Causes of nosocomial pneumonia and evaluation of risk factors in a university hospital in Turkey

OBJECTIVE: To determine the incidence, risk factors, mortality rate, and organisms causing nosocomial pneumonia (NP).

METHODS: We carried out this study in the Intensive Care Units (ICUs), General Medical and Surgical wards of Baskent University, Training and Research Hospital in Adana, Turkey, between November 2000 and August 2002. Patients were observed from the time of admission until 48 hours after discharge from the hospital.

RESULTS: In this study, 618 (2.1%) nosocomial infections (NIs) were detected in 29778 patients. One hundred and fifteen of these infections were NP and investigated with surveillance prospectively. The most frequently isolated microorganisms in NP were methicillin-resistant Staphylococcus aureus (MRSA) 32.8%, Pseudomonas species 21.5%, methicillin-sensitive Staphylococcus aureus (MSSA) 10.2%, Klebsiella species (9.1%) and Acinetobacter species 5.9%, E. coli; 5.4% (10/186), Streptococcus species; 4.8% (9/186), Candida species; 4.8% (9/186), Enterobacter species; 2.7% (5/186) and the other bacteria; 2.7%. The predominant pathogens isolated in this study were MRSA (33.8%), Pseudomonas species (16.9%) and MSSA (16.9%) in early-onset pneumonias and MRSA (32.2%), Pseudomonas species (24.0%), and Klebsiella species (10.7%) in late-onset pneumonias.

CONCLUSION: This study demonstrated that the possibility of developing NP, significantly increases with such risk factors as decreased level of consciousness, respiratory failure, mechanical ventilation and tracheostomy. Each center should know its patients' profile, the factors that increase the infection, the antibiotic resistance patterns of microorganisms, and the distribution of hospital infections in every department. Strategies to prevent both development of antibiotic resistance and spread of resistant organisms are necessary.