Abstract
Background
In addition to controversies as to the definition of nosocomial pneumonia (NP) because
of the lack of a widely accepted diagnostic standard, there has been no agreement
concerning the time span from hospital admission to disease onset. This study aims
at both estimating the time span, in hours, from admission to the occurrence of suspected
NP and investigating risk factors that might influence this time span.
Methods
This is a cohort study, and subjects were patients with nosocomial infection acquired
in the intensive care unit of Edgard Santos University Hospital (HUPES/ICU) in Salvador,
Brazil, from January 1995 to December 1997. Patients were observed from admission
to 48 hours after discharge from the intensive care unit. The time span from admission
to occurrence of suspected NP, the reason for admission, patient's origin, history
of surgery, general anesthesia, mechanical ventilation, and use of antibiotic were
analyzed and given a multivariate analysis using Cox regression model.
Results
Among 246 patients with nosocomial infection, 198 (80.5%) were suspected cases of
NP, whereas 48 patients (19.5%) were not classified as such. The mean time, in hours,
for the NP-free time span was 85.1 ± 3.5 hours, and the median time was 72 hours when
estimated by Kaplan-Meier method. Patients admitted from surgical heart procedures
who had been given general anesthesia, mechanical ventilation, and antibiotics showed
statistically significant shorter mean time spans from admission to NP occurrence
when compared with the other patients. Age ≥50 years, use of mechanical ventilation,
and use of antibiotics were associated with NP.
Conclusions
Our finding for the estimated mean NP-free time span at the HUPES/ICU is somewhat
in accordance with the literature (48 to 72 hours). Patients at HUPES/ICU might be
considered as showing early NP, because they were diagnosed before the 5th day after
admission. Preventive measures to NP should be reviewed and intensified at the HUPES/ICU,
especially as related to mechanical ventilation.
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Article info
Publication history
Canela Salvador, Brazil
Identification
Copyright
© 2004 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
