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Nosocomial Pneumonia in a Canadian Tertiary Center: A Prospective Surveillance Study

Published online by Cambridge University Press:  21 March 2023

M. Louie ,
B. Dyck ,
S. Parker ,
L. Sekla  and
L.E. Nicolle
M. Louie
Affiliation:
Departments of Medical Microbiology, Winnipeg, Manitoba Internal Medicine, Winnipeg, Manitoba
B. Dyck
Affiliation:
The University of Manitoba, Health Sciences Centre, Winnipeg, Manitoba
S. Parker
Affiliation:
Departments of Medical Microbiology, Winnipeg, Manitoba The University of Manitoba, Health Sciences Centre, Winnipeg, Manitoba
L. Sekla
Affiliation:
Cadham Provincial Laboratory, Winnipeg, Manitoba
L.E. Nicolle*
Affiliation:
Departments of Medical Microbiology, Winnipeg, Manitoba Internal Medicine, Winnipeg, Manitoba
*
Infection Control Unit, MS675D, Health Sciences Centre, 820 Sherbrook Street, Winnipeg, Manitoba, Canada U3A 1R9.
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Abstract

Objective:

To determine the contribution of etiologic agents, including Legionella pneumophila and respiratory viruses to nosocomial pneumonia at a tertiary care center.

Design:

Prospective surveillance of nosocomial pneumonia with standardized laboratory investigations.

Setting:

A 1,100-bed tertiary care center.

Patients:

All adult inpatients.

Results:

One hundred and thirty-five Nosocomial pneumonias (5.7/1,000 discharges) were identified. Four (3.0%) were L pneumophila sero-group 1 infections (0.17/1,000 discharges). LegionelIosis occurred in non-high-risk patients, and three cases would not have been identified without active surveillance. viral seroconversion was identified in seven (19%) of 36 cases with specimens available (0.59/1,000 discharges): five influenza B, one influenza A, and one respiratory syncytial virus. IgM serology was positive in one case each for Mycoplasma pneumoniae and Chlamydia species. No geographical clustering was observed for viral infections, and these would not have been identified without active surveillance. Mortality for all nosocomial pneumonia was 25%. Patient factors significantly associated with a poorer outcome included older age, underlying disease, low serum albumin, renal insufficiency, lower platelet count, endotracheal intubation, respiratory failure, bacteremia, and use of antacids.

Conclusions:

This prospective surveillance suggested that L pneumophila and viral agents were uncommon causes of nosocomial pneumonia at our institution during this surveillance period.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 12 , Issue 6 , June 1991 , pp. 356 - 363
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1991

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References

1. Graybill, JR, Marshall, LW, Charache, P, Wallace, CK, Melvin, VB. Nosocomial pneumonia: a continuing major problem. Am Rev Respir Dis. 1973;108:1130–1140.Google ScholarPubMed
2. LaForce, FM. Hospital acquired gram-negative rod pneumonias: an overview . Am J Med. 1981;70:707–711.CrossRefGoogle ScholarPubMed
3. England, AC III Frazer, DW. Sporadic and epidemic nosocomial legionellosis in the United States. Epidemiologic features. Am J Med. 1981;70:707–711.CrossRefGoogle ScholarPubMed
4. Kirby, BD, Harria, AA. Nosocomial legionnaires' disease. Semin Respir Infect. 1987;2:255–261.Google ScholarPubMed
5. Kovick, ZA, Yu, VL, Fang, G. Legionella species as hospital-acquired respiratory pathogens. Semin Respir Infect. 1987;2:34–47.Google Scholar
6. Bartlett, JG, O'Keefe, P, Tally, FP, Louie, TJ, Gorbach, SL. Bacteriology of hospital-acquired pneumonia. Arch Intern Med. 1986;146:868–871.CrossRefGoogle ScholarPubMed
7. Gross, PA. Epidemiology of hospital-acquired pneumonia. Semin Respir Infect. 1987;2:2–7.Google ScholarPubMed
8. LeSaux, NM, Sekla, L, McLeod, J, Parker, S, Rush, D, Jeffrey, JR, Brunham, RC. Epidemic of nosocomial legionnaires' disease in renal transplant recipients: a case-control and environmental study. Canadian Medical Association journal. 1989;140:1047–1053.Google Scholar
9. Celis, R, Torres, A, Gatell, JM, Almela, M, Rodriguez-Raisin, R, Agusti-Vidal, . A nosocomial pneumonia: a multivariate analysis of risk and prognosis. Chest. 1988;93:318–324.CrossRefGoogle ScholarPubMed
10. Tafuro, P, Diagamon-Belran, M, Cunha, BA. Approach to hospital-acquired pneumonias. Heart Lung, 1984;13:482–485.Google ScholarPubMed
11. Bartlett, JG, Ryan, KJ, Smith, TF, Wilson, PM. In: Washington, JA III. ed. Laboratory Diagnosis of Lower Respiratory Tract Infections. Washington, DC: American Society for Microbiology; 1987.Google Scholar
12. Lennett, EH. Balows, A Hausler, WI. Shadomy, HI. eds. Manual of Clinical Microbiology. 4th ed. Washington, DC: American Society for Microbiology; 1985.Google Scholar
13. Wadowsky, R, Yee, R. Glycinecontaining selective medium for isolation of Legionellaeae from environmental specimens. Appl Environ Microb. 1981;42:768–772.CrossRefGoogle ScholarPubMed
14. Joly, J, McKinney, RM, Tobin, JO, Bibb, WF, Watkins, ID. Development of a standard subgrouping scheme for Legionella pneumophila serogroup 1 using monocloned antibodies.] Clin Microbiol. 1986;23:768–771.CrossRefGoogle Scholar
15. Demers, RR, Irwin, RS. Oxygen therapy. In: Rippe, JM, Csete, ME, eds. Manual of Intensive Care Medicine. 1st ed. Boston, Mass: Little, Brown id Company; 1984:133.Google Scholar
16. Armitage, P. Statistical Methods in Medical Research. Oxford. London: Blackwell Scientific Publications; 1971.Google Scholar
17. Haley, RW, Culver, DH, White, JN, et al. The Nationwide Nosocomial Infection Rate: a new need for vital statistics. Am J Epidemiol. 1985;121:159–157.CrossRefGoogle ScholarPubMed
18. Hughes, JM, Culver, DH, White, JW, et al. Nosocomial infections surveillance, 1980-1982. MMWR. 1983;32:1–16.Google Scholar
19. Leu, HS, Kaiser, DL, Mori, M, Woolson, RF, Wenzel, RP. Hospital-acquired pneumonia: attributable mortality and morbidity. Am J Epidemiol. 1989;129:1258–1267.CrossRefGoogle ScholarPubMed
20. Pennington, JE. Hospital acquired pneumonia. In: Wenzel, RP, ed. Prevention and Control of Nosocomial Infections. Baltimore, MD: Williams and Wilkins; 1987:321–334.Google Scholar
21. Garibaldi, RA, Britt, MR, Coleman, ML. Reading, JC. Pace, NL. Risk factors for postoperative pneumonia. Am J Med. 1481;70:677–680.CrossRefGoogle Scholar
22. Paler, DL. Microbiology of pneumonia in the patient at risk. Am J Med. 1984;76(suppl):53–60.CrossRefGoogle Scholar
23. Winterbamer, RH, Dreis, DE New diagnostic approaches to the hospitalized patient with pneumonia. Semin Respir Infect. 1987;2:57–66.Google Scholar
24. Yu, VL, Kroboth, FJ, Shonnard, J, Brown, A, McDearman, S, Magnussan, M. Legionnaires' disease: new clinical perspective from a prospective pneumonia study. Am J Med. 1982;73:357–361.CrossRefGoogle ScholarPubMed
25. Johnson, JT, Yu, VL, Best, MG, et al. Nosocomial legionellosis in surgical patients with head and neck cancer: implications for epidemiological reservoir and mode of transmission. Lancet. 1985;ii:298–299.CrossRefGoogle Scholar
26. Muder, RR, Yu, VL, McClure, JK, Kroboth, FJ, Kominos, SD, Lumish, RM. Nosocomial legionnaire's disease uncovered in a prospective pneumonia study: implications for underdiagnosis. JAMA. 1983;249:3184–3188.CrossRefGoogle Scholar
27. Rudin, JE, Wing, EJ. Prospective study of pneumonia: unexpected incidence of leeionellosis. South Med J. 1986;79:417–419.CrossRefGoogle Scholar
28. Monforte, R, Estruch, R, Vidal, J, Cervera, R, ‘Urbano-Marquez, A. Delayed seroconversion in legionnaires' disease. Lancet. 1988;ii:513.CrossRefGoogle Scholar
29. Ruf, B, Szhurmann, D, Horbach, I, Fehrenbach, FJ, Pohle, HD. The incidence of legionella pneumonia: a l-year prospective study in a large community hospital. Lung. 1989;167:11–22.CrossRefGoogle Scholar
30. Bollin, GE. Plouffe, JF. Para, ME. Prior, RB. Difference in virulence of environmental isolates of Legionella pneumophila . J Clin Microbiol. 1985;21:674–677.CrossRefGoogle ScholarPubMed
31. Hall, CB. Hospital-acquired pneumonia in children: the role of respiratory viruses. Semin Respir Infect. 1987;2:48–56.Google ScholarPubMed
32. Kapila, R, Lintz, DI, Tecson, FT, Ziskin, L, Louis, DB. A nosocomial outbreak of influenza A. Chest. 1977;71:576–579.CrossRefGoogle ScholarPubMed
33. Kimball, NM, Foy, HM, Cooney, MK, Allan, ID, Matlock, M, Plourde, JJ. Isolation of respiratory syncytial and influenza viruses from the sputum of patients hospitalized with pneumonia. J Infect Dis. 1983;147:181–184.CrossRefGoogle ScholarPubMed
34. Glezen, WP. Viral pneumonia as a cause and result of hospitalization. J Infect Dis. 1983;147:765–770.CrossRefGoogle ScholarPubMed
35. Weingartan, S, Friedlander, M, Rascon, D, Ault, M, Morgan, M, Meyer, RD. Influenza surveillance in an acute care hospital. Arch Intern Med. 1988;148:113–116.CrossRefGoogle Scholar
36. Grayston, JT, Diwan, VK, Cooney, M, Wang, S. Community and hospital acauired uneumonia associated with Chlamydia TWAR infection demonstrated serologically. Arch Intern Med. 1989;149:169–173.CrossRefGoogle Scholar
37. Muraca, PN, Yu, VL, Goetz, A. Disinfection of water distribution systems for legionella: a review of application, procedures, and methodologies. Infect Control Hosp Epidemiol. 1990;11:79–88.CrossRefGoogle ScholarPubMed