Chapter

Prevention of Hospital‐Acquired Pneumonia

Critical Care Department, University Rovira and Virgili, Pere Virgili Health Institute, Joan XXIII University Hospital, CIBER Enfermedades Respiratorias, Tarragona, Spain; Intensive Care Unit, Puerta del Mar University Hospital, University of Cádiz, Spain
DOI: 10.1002/9780470518274.ch2 In book: Nosocomial Pneumonia: Strategies for Management, pp.11 - 42
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    ABSTRACT: In the 1950s the scope of the infection problem in hospitals changed. The introduction and widespread use of chemotherapeutic and antibiotic agents resulted in profound changes in the character of infections and microorganisms that were encountered. Deaths from community-acquired infection with gram-positive pathogens such as S. pneumoniae, S. pyogenes and S. aureus became less common, while the proportion of deaths attributable to hospital-acquired infections with aerobic gram-negative bacilli (AGNB) became manifest. These so-called nosocomial infections became increasingly prevalent in that period, especially in patients whose severe underlying disease was ameliorated by improving medical therapy. Infections due to AGNB became a frequent cause of death in patients treated for leukaemia or non-Hodgkin lymphoma, renal transplantation patients and patients on mechanical ventilation. In the 1960s and 1970s the frequency of nosocomial infections continued to be a problem despite the introduction of new broad-spectrum antibiotics. It became evident that it was not hospitalisation in itself that predisposed patients to infection; rather, the hospitalised patient was an “altered host” with enhanced susceptibility to infection. Feingold [1], in 1970, described two main reasons for higher susceptibility to infection: conditions impairing cellular or humoral defence mechanisms against infection, such as leukopenia, defective function of leucocytes, Hodgkin’s disease and immunosuppressive therapy, and conditions compromising the mechanical defence barriers such as urinary and intravenous catheters, surgical wounds, burns and tracheostomy.
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