Microbial Etiologies of Hospital-Acquired Bacterial Pneumonia and Ventilator-Associated Bacterial Pneumonia

• Published in: Clinical infectious diseases Vol. 51; no. Supplement-1; pp. S81 - S87
• Main Author: Jones, Ronald N.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Oxford The University of Chicago Press 01.08.2010; University of Chicago Press; Oxford University Press
• Subjects: Acinetobacter; Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Antimicrobial agents; Antimicrobials; Bacteria - classification; Bacteria - drug effects; Bacteria - isolation & purification; Bacterial diseases; Bacterial diseases of the respiratory system; Bacterial pneumonia; Biological and medical sciences; Clinical trials; Cross Infection - drug therapy; Cross Infection - epidemiology; Cross Infection - microbiology; Drug resistance; Drug Resistance, Bacterial; Drugs; Enterobacter; Escherichia coli; Etiology; General aspects; Geography; Gram-negative bacilli; Gram-negative bacteria; Haemophilus influenzae; Hospitals; Human bacterial diseases; Human infectious diseases. Experimental studies and models; Humans; Incidence; Infectious diseases; Klebsiella; Medical sciences; Nosocomial infections; Pathogens; Patient surveillance; Pharmacology; Pneumonia; Pneumonia, Bacterial - drug therapy; Pneumonia, Bacterial - epidemiology; Pneumonia, Bacterial - microbiology; Pneumonia, Ventilator-Associated - drug therapy; Pneumonia, Ventilator-Associated - epidemiology; Pneumonia, Ventilator-Associated - microbiology; Pseudomonas aeruginosa; Reviews; Serratia; Staphylococcus aureus; Stenotrophomonas maltophilia; Ventilator associated pneumonia; Lung disease; Nosocomial infection; Artificial ventilation; Respiratory disease; Etiology; Bacterial pneumonia
• ISSN: 1058-4838; 1537-6591; 1537-6591
• DOI: 10.1086/653053

Hospital-acquired bacterial pneumonia (HABP) and ventilator-associated bacterial pneumonia (VABP) can be caused by a wide variety of bacteria that originate from the patient flora or the health care environment. We review the medical and microbiology literature and the results of the SENTRY Antimicrobial Surveillance Program (1997-2008) to establish the pathogens most likely to cause HABP or VABP. In all studies, a consistent 6 organisms (Staphylococcus aureus [28.0%], Pseudomonas aeruginosa [21.8%], Klebsiella species [9.8%], Escherichia coli [6.9%], Acinetobacter species [6.8%], and Enterobacter species [6.3%]) caused ∼80% of episodes, with lower prevalences of Serratia species, Stenotrophomonas maltophilia, and community-acquired pathogens, such as pneumococci and Haemophilus influenzae. Slight changes in the pathogen order were noted among geographic regions; Latin America had an increased incidence of nonfermentative gram-negative bacilli. In addition, VABP isolates of the same species had a mean of 5%-10% less susceptibility to frequently used extended-spectrum antimicrobials, and the rate of drug resistance among HABP and VABP pathogens has been increasing by 1% per year (2004-2008). In conclusion, the empirical treatment of HABP and VABP due to prevailing bacterial causes and emerging drug resistance has become more challenging and requires use of multidrug empirical treatment regimens for routine clinical practice. These facts have profound impact on the choices of comparison therapies to be applied in contemporary new drug clinical trials for pneumonia.