NOSOCOMIAL PNEUMONIA ON GENERAL MEDICAL AND SURGICAL WARDS IN A TERTIARY-CARE HOSPITAL

OBJECTIVE: To describe the demographic, clinical, and microbiologic ch aracteristics of patients who develop nosocomial pneumonia on general medical and surgical wards of a tertiary-care hospital. DESIGN: A 1-ye ar, prospective, descriptive study. SETTING: A 1,100-bed, tertiary-car e, urban hospital. POPULATION: Patients experiencing nosocomial pneumo nia were identified through surveillance on general medical and surgic al wards, using a standard case definition. RESULTS: 92 pneumonias in 85 patients on general wards were identified. The mean age of patients was 63+/-17 years, 55 patients (65%) were male, and 75 cases of pneum onia (81%) were acquired on surgical wards. Bacteremia was identified in 8 (13% of 62 episodes, and 48 (52%) grew potential pathogens from r espiratory specimens. Twenty-six patients (28%) required transfer to t he intensive-care unit (ICU), and 20 (22%) received mechanical ventila tion. By multivariate analysis, patients with a thoracic surgical proc edure or with Staphylococcus aureus isolated from respiratory secretio ns were more likely to require ICU admission. The overall mortality ra te was 20% (17/85), with a directly associated mortality of 14% (12/85 ). Patients who died were older, more frequently resided on a medical ward, and had a greater mean number of comorbidities. These patients o ften were treated nonaggressively and were not considered candidates f or ICU admission due to advanced age and poor underlying clinical stat us. CONCLUSIONS: Although the morbidity of nosocomial pneumonia in thi s population was high, as evidenced by high rates of transfer to ICU, the directly associated mortality was relatively low. Those requiring ICU admission require further study to identify preventive measures th at could decrease the morbidity in this group. Interventions to preven t pneumonia or to improve prognosis may not be feasible for the majori ty of these patients who die from nosocomial pneumonia (Infect Control Hosp Epidemiol 1997;18:749-756).