TIMING OF ONSET OF PNEUMONIA ASSOCIATED WITH PREVIOUS HOSPITALIZATION, DEPENDING ON MICROBIOLOGICAL PATHOGENS


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Abstract

Hospital-acquired pneumonia (HAP) is one of the most common complications in healthcare. PFS can be clinically manifested in patients after discharge from a medical organization. At the same time, there are no data on the peculiarities of the timing of the onset of pneumonia associated with previous hospitalization (PSAH) in the territory of the Tomsk region. 

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Relevance. Nosocomial pneumonia (HAP) is one of the most common complications that occur in the provision of medical care [1]. PFS worsens the clinical prognosis, increases the length of stay of patients, increases the financial costs of treatment due to the fact that they are often associated with resistant microorganisms that are difficult to treat [2]. PFS can be clinically manifested in patients after discharge from a medical organization. At the same time, there are no data on the spectrum of pathogens and features of the timing of the onset of pneumonia associated with previous hospitalization (IPS) in the Tomsk region. The purpose of the study. To study the timing of the occurrence of HSV depending on the etiological agent in the Tomsk region. Material and methods. A retrospective epidemiological study based on two multidisciplinary hospitals in the Tomsk region, during which an analysis of 59 cases of HSV was performed. The study included patients with documentary confirmation of the diagnosis of "Pneumonia", the fact of previous hospitalization within the last 90 days, as well as a verified microorganism. The isolation of strains from bronchoalveolar lavage > 104 CFU/ml, from sputum ≥ 105 CFU/ml was considered etiologically significant. The isolated strains were taken into account in the WHONET and AMRcloud microbiological monitoring programs. Statistical data processing was carried out using Microsoft Office Excel, Statistica 10 software. For quantitative variables, descriptive statistics methods were used: calculation of the mean value, standard error of the mean. Results. HSVH developed in patients on average 11.3±1.8 days after discharge from the previous hospital. In 68% of cases, pneumonia was registered up to 10 days after discharge. In 19% of cases, pneumonia manifested itself from 11 to 20 days, in 13% of cases on 21 days or more after the previous hospitalization. A total of 81 strains of microorganisms were identified in the study. Common etiological agents of HSVH occurring up to 10 days after discharge from a previous hospital were K. pneumoniae (n=22; 52%), K. oxytoca (n=10; 24%) and P. aeroginosa (n=7; 17% ). Pneumonia, manifested from 11 to 20 days after discharge, differed in microbiological diversity. The etiological structure included Acinetobacter sp, E. coli, P. aeroginosa, S. aureus, and S. haemolyticus. Moreover, in most cases, these HSVH were associated with K. oxytoca (n=44; 33%) and K. pneumoniae (n=3; 25%). In the later stages of the development of HSVH from 21 days after discharge from the previous hospital, K. pneumoniae (n=4; 40%), K. oxytoca (n=2; 20%) and P. aeroginosa (n=2; 20%) prevailed. ).The average number of bed-days spent by patients with HSV associated with P. aeroginosa was 18.2 ± 4.2. The average duration of hospitalization of patients with HSV associated with K. pneumoniae was 18.4±2.4 bed-days. While patients with HSV caused by K. oxytoca were in a medical organization for an average of 10.4 ± 0.8 bed-days. Conclusions. HSV most commonly developed in patients within 10 days of discharge from a previous hospital. The spectrum of pathogens causing HSV in the early (up to 10 days) and late periods (more than 20 days) after discharge was identical, which should probably be taken into account when stratifying patients depending on the risk of semi-resistant pathogens.

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About the authors

Daria Yuryevna Perfileva

Siberian State Medical University

Author for correspondence.
Email: daria.perfileva@mail.ru
ORCID iD: 0000-0002-1168-7405
SPIN-code: 6217-4710
Russian Federation, 2, Moscow tract, Tomsk, 634050, Russia

References

  1. Global report on infection prevention and control. World Health Organization. 2022.
  2. Afsharipour M., Mahmoudi S., Raji H. et al. Three-year evaluation of the nosocomial infections in pediatrics: bacterial and fungal profile and antimicrobial resistance pattern // Annals of Clinical Microbiology and Antimicrobials. 2022; 21(1):6. https://doi.org/10.1186/s12941-022-00496-5.

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