Nosocomial pneumonia in a neurological intensive care unit

Background and objecitve: Nosocomial pneumonia in patients in an intensive care unit (ICU) are a great problem as a cause of increased morbidity and m ortality as well as the resulting high cost of treatment. This study was ai med at determining the incidence of nosocomial pneumonia and the risk facto rs for its occurrence in patients with severe neurological disease. Patients and methods: Between 1.1, and 31.12.199, 217 patients (125 men, 92 women; average age 63.4 years) were prospectively included if they were tr eated for more than 48 hours in the ICU of the Neurology Department of Erla ngen University. The occurrence of nosocomial pneumonia (MP) was noted, usi ng the criteria of the Center of Disease Control and Prevention (CDC). Inci dence of the diseases was related to age, sex, initial state of consciousne ss, type of ventilation, duration of stay in the ICU and any associated med ical condition. Results: NP was diagnosed in 68 patients (31.4%). Statistically significant relative risks were male sex (2.4 fold, P < 0.01), clouded consciousness w ith a Glasgow coma score <8 (6.2 fold, P<0.001), mechanical ventilation (8. 4 fold, P<0.001), time in ICU greater than or equal to 8 days (9.3 fold, P< 0.001) and associated medical condition (3.3 fold, P< 0.005). In 17.7% of Eases no relevant pathogen was identified microbiologically. A mixed infect ion was present in 36.8% of cases. The most common Gram-positive organism w as Staph. aureus (35.3%), the most common Gram-negative ones were Ps. aerug inosa (25%), Kl. pneumoniae and Kl. oxytoca (11.8%), E. Coli (10.3%) and Ac inetobacter species (7.4%). There was also a high rate of infection or infe station with Candida albicans or glabrata (41.2%). NP played a clinically d ecisive role in the fatal course of 13 of the 47 patients who died. Conclusion: These data (incidence, relative risk) can, by taking into consi deration various aspects of specialist and hospital hygienic practices, con tribute to a continuing optimization of the prevention and treatment of dis ease.