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The Rise of Drug-Resistant Bacteria: Why Hospital-Infected Pneumonia Becomes a Deadly Threat?
Hospital-acquired pneumonia (HAP) refers to pneumonia that patients contract within at least 48 to 72 hours after being admitted to the hospital. This condition is usually caused by a bacterial infection and is distinguished from community-acquired pneumonia (CAP). According to statistics, nosocomial pneumonia is the second most common nosocomial infection, second only to urinary tract infections, accounting for 15% to 20% of all nosocomial infections. This type of infection is one of the main causes of death in the intensive care unit (ICU).
“Nosocomial pneumonia is the most common cause of death in hospitals and one of the most common nosocomial infections in children worldwide.”
Signs and symptoms of hospital-acquired pneumonia
Patients with nosocomial pneumonia usually present with progressive pulmonary infiltrates, accompanied by the following symptoms:
- Temperature above 37.8°C (100°F)
- Pusulum
- Leukocytosis (more than 10,000 cells/μl)
Particularly in older patients, the first signs may not be typical respiratory symptoms but psychological changes or confusion. Other possible symptoms include:
- Cough with green or pus-like sputum
- High fever and chills
- General discomfort or weakness
- Loss of appetite
- Nausea and Vomiting
- Chest pain worsens when taking deep breaths or coughing
- Difficulty breathing
- Reduced blood pressure and increased heartbeat
Types of pneumonia
Nosocomial pneumonia is mainly caused by bacteria, with most cases associated with various rod-shaped Gram-negative bacteria (52%) and Staphylococcus aureus (19%), especially methicillin-resistant Staphylococcus aureus (MRSA) type. In addition, pneumonia caused by viruses including influenza virus and respiratory syncytial virus accounts for about 10% to 20%.
Ventilator-associated pneumonia
Ventilator-associated pneumonia (VAP) is a special type of nosocomial pneumonia that mainly occurs in patients receiving mechanical ventilation. The diagnosis of VAP needs to be based on positive culture results after intubation.
“Because patients are often immunocompromised, the risk of ventilator-associated pneumonia is significantly increased.”
Healthcare-associated pneumonia
Patients with Healthcare-associated pneumonia (HCAP) often come from the community but have frequent contact with healthcare settings. This type of pneumonia generally has a poor prognosis and a higher proportion of multidrug-resistant pathogens. Although HCAP was once considered a separate clinical entity, new research shows that not all HCAP patients are at high risk.
Causes of hospital-acquired pneumonia
Pneumonia usually results from a patient's microaspiration or macroaspiration (e.g., gastric fluid). Although Gram-negative bacilli are common pathogens and are present in very small numbers in normal human respiratory tracts in the absence of pneumonia, this has led to the speculation of oral and throat infection routes.
“The hospital environment is often filled with multidrug-resistant pathogenic bacteria, making the treatment of pneumonia more difficult.”
Diagnosis and treatment
The diagnosis of nosocomial pneumonia is usually determined based on clinical manifestations and imaging examinations combined with medical history. Suspected cases of pneumonia require microbiological testing of sputum or tracheal aspirates. Depending on the causative agent, empiric antibiotic therapy is often used initially.
Before receiving antibiotics, recent medication history and potential resistance of the pathogen need to be considered. According to the 2016 guidelines, treatment of HCAP should begin as early as possible and consider incorporating antibiotics to combat drug-resistant bacteria such as MRSA.
"Inappropriate use of antibiotics may have a negative impact on the patient's condition and worsen the condition."
Prognosis and epidemiology
Based on multiple studies, even though the mortality rate of HCAP is similar to that of HAP, it is still lower than that of community-acquired pneumonia. As the number of long-term care facility residents grows, so does the risk of pneumonia for this group.
Conclusion
In today's society, as drug-resistant bacteria continue to rise, the prevalence and mortality of hospital-acquired pneumonia are gradually increasing. Does this mean we must re-examine our healthcare system as we fight the infection to withstand greater challenges in the future?
