• Journal of Korean Public Health Nursing
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• v.15 no.2
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• pp.239-248
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• 2001

The purpose of this study was to analyze risk factors for nosocomial pneumonia in patients admitted to NS ICU, and to provide a basic data to decrease respiratory nosocomial infection rate engendered from medical environments in NS ICU. The study site was the NS ICU at a university hospital located in Seoul, Korea. The subjects were 31 patients diagnosed with nosocomial pneumonia, who were selected from the initial list of 300 potential subjects who had been a) admitted between September 1999 and January 2000, and September 2000 and January 2001, b) resided at the NS ICU over 72 hours. The diagnostic standard of nosocomial pneumonia was based on the nosocomial infection guides of C university hospital. The data were analyzed using frequencies and logistic regression analysis. The sputums obtained from the subjects were cultivated and causal viruses were separated. The results were as follows: 1. The nosocomial pneumonia rate was $10.3\%$. There were 7 types of causal viruses separated from the sputum. and the most prevalent type of virus was MRSA as $62.2\%$. 2. The factors significantly influencing the incidence of nosocomial pneumonia included age, the residential duration at the NS ICU, GCS scores, diabetes mellitus, insertion of tracheal tube and its duration, tracheostomy and its length of insertion, the use of artificial ventilator and the length of its use, and the insertion of naso-gastic tube. The most significant risk factor among these was the insertion of tracheal tube (odds ratio=18.684. $95\%$ CI=6.849-50.974), followed by the use of tracheostomy (odds ratio=15.419, $95\%$ CI=6.615-35.942), the insertion of naso-gastric tube (odds ratio=14.875, $95\%$ CI=6.396-34.595), and the use of artificial ventilator (odds ratio=13.000. $95\%$ CI=5.633­30.001). 3. Regarding the use of the mechanical aids, the insertion of tracheal tube resulted in 12.968 times increase of the nosocomial pneumonia rate, and the use of artificial ventilator lead 6.714 times increase of the nosocomial pneumonia rate. One point increase of the GCS score resulted in the 1.210 times increase of the nosocomial pneumonia rate. For patients who had tracheal tube, tracheostomy, and artificial ventilator, one day increase of their residential duration at NS ICU lead 1.073 times increase of the nosocomial pneumonia rate. 4. In terms of duration of the mechanical aid usage, one day increase in the use of artificial ventilator engendered 1.080 times increase in the nosocomial pneumonia rate. One day increase of the residential duration at the NS ICU lead 1.604 times increase in the nosocomial pneumonia rate. As one point of the GCS score increased, 0.876 times decrease of the nosocomial pneumonia rate was reported. These study findings show that the risk factors significantly influencing the incidence of nosocomial pneumonia include the use of tracheal tube, tracheostomy, naso-gastic tube, and artificial ventilator. It is recommended that nurses working at NS ICU should pay more attention to the patients with these factors as the risky group for the nosocomial pneumonia, and thus make more active efforts to provide nosocomial pneumonia prevention strategies for them. In further studies patients admitted to the different types of ICUs such as internal medicine or surgery unit ICU will be also included, and more wide investigation of nosocomial pneumonia risk factors will be conducted through one-year longitudinal follow up.

• Korean Journal of Clinical Pharmacy
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• v.26 no.1
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• pp.46-52
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• 2016

Background: The use of acid suppressive agents became a standard therapy in an intensive care unit (ICU) to prevent stress related gastrointestinal mucosal damage. However, the risk of infectious diseases has been concerned. Objective: The study was to determine the differences between histamine 2 receptor antagonists (H2RA) and proton pump inhibitors (PPI) in incidence of nosocomial pneumonia and pseudomembranous colitis (PMC) by Clostridium difficile with patients in ICU. Methods: This is a retrospective comparative study including patients admitted to the ICU who were at least 18 years of age and stayed for more than 48hrs from August 1, 2014 to January 31, 2015. The propensity score analysis and propensity matched multivariable logistic regression were used in analyzing data to control for confounders. Results: A total of 155 patients were assessed. H2RA were prescribed in 110 (53.9%) and PPI were in 45 (22.1%). Nosocomial pneumonia developed in 37 (23.9%); 25 (22.7%) were on H2RA and 12 (26.7%) were on PPI. The unadjusted incidence of nosocomial pneumonia was slightly higher in the patients with PPI (odds ratio (OR) 1.24; 95% confidence interval (CI): 0.54-2.71) compared to them with H2A. After adjusting with propensity score, the adjusted OR with PPI was 1.35 (95% CI: 0.44-4.11). The propensity score matched analyses showed similar results. Conclusion: The uses of PPI and H2RA as a stress ulcer prophylaxis agent showed similarity in the incidence of nosocomial pneumonia and PMC.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.7
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• pp.3071-3074
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• 2014

Background: To investigate the related risk factors of postoperative nosocomial pneumonia (POP) in patients withI-IIIa lung cancer. Methods: Medical records of 511 patients who underwent resection for lung cancer between January 2012 to December 2012 were retrospectively reviewed. Risk factors of postoperative pneumonia were identified and evaluated by univariate and multivariate analyses. Results: The incidence of postoperative pneumonia in these lung cancer patients was 2.9% (15 cases). Compared with 496 patients who had no pneumonia infection after operation, older age (>60), histopathological type of squamous cell carcinoma and longer surgery time (>3h) were significant risk factors by univariate analysis. Other potential risk factors such as alcohol consumption, history of smoking, hypersensitivity, hypertension, diabetes mellitus and so on were not showed such significance in this study. Further, the multivariate analysis revealed that old age (>60 years) (OR 5.813, p=0.018) and histopathological type of squamous cell carcinoma (OR 5.831, p<0.001) were also statistically significant independent risk factors for postoperative pneumonia. Conclusions: This study demonstrated that being old aged (>60 years) and having squamous cell carcinoma histopathological type might be important factors in determining the risk of postoperative pneumonia in lung cancer patients after surgery.

• Tuberculosis and Respiratory Diseases
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• v.44 no.1
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• pp.114-123
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• 1997

Background : To assess the diagnostic role of bronchoscopic lavage for the evaluation of pneumonia in intensive care unit(ICU), the results were compared to blind endobronchial specimen. Method : From September 1993 to August 1996, twenty-eight ICU patients suspected pneumonia on the basis of clinical evidence and performed bronchoscopy under the diagnostic or therapeutic purpose were studied retrospectively for the clinical findings including culture of bronchoscopic and blind endobronchial specimen. Bronchoscopic specimen was got through small amount of bronchoalveolar lavage with 20-40ml saline, one or two times on the suspected site. Results : l. Main reasons of ICU admission were respiratory and impending respiratory failure Nosocomial pneumonia was most common with 16 cases; each for community acquired and immunocompromised type with 6 cases. Diagnostic purpose of bronchoscopy was performed in 20 cases as 71 percent in total, whereas therapeutic removal of secretion in 8 cases. The complication during bronchoscopic evaluation was trivial. 2. The agreement between blind endobronchial and bronchoscopic specimen on microbial culture was only 39.3 percent. However, 2 cases each for aspergillosis and tuberculosis were diagnosed under bronchoscopic evaluation. 3 The application of mechanical ventilation occured significantly frequently in multidrug resistant pneumonia compared with other pneumonia in terms of bronchoscopic specimen. 4. The application of mechanical ventilation was significantly common in nosocomial pneurmonia compared with other types of pneumonia. Conclusion : The selective bronchoalveolar lavage and therapeutic removal of bronchial secretion with bronchoscopy in ICU patient accompanying pneumonia is a very useful tool with safety. The multidrug resistant pneumonia or nosocomial pneumonia could be closely associated with the use of mechanical ventilation.

• Genomics & Informatics
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• v.21 no.3
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• pp.34.1-34.10
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• 2023

Nosocomial infections, commonly referred to as healthcare-associated infections, are illnesses that patients get while hospitalized and are typically either not yet manifest or may develop. One of the most prevalent nosocomial diseases in hospitalized patients is pneumonia, among the leading causes of mortality and morbidity. Viral, bacterial, and fungal pathogens cause pneumonia. More severe introductions commonly included Staphylococcus aureus, which is at the top of bacterial infections, per World Health Organization reports. The staphylococci, S. aureus, strain RMI-014804, mesophile, on-sporulating, and non-motile bacterium, was isolated from the sputum of a pulmonary patient in Pakistan. Many characteristics of S. aureus strain RMI-014804 have been revealed in this paper, with complete genome sequence and annotation. Our findings indicate that the genome is a single circular 2.82 Mbp long genome with 1,962 protein-coding genes, 15 rRNA, 49 tRNA, 62 pseudogenes, and a GC content of 28.76%. As a result of this genome sequencing analysis, researchers will fully understand the genetic and molecular basis of the virulence of the S. aureus bacteria, which could help prevent the spread of nosocomial infections like pneumonia. Genome analysis of this strain was necessary to identify the specific genes and molecular mechanisms that contribute to its pathogenicity, antibiotic resistance, and genetic diversity, allowing for a more in-depth investigation of its pathogenesis to develop new treatments and preventive measures against infections caused by this bacterium.

• Tuberculosis and Respiratory Diseases
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• v.61 no.1
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• pp.13-19
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• 2006

Background: Acinetobacter baumannii has emerged as an important nosocomial pathogen worldwide. The incidence of these infections has recently begun to increase. The mortality rate associated with these infections is high (bacteremia; 52%, pneumonia: 23%~73%) and multidrug resistance has been reported. For the effective control of multidrug-resistant Acinetobacter baumannii(MDR-AB), the impact of these organisms in clinical practice should be determined. This study compared the clinical characteristics, mortality and morbidity of Acinetobacter nosocomial pneumonia between MDR strain and non-MDR strain. Methods: From Jan. 1, 2002 to Nov. 1. 2004, 47 adult patients with Acinetobacter nosocomial pneumonia in Chuncheon Sacred Heart Hospital were recruited and analyzed retrospectively. MDR-AB was defined as showing in vitro resistance to all commercially available antibiotics against A. baumannii. Results: There were 47 patients with Acinetobacter nosocomial pneumonia. MDR-AB and non MDR-AB was the cause of the pneumonia in 17 and 30 patients, respectively. Mean age of the former was $69{\pm}11$ years old and the latter was $70{\pm}13$ years old. The mean APCHE II score, ICU days and mortality were not different between the two groups ($16.1{\pm}5.4$ vs. $14.9{\pm}4.8$, P=0.43, $25.1{\pm}13.6$ vs. $39.1{\pm}31.0$, P=0.2, 58.8% vs. 40%, P=0.21). Conclusion: There are no significant differences in mortality and morbidity between MDR and non-MDR Acinetobacter baumannii. The mortality of the two groups is surprisingly high, therefore proper infection control practices are essential.

• Tuberculosis and Respiratory Diseases
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• v.64 no.2
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• pp.102-108
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• 2008

Background: Recently, multidrug-resistant (MDR) A. baumannii has been implicated for a significant proportion of nosocominal pneumonia in many intensive care units (ICUs), and its acquisition may increase mortality and the length of stay in the ICU. Aerosolized colistin has been successfully used in patients with cystic fibrosis, but there is a lack of data regarding the use of aerosolized colistin in patients with nosocomial pneumonia. Methods: We conducted the present study to assess the effectiveness of aerosolized colistin for the treatment of MDR A. baumannii nosocomial pneumonia. We retrospectively reviewed the medical records of 10 patients who had been hospitalized in the medical ICU and had received aerosolized colistin as a therapy for MDR A. baumannii pneumonia. Results: The mean duration of aerosolized colistin therapy was $12.7{\pm}2.4$ days. Nine (90%) of 10 patients showed a favorable response to the therapy. Follow-up cultures were available for all patients, and the responsible pathogen was completely eradicated. One patient suffered from bronchospasm, which resolved after treatment with nebulized salbutamol. Conclusion: Our results corroborate previous reports that aerosolized colistin may be an effective and safe choice for the treatment of nosocomial pneumonia caused by MDR A. baumannii. Larger prospective controlled clinical studies are warranted to validate further the effectiveness and safety of aerosolized colistin therapy.

• Journal of Korean Neurosurgical Society
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• v.48 no.2
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• pp.99-104
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• 2010

Objective : We conducted this study to evaluate the clinical impact of early enteral nutrition (EN) on in-hospital mortality and outcome in patients with critical hypertensive intracerebral hemorrhage (ICH). Methods : We retrospectively analyzed 123 ICH patients with Glasgow Coma Scale (GCS) score of 3-12. We divided the subjects into two groups : early EN group (< 48 hours, n = 89) and delayed EN group ($\geq$ 48 hours, n = 34). Body weight, total intake and output, serum albumin, Creactive protein, infectious complications, morbidity at discharge and in-hospital mortality were compared with statistical analysis. Results : The incidence of nosocomial pneumonia and length of intensive care unit stay were significantly lower in the early EN group than in the delayed EN group (p < 0.05). In-hospital mortality was less in the early EN group than in the delayed EN group (10.1% vs. 35.3%, respectively; p = 0.001). By multivariate analysis, early EN [odds ratio (OR) 0.229, 95% CI : 0.066-0.793], nosocomial pneumonia (OR = 5.381, 95% CI : 1.621-17.865) and initial GCS score (OR = 1.482 95% CI : 1.160-1.893) were independent predictors of in-hospital mortality in patients with critical hypertensive ICH. Conclusion : These findings indicate that early EN is an important predictor of outcome in patients with critical hypertensive ICH.

• Journal of Chest Surgery
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• v.18 no.4
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• pp.740-745
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• 1985

A retrospective double blind study comparing 7 day with 2 day regimen of antibiotic prophylaxis was conducted among 200 patients undergoing open heart surgery. No case of endocarditis and wound infection occurred. Pneumonia developed in 5 cases of the 7 day and 1 case of the 2 day group. Urinary tract infection without clinical significance developed in 1 case of the 7 day and 3 cases of the 2 day group. Bacteremia developed in 2 cases of the 7 day and 1 case of the 2 day group. We concluded as follows: l. Administration of antibiotics for 2 days appears to be without substantial risk of infection comparing long term 7 day regimen. 2. 7 days of antibiotics may actually increase the risk of serious infection such as nosocomial pneumonia, and predispose to the development of infections with fungi or antibiotic resistant bacteria. 3. 2 days of prophylaxis is more beneficial than long term 7 day regimen for example economically.

• Pediatric Infection and Vaccine
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• v.16 no.1
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• pp.1-5
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• 2009

Methicillin-resistant Staphylococcus aureus (MRSA), a leading cause of nosocomial infections, has been increasingly recognized in communities of the United States. This article will review the clinical spectrum and treatment of MRSA infections in children in the context of recent epidemiological changes of MRSA infections. In general, community-associated (CA) MRSA most frequently causes skin and soft tissue infections and has an increased association with invasive infections, particularly pneumonia and musculoskeletal infections. Hospital-associated (HA) MRSA strains tend to be associated with bloodstream infections, pneumonia, and surgical site infections. Different from the United States, CA-MRSA infections are not common in Korea (only 5.9%); however, there are some CA-MRSA clones that are different from HA-MRSA clones in Korea and from CA-MRSA clones in other countries. The treatment of MRSA infections should be guided by antimicrobial susceptibility testing, the site of infection, and the infection severity. Vancomycin is the treatment of choice for invasive MRSA infections. Other agents such as trimethoprim-sulfamethoxazole, clindamycin, linezolid, quinupristin-dalfopristin, and daptomycin have been used for some conditions.