Nosocomial pneumonia is an acute infectious process that occurs in the body under the influence of the active vital activity of pathogenic bacteria. The characteristic features of the disease is the defeat of the respiratory tract of the pulmonary department with the internal accumulation of a large volume of fluid. The exudate subsequently seeps through the cells and into the kidney tissue.
Updated national guidelines for nosocomial pneumonia
Since 2014, the Respiratory Society has provided clinical guidelines to the world. They are based on an algorithm for diagnosis and therapy in situations where there is a suspicion that the patient is progressing nosocomial pneumonia. National guidelines have been developed by medical practitioners to help he althcare workers who are faced with acute respiratory infections.
In short, the algorithm consists of four steps.
- Determining the need for hospitalizationpatient. A positive decision is made if the patient has clearly expressed respiratory failure, there is a decrease in tissue perfusion, acute autointoxication, impaired consciousness, unstable blood pressure. To be admitted to a hospital, it is enough to determine at least one symptom.
- Determination of the cause of the disease. To do this, the patient is prescribed a number of laboratory studies of biological materials: blood culture from a vein, sputum culture, a speed test to determine bacterial antigenuria.
- Determining the duration of treatment. Provided that the disease is of bacterial origin, but the true cause is not established, therapy is carried out for ten days. With various complications or extrapulmonary localization of the focus, the therapeutic course can be up to 21 days.
- Necessary measures for inpatient stay. Critically ill patients require respiration or non-invasive ventilation.
Also, preventive measures are prescribed in the national recommendations. The most effective is vaccination against influenza and pneumococcus, which is prescribed mainly for patients with chronic pneumonia and people of the older age group.
Features of community-acquired pneumonia
Community-acquired nosocomial pneumonia has another common name - community-acquired. The disease is caused by an infection of bacterial etiology. The main route of infection is the environment. Accordingly, the definition will sound as followsway: an inflammatory lesion of the pulmonary region, obtained by airborne droplets, while the patient had no previous contact with infection carriers in medical institutions.
Community-acquired and nosocomial pneumonia of bacterial origin is more often diagnosed in patients with reduced immunity, when the body is unable to resist pathogenic microorganisms (pneumococci, Haemophilus influenzae, Klebsiella). They enter the lung cavity through the nasopharynx.
The risk group includes children of a younger age group and patients with chronic lung pathologies. In this case, the causative agent is Staphylococcus aureus.
Community-acquired nosocomial pneumonia: principles of disease classification
To develop the right treatment, pneumonia is usually classified according to the following parameters:
- a disease that is not accompanied by a decrease in the protective function of the body;
- disease caused by reduced immunity;
- a disease that occurs in the acute stage of AIDS;
- disease formed in conjunction with other diseases.
As a rule, the diagnosis is confirmed in patients who have a problem in the form of reduced immunity due to oncology or hematology. Also at risk are patients who have been taking high-dose glucocorticosteroids for a long time. There are also situations when the disease occurs in patients with chronic immune pathologies.
Besides this, toa separate category includes such a type of pneumonia as aspiration.
Doctors note that at the moment, in the mechanism of the origin of any type of aspiration pneumonia, there are foreign bodies, when they enter, the disease develops.
Features of nosocomial pneumonia
In this concept, doctors put such a condition of the patient, when the inflammatory process in the pulmonary region manifests itself approximately 72 hours after infection. The danger lies in the fact that nosocomial nosocomial pneumonia has a complicated course and most often ends in death. This is due to the fact that the bacteria that live in the walls of a medical institution are resistant to most medications, so it is very difficult to find the right antibiotic the first time.
Nosocomial nosocomial pneumonia: principles of disease classification
Primarily hospital-type nosocomial pneumonia is classified by stage of infection:
- Early stage - in the first five days of the patient's stay in hospital, clear signs of the disease begin to appear.
- Late stage - the onset of symptoms is delayed for more than five days.
Depending on the etiology of the development of the disease, three types are distinguished:
- Aspiration nosocomial pneumonia.
- Post-op.
- Fan-associated.
It is worth noting that the presented classification by type is conditional, and in most cases pneumonia is diagnosed in a mixed form. This, in turn, significantly aggravates the patient's condition and reduces the chances of recovery.
Aspiration
The presented form of the disease is the most common. When the infected mucus of the nasopharynx enters the pulmonary region, the body self-infects.
The nasopharyngeal fluid is an ideal place for pathogenic bacteria to feed, therefore, once in the lungs, microorganisms begin to multiply actively, which contributes to the development of aspiration pneumonia.
Post-op
The presented type of pneumonia is diagnosed in 18 out of 100 clinical cases and occurs exclusively in patients who have undergone surgery.
In this case, the infection occurs in the same way as with aspiration pneumonia, only gastric secretion is added to the nasopharyngeal fluid, which is no less dangerous. Also, it is not necessary to exclude the infection of the patient with medical instruments and devices. Through a tube or catheter, the infection can easily spread to the lower respiratory tract.
Fan-associated
Diagnosed in patients who are under mechanical ventilation for a long time. The safe period is no more than 72 hours of being in this state, and then every day the risk of developing pneumonia increases.
Pathogens of nosocomial pneumonia
Nosocomial nosocomial pneumonia is more commonly caused by pneumococci. Such diagnoses range from 30 to 50percent of all clinical cases.
The least aggressive bacteria are chlamydia, mycoplasma and legionella. Under their influence, pneumonia develops in no more than 30% of cases, but not less than 8%.
The least common disease that occurs against the background of vigorous activity: Haemophilus influenzae, Staphylococcus aureus, Klebsiella and Enterobacteria.
Another nosocomial pneumonia pathogens are influenza A and B viruses, parainfluenza, adenovirus, respiratory syncytial virus.
The most common pathogens of nosocomial pneumonia of an aggressive type, capable of generating epidemic outbreaks, are mycoplasma and legionella. At the same time, in the first case, adolescents and young people under 25 are most often ill. And legionella infection occurs through water, for example, in a public shower, pool, etc.
Methods of modern diagnostics
If a patient has community-acquired pneumonia, it is often diagnosed during a medical examination. In each clinical case, for the convenience of monitoring the patient's condition and symptoms of the disease, a separate card or medical history is created.
Step-by-step outpatient diagnostics looks like this:
Chest X-ray is a method of radiation diagnostics, which projects the state of the lungs in several planes in the pictures. In the presence of dark, dense spots, the diagnosis is confirmed. Diagnosis is shown twice: at the beginning of treatment and after antibiotic therapy
- Lab tests - the patient will need to donate blood for a general analysis and determination of the number of leukocytes, glucose and electrolytes.
- Microbiological tests - analysis of pleural fluid and staining of the lower respiratory tract is performed, the presence of antigens in the urine is determined.
The results of these diagnostic procedures are sufficient to make a final diagnosis and develop a treatment plan.
Advice on patient care
Clinical guidelines for the treatment of nosocomial pneumonia are to first prescribe a broad-spectrum antibiotic.
After receiving the results of the examinations, it is within the competence of the doctor to change the previously prescribed drug to a more effective one. The type of pathogenic microorganisms is taken as the basis.
Principles of therapy for patients with nosocomial pneumonia
Treatment of nosocomial pneumonia is the selection of the correct antibiotic, its regimen, method of administration and dosage. This is done only by the attending physician. Also an integral part of the therapy is the procedure of sanitation of the respiratory tract (removal of accumulated fluid).
The important point is that the patient is in a state of physical activity. Breathing exercises and small physical activity in the form of squats should be performed. Patients who are in serious condition are assisted by nurses. They are engaged in a regular change in the position of the patient, whichallows not to stagnate liquid in one place.
Prevent a recurrence of the disease will help prevent nosocomial pneumonia, which will be discussed in detail by the attending physician.
Antibacterial therapy
Treatment to fight bacteria is of two types: targeted and empirical. Initially, all patients receive empirical treatment, and directed treatment is prescribed after the identification of the causative agent of the disease.
The most important conditions for recovery are:
- Developing the right antibiotic treatment.
- Reducing the use of antimicrobials.
Only the attending physician can choose antibacterial medicines, as well as their dosage, self-substitution of drugs is unacceptable.
Prognosis for recovery
Depending on the correctness of the selected drugs, the severity of the disease and the general condition of the patient, the outcome of treatment may be as follows: recovery, slight improvement in the condition, ineffectiveness of therapy, relapse, death.
With nosocomial pneumonia, the likelihood of death is much higher than with community-acquired pneumonia.
Preventive measures
Prevention of nosocomial pneumonia is represented by a complex of medical and epidemiological measures:
- timely treatment of concomitant diseases;
- compliance with the rules and norms of hygiene;
- taking immunomodulating agents;
- vaccination.
Veryit is important to improve the patient's condition - to prevent relapse - to monitor compliance with simple rules: regular sanitation of the oral cavity, expectoration of accumulated fluid, physical activity.
