Bacterièmia en la pneumònia nosocomial i pneumònia associada a ventilació mecànica en pacients traumàtics
Nosocomial pneumonia (NP) is the second most common nosocomial infection in hospitalized patients being ventilator-associated pneumonia (VAP), the leading nosocomial infection in Intensive Care Units (ICU) and represents over 80% of all episodes of NP. The frequency ranges of NP ranging between five...
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| Tipo de recurso: | tesis doctoral |
| Fecha de publicación: | 2013 |
| País: | España |
| Institución: | Universitat Autònoma de Barcelona |
| Repositorio: | Dipòsit Digital de Documents de la UAB |
| Idioma: | catalán |
| OAI Identifier: | oai:ddd.uab.cat:106889 |
| Acceso en línea: | https://ddd.uab.cat/record/106889 |
| Access Level: | acceso abierto |
| Palabra clave: | Bacterièmia Pneumònia Infeccions hospitalàries |
| Sumario: | Nosocomial pneumonia (NP) is the second most common nosocomial infection in hospitalized patients being ventilator-associated pneumonia (VAP), the leading nosocomial infection in Intensive Care Units (ICU) and represents over 80% of all episodes of NP. The frequency ranges of NP ranging between five and ten cases per 1,000 hospital admissions, and increases from 6 to 20 times in patients undergoing mechanical ventilation (MV). Due to the importance of pneumonia that requires VM with respect to the frequency, mortality and healthcare costs, medical literature is full of discussions about the methods to be used to diagnose pneumonia in ICU. However, there is a big difference between the importance of this entity and the limited information on actual practice. Given this lack of information in our field, we designed the study EU-PNEUMONIA Survey 2005 to examine prospectively the clinical diagnosis of all types of pneumonia requiring MV in a large sample from 27 ICUs of nine european countries in order to define the actual clinical practice of pneumonia in ventilated patients. The availability of epidemiological data, etiology, risk factors and outcomes of such a large sample of patients has allowed us to analyze and extract data from multiple subgroups that have specific characteristics that distinguish the group as a whole. Within this broad sample of patients diagnosed with pneumonia who require MV, there are two major subgroups of patients who have undergone multiple studies about the etiology, epidemiology, risk factors and mortality. These two subgroups, which are the objectives of this thesis and analysis are: bacteremic NP and VAP in trauma patients. Since in some UCIs blood cultures are not performed as a diagnostic protocol for patients suspected of NP and this information provides useful data on the epidemiological information on the causative pathogen of the NP and its resistance, a second analysis was conducted. On the other hand, a major cause of morbidity and mortality in industrialized countries are trauma patients. Many of them require admission to ICU and requiring MV. In trauma patients undergoing the MV, VAP is one of the major complications with an incidence of approximately 40 to 50%. Although, in recent decades several studies show that mortality of patients in the trauma VAP is 8% to 59%, in other recent studies we found that the VAP does not seem to increase mortality in trauma patients. The VAP in trauma patients differs from the VAP in patients non- trauma because it was not related to the days of MV and is frequently associated with specific pathogens. To examine differences in the etiology, risk factors and outcomes of this subgroup of patients was realize a second analysis of this multicenter cohort of VAP in trauma patients. The conclusions of both secondary analysis were: bacteremia is an independent risk factor associated with increased mortality in intubated patients with NP. Therefore, recognition of risk factors is important for good clinical practice. Our findings support the need for blood cultures in hospitalized patients with NP. The VAP is associated with lower mortality in trauma patients than in trauma patients. Given the high incidence of VAP in trauma patients, various prevention strategies should be directed to reduce its incidence. |
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