Background
Pneumonia is the leading infection-related cause of death. The use of simple clinical
criteria and contemporary epidemiology to identify patients at high risk of nosocomial
pneumonia should enhance prevention efforts and facilitate development of new treatments
in clinical trials.
Research Question
What are the clinical criteria and contemporary epidemiology trends that are helpful
in the identification of patients at high risk of nosocomial pneumonia?
Study Design and Methods
Within the ICUs of 28 US hospitals, we conducted a prospective cohort study among
adults who had been hospitalized >48 hours and were considered high risk for pneumonia
(defined as treatment with invasive or noninvasive ventilatory support or high levels
of supplemental oxygen). We estimated the proportion of high-risk patients who experienced
the development of nosocomial pneumonia. Using multivariable logistic regression,
we identified patient characteristics and treatment exposures that are associated
with increased risk of pneumonia development during the ICU admission.
Results
Between February 6, 2016, and October 7, 2016, 4,613 high-risk patients were enrolled.
Among 1,464 high-risk patients (32%) who were treated for possible nosocomial pneumonia,
537 (37%) met the study pneumonia definition. Among high-risk patients, a multivariable
logistic model was developed to identify key patient characteristics and treatment
exposures that are associated with increased risk of nosocomial pneumonia development
(c-statistic, 0.709; 95% CI, 0.686-0.731). Key factors associated with increased odds
of nosocomial pneumonia included an admission diagnosis of trauma or cerebrovascular
accident, receipt of enteral nutrition, documented aspiration risk, and receipt of
systemic antibacterials within the preceding 90 days.
Interpretation
Treatment for nosocomial pneumonia is common among patients in the ICU who are receiving
high levels of respiratory support, yet more than one-half of patients who are treated
do not fulfill standard diagnostic criteria for pneumonia. Application of simple clinical
criteria may improve the feasibility of clinical trials of pneumonia prevention and
treatment by facilitating prospective identification of patients at highest risk.
Key Words
Abbreviations:
FDA ( Food and Drug Administration), HABP ( hospital-acquired bacterial pneumonia), VABP ( ventilator-associated bacterial pneumonia)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: June 28, 2020
Footnotes
FUNDING/SUPPORT: This study was funded by the Food and Drug Administration through grant R18FD005292 and partially funded by pooled membership fees from CTTI’s member organizations (https://www.ctti-clinicaltrials.org/membership); V. G. F. was supported by mid-career mentoring award K24-AI093969 from the National Institutes of Health .
Identification
Copyright
© 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
