Pneumonia as one of major types of infections

Pneumonia as one of major types of infections

Pneumonia is one of the serious infections that affecting the lower respiratory system so surveillance for the pneumonia is very important and during the surveillance we have to keep in our minds that physicians diagnosis alone for pneumonia (Clinically) is not accepted criterion for defining health care associated pneumonia and we have special criteria for each type of pneumonia : clinically-defined pneumonia (PNU1), pneumonia with specific laboratory findings (PNU2), and pneumonia in immunocompromised patients (PNU3).preventing pneumonia is one of the top priority for patient safety

Pneumonia as one of major types of infections

Pneumonia as one of major types of infections

 

One of the main problem for misdiagnosis of pneumonia is the positive culture of ETT for the intubated patients the misdiagnosis arises from mixing between pneumonia , Tracheal colonization, upper respiratory tract infection and mainly as long as positive culture arise the patient will be recorded pneumonia !!!So it should be more careful interpretation of the culture report for the specimens and we have to differentiate between colonization, infection and the biofilm formation over the medical devices other issue regarding the clinical assessment as long as changes of the patient conditions may be from other causes e.g. myocardial infarction , Cancer , COPD …..And many other medical conditions so diagnosis need to find a certain criteria for final decision

Onset of health care associated pneumonia can be early or late onset within 4 days is early onset HAP (Health Care Associated Pneumonia )and this infection is mainly caused by H influenzae, and S pneumoniae, Moraxella catarrhalis for late HAP (more than 4 days) the causative organism mainly will be S aureus , MRSA , gram negative bacteria , yeast and fungi, also keep in mind the new emergent pathogen can cause pneumonia e.g .novel influenza virus H7N9  and Middle East Respiratory Syndrome Coronavirus (MERS-CoV)

 

The pathogen  (addition or changing ) is not indicative of new episodes of pneumonia to consider new episode of pneumonia for the same patient first we have to be sure of the complete resolution  from the first diagnosed pneumonia and a new incidence is meeting the criteria for diagnosing of pneumonia but not using the changes of pathogen from a microbiology report as if this is a conclusive way so scientific active surveillance of pneumonia is needed in each health care facility

 

For the three types of HAP radiological evidence has to show evidence of pneumonia we couldn’t depend solely on clinical judgment alone or microbiological lab report (Colonization, Contamination, Biofilm….) and the diagnosis is almost clear for the patient with no underling pulmonary or cardiac disease or not ventilated but it will be quite difficult (e.g., interstitial lung illness or congestive heart failure), diagnosis of PNU is particularly difficult. Other noninfectious conditions (e.g., pulmonary edema due to decompensated congestive heart failure) may simulate the presentation of pneumonia so it is advisable to do serial chest radiographs for those difficult patient to confirm or exclude the diagnosis ,mainly the pneumonia is rapid and progressive onset but not resolved quickly and radiological evidence can persist for several weeks.

We have a new classification called VAE (Ventilator Associated Events) is one of the chest problems also the pneumonia which followed the surgical procedure is called PPP(Post procedure pneumonia)

 

Reference

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