill patients alive. Because modem antibiotics and supportive care in intensive care units have not appreciably affected the high mortality of nosocomial pneumonias, prevention is important. This article concentrates on pathogenesis and risk factors for nosocomial pneumonia and outlines an approach to diagnosis, treatment, and prevention.