Skip to main content

Pulmonary Infections in the Intensive Care Unit

  • Chapter
Book cover Perioperative and Critical Care Medicine
  • 139 Accesses

Abstract

Pulmonary infections in the intensive care unit (ICU) include two different entities: firstly, patients admitted with pneumonia, which may be either community (CAP)- or hospital acquired (HAP), and, second pneumonia developing in critically ill, mechanically ventilated patients (VAP or ventilator- associated pneumonia).

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. (1999) Gruppo italiano di studio sulle infezioni gravi GISIG. Diagnostica e terapia del paziente con o senza deficit immunologico che entra con polmonite e grave insufficienza respiratoria. In: Infezioni in Terapia Intensiva, Langer M (ed) Effetti, Milano:49–67

    Google Scholar 

  2. Marrie TJ, Durant H, Yates L et al (1989) Community acquired pneumonia requiring hospitalisation: 5 year prospective study. Rev Infect Dis 11:586–599

    Article  CAS  PubMed  Google Scholar 

  3. (1997) Centers for desease control and prevention. Premature deaths, monthly mortality and monthly physicians contacts-United States. MMWR Morb Mortal Wkly Rep 46:556

    Google Scholar 

  4. Marston BJ, Plouffe JF, File TM et al (1997) Incidence of community-acquired pneumonia requiring hospitalization: results of a population based active surveillance study in Ohio. Arch Int Med 157:1509–1718

    Article  Google Scholar 

  5. Blasi F (2002) Polmonite acquisita in comunità: epidemiologia e definizione. In: Polmoniti Clinica e Terapia, Blasi F (ed) Pharma Project Group, Saronno (VA):3–7

    Google Scholar 

  6. Fine MJ, Smith MA, Carson CA et al (1996) Prognosis and outcomes of patients with community-acquired pneumonia: a meta analysis. Jama 275:134–141

    Article  CAS  PubMed  Google Scholar 

  7. Torres A, El Ebiary M, Zavola E et al (1996) Severe community acquired pneumonia. Sem Respir Crit Care Med 17:265–271

    Google Scholar 

  8. (2001) American Thoracic Society Guidelines for the management of adults with community-acquired pneumonia. Diagnosis, assessment of severity, antimicrobial therapy, and prevention. Am J Respir Crit Care Med 163:1730–1754

    Google Scholar 

  9. (1993) American Thoracic Society Guidelines for the initial management of adults with community acquired pneumonia: diagnosis, assessment of severity and initial antimicrobial therapy (official ATS statement). Am Rev Respir Dis 148:1418–1426

    Google Scholar 

  10. Ewig S, Ruiz M, Mensa J et al (1998) Severe community acquired pneumonia: assessment of severity criteria. Am J Respir Crit Care Med 158:1102–1108

    CAS  PubMed  Google Scholar 

  11. Moine P, Verken JB, Chevret S et al (1994) Severe CAP. Etiology, epidemiology and prognosis factors. French Study Group for CAP in ICU. Chest 105:1487–1495

    CAS  Google Scholar 

  12. Luzzani A, Polati E, Dorizzi R, Rungatscher A, Pavan R, Merlini A (2003) Comparison of procalcitonin and C-reactive protein as markers of sepsis. Crit Care Med 31 (in press)

    Google Scholar 

  13. Bartlett JG, Dowell SF, Mandell LA et al (2000) Practice guidelines for the management of community-acquired pneumonia in adults. Guidelines from the Infectious Diseases Society of America Guidelines from the Infectious Diseases Society of America. Clin Infect Dis 31:347–382

    CAS  Google Scholar 

  14. Sorensen J, Forsberg P, Hakanson E et al (1989) A new diagnostic approach to the patient with severe pneumonia. Scand J Infect Dis 21:33–41

    Article  CAS  PubMed  Google Scholar 

  15. Rello J, Paiva JA, Dias CS et al (2003) Current dilemmas in the management of adults with severe community-acquired pneumonia. In: Yearbook of Intensive Care and Emergency Medicine, Vincent JL (ed) Springer-Verlag, Berlin, Heidelberg, New York, London, Milan, Paris, Tokyo 162–174

    Google Scholar 

  16. Gordon GS, Throop D, Berberian L et al (1996) Validation of the therapeutic recommendations of the American Thoracic Society (ATS) guidelines for community acquired pneumonia in hospitalized patients. Chest 110:55S

    Article  Google Scholar 

  17. Gleason PP, Kapoor WN, Stone RA et al (1997) Medical outcomes and antimicrobial costs with the use of American Thoracic Society guidelines for outpatients with community-acquired pneumonia. JAMA 278:32–39

    Article  CAS  PubMed  Google Scholar 

  18. Leroy O, Santre C, Beuscart C et al (1995) A 5-year study of severe community-acquired pneumonia with emphasis on prognosis in patients admitted to an ICU. Intensive Care Med 21:24–31

    Article  CAS  PubMed  Google Scholar 

  19. (1998) European Study on Community-acquired pneumonia (ESOCAP) Committee. Guidelines for management of adult community-acquired lower respiratory tract infections. Eur Respir J 11:986–991

    Google Scholar 

  20. Arbo MDJ, Snydman DR (1994) Influence of blood cultures results on antibiotic choice in treatment of bacteremia. Arch Intern Med 154:2641–2645

    Article  CAS  PubMed  Google Scholar 

  21. Relio J, Paiva JA, Baraibar J et al (2001) International Consensus Conference for the Development of Consensus on the Diagnisis and Treatment of Ventilator-Associated Pneumonia, Chest 120:955–970

    Article  Google Scholar 

  22. Chastre J, Fagon JY (2002) Ventilator-associated pneumonia, State of the Art. Am J Respir Crit Care Med 165:867–903

    PubMed  Google Scholar 

  23. Langer M, Cigada M, Mandelli M et al (1987) Early onset pneumonia: a multicenter study in intensive care unit. Intensive Care Med 13:342–346

    Article  CAS  PubMed  Google Scholar 

  24. Kerver AJ, Rommes JH, Mevissen Verhage EA et al (1987) Colonization and infection in surgical intensive care patients: a prospective study. Intensive Care Med 13:347–351

    Article  CAS  PubMed  Google Scholar 

  25. Hubmayr RD (2002) Statement of the 4th International Consensus Conference in Critical Care on ICU-acquired pneumonia-Chicago, Illinois, May 2002. Intensive Care Med 28:1521–1526

    Article  CAS  PubMed  Google Scholar 

  26. Chevret S, Hemmer M, Carlet J, Langer M et al (1993) Incidence and risk factors of pneumonia acquired in ICU. Int.Care Med 19:256–264

    CAS  Google Scholar 

  27. Vincent JL, Bihari DJ, Suter PM et al (1995) The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committe. JAMA 274:639–644

    CAS  Google Scholar 

  28. Warren DK, Shukl SJ, Olsen MA et al (2003) Outcome and attributable cost of ventilator associated pneumonia among intensive care unit patients in a suburban medical centre. Crit Care Med 31:1312–1321

    PubMed  Google Scholar 

  29. (1996) American Thoracic Society. Hospital acquired pneumonia in adults: diagnosis, assessment of severity, initial antimicrobical therapy, and preventive strategies. Am J Resp Crit care Med Hospital acquired pneumonia in adults: diagnosis, assessment of severity, initial antimicrobical therapy, and preventive strategies. Am J Resp Crit care Med 153:1711–1725

    Google Scholar 

  30. Torres A, Gatell JM, Aznar E et al (1995) Re-intubation increases the risk of nosocomial pneumonia in patients needing mechanical ventilation. Am J Respir Crit Care Med 152:137–141

    CAS  PubMed  Google Scholar 

  31. Kollef MH (1993) Ventilator-associated pneumonia. A multivariate analysis. JAMA 270:1965–1970

    CAS  Google Scholar 

  32. Drakulovic MB, Torres A, Bauer TT et al (1999) Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial. Lancet 354:1851–1858

    Article  CAS  PubMed  Google Scholar 

  33. Cook D, Guyatt G Marshall J et al (1998) A comparison of sucralfate and ranitidine for the prevention of upper gastrointestinal bleeding in patients requiring mechanical ventilation. Canadian Critical Care Trials Group. N Eng J Med 338:791–797

    CAS  Google Scholar 

  34. Allegranzi B, Luzzati R, Luzzani A et al (2002) Impact of antibiotic changes in empiricalal therapy on antimicrobial resistance in intensive care unit-acquired infections. J Hosp Infect 52:136–140

    Article  CAS  PubMed  Google Scholar 

  35. Sirvent JM, Torres A, El-Ebiary M et al (1997) Protective effect of intravenously administered cefuroxime against nosocomial pneumonia in patients with structural coma. Am J Respir Crit Care Med 155:1729–1734

    CAS  PubMed  Google Scholar 

  36. D’Amico R, Pifferi S, Leonetti C et al (1998) Effectiveness of antibiotic prophylaxis in critically ill adult patients: systematic review of randomised controlled trials. Br Med J 316:1275–1285

    Article  CAS  Google Scholar 

  37. Rello J, Diaz E, Roque M et al (1999) Risk factors for developing pneumonia within 48 hours of intubation. Am J Respir Crit Care Med 159:1742–1746

    CAS  PubMed  Google Scholar 

  38. George DL, Falk PS, Wunderink RG et al (1998) Epidemiology of ventilator-acquired pneumonia based on protected bronchoscopic sampling. Am J Respir Crit Care Med 158:1839–1847

    CAS  PubMed  Google Scholar 

  39. Cook DJ, Walter SD, Cook RJ et al (1998) Incidence and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Intern Med 129:433–440

    Article  CAS  PubMed  Google Scholar 

  40. Heinenger A, Krueger WA, Unertl KE (2003) A reappraisal of selective decontamination of the digestive tract. In: Yearbook of Intensive Care and Emergency Medicine, Vincent JL (ed) Springer-Verlag, Berlin, Heidelberg, New York, London, Milan, Paris, Tokyo: 199–208

    Google Scholar 

  41. Loirat P, Johanson WG, Van Saene HFK et al (1992) Selective decontamination in intensive care unit patients. Intensive Care Med 18:182–188

    Article  Google Scholar 

  42. Nathens AV, Marshall JC (1999) Selective decontamination of the digestive tract in surgical patients. Arch Surg 134:170–176

    Article  CAS  PubMed  Google Scholar 

  43. Krueger WA, Lenhart FP, Neesen G et al (2002) Influence of combined intravenous and topical antibiotic prophylaxis on the incidence of infections, organ dysfunctions, and mortality in critically ill surgical patients. Am J Respir Crit Care Med 166:1029–1037

    PubMed  Google Scholar 

  44. De Jonge E, Schultz M, Spanjaard L et al (2002) Effects of selective decontamination of the digestive tract on mortality and antibiotic resistance. Intensive Care Med 28 (Suppl 1):S12

    Google Scholar 

  45. Gruppo italiano di studio sulle infezioni gravi GISIG (1999) La polmonite nel paziente ventilato. In: Infezioni in Terapia Intensiva, Langer M (ed) Effetti, Milano: 68–97

    Google Scholar 

  46. Rello J, Ausina V, Ricart M et al (1993) Impact of previous antimicrobial therapy on the etiology and outcome of ventilator-associated pneumonia. Chest 104:1230–1235

    Article  CAS  PubMed  Google Scholar 

  47. Trouillet JL, Chastre J, Vaugnat A et al (1998) Ventilator-associated pneumonia caused by potentially drug-resistant bacteria. Am J Respir Crit Care Med 157:531–539

    CAS  PubMed  Google Scholar 

  48. Aarts MA, Marshall JC (2003) Empirical antibiotics in critical illness: do they help or harm? In: Yearbook of Intensive Care and Emergency Medicine, Vincent JL (ed) Springer-Verlag, Berlin, Heidelberg., New York, London, Milan, Paris, Tokyo: 219–28

    Google Scholar 

  49. Torres A, El-Ebiary M, Padro L et al (1994) Validation of different techniques for the diagnosis of ventilator-associated pneumonia. Comparison with immediate postmortem pulmonary biopsy. Am J Respir Crit Care Med 149:324–331

    CAS  Google Scholar 

  50. Pugin J, Auckenthaler R, Mili N at al (1991) Diagnosis of ventilator-associated pneumonia by bacteriologic analysis of bronchoscopic and non-bronchoscopic “blind” bronchoalveolar lavage fluid. Am Rev Respir Dis 143:1121–1129

    Article  CAS  PubMed  Google Scholar 

  51. Singh N, Yu V (2000) Rational empirical antibiotic prescription in the ICU: clinical research is mandatory. Chest 117:1496–1499

    Article  CAS  PubMed  Google Scholar 

  52. Singh N, Rogers P, Atwood CW et al (2000) Short-course empirical antibiotic therapy for patients with pulmonary infiltrates in the intensive care unit: a proposed solution for indiscriminate antibiotic prescription. Am J Respir Crit Care Med 162:505–511

    CAS  PubMed  Google Scholar 

  53. Luna MC, Blanzaco D, Niederman MS et al (2003) Resolution of ventilator-associated pneumonia: prospective evaluation of the clinical pulmonary infection score as an early clinical predictor of outcome. Crit Care Med 31:676–682

    PubMed  Google Scholar 

  54. Torres A, Puig de la Bellacasa J, Xaubet A et al (1989) Diagnostic value of quantitative cultures of bronchoalveolar lavage and telescoping plugged catheters in mechanically ventilated patients with bacterial pneumonia. Am Rev Respir Dis 140:306–310

    Article  CAS  PubMed  Google Scholar 

  55. Torres A, Martos A, Puig de la Bellacasa J et al (1993) Specificity of endotracheal aspiration, protected specimen brush and bronchoalveolar lavage in mechanically ventilated patients. Am Rev Respir Dis 147:952–957

    Article  CAS  PubMed  Google Scholar 

  56. Marquette CH, Georges H, Wallet F et al (1993) Diagnostic efficiency of endotracheal aspirates with quantitative bacterial cultures in intubated patients with suspected pneumonia. Comparison with the protected specimen brushing. Am Rev Respir Dis 148:138–144

    CAS  Google Scholar 

  57. El-Ebiary M, Torres A, Gonzales J et al (1993) Quantitative cultures of endotracheal aspirates for the diagnosis of ventilator associated pneumonia. Am Rev Respir Dis 148:1552–1567

    Article  CAS  PubMed  Google Scholar 

  58. Marquette CH, Copin MC, Wallet F et al (1995) Diagnostic tests for pneumonia in ventilated patients: prospective evaluation of diagnostic accuracy using histology as a diagnostic gold standard. Am J Respir Crit Care Med 151:1878–1888

    CAS  PubMed  Google Scholar 

  59. Cook D, Mandell L (2000) Endotracheal aspiration in the diagnosis of ventilator-associated pneumonia. Chest 117(S):195–197

    Article  Google Scholar 

  60. Niederman MS, Torres A, Summer W et al (1994) Invasive diagnostic testing is not needed routinely to manage suspected ventilator-associated pneumonia. Am J Respir Crit Care Med 150:565–569

    CAS  PubMed  Google Scholar 

  61. Chastre J, Fagon JY (1994) Invasive diagnostic testing should be routinely used to manage patients with suspected pneumonia. Am J Respir Crit Care Med 150:570–574

    CAS  PubMed  Google Scholar 

  62. Sanchez-Nieto JM, Torres A, Garcia Cordoba F et al (1998) Impact of invasive and non invasive quantitative culture sampling on outcome of ventilator-associated pneumonia: a pilot study. Am J Respir Crit Care Med 157:371–376

    CAS  PubMed  Google Scholar 

  63. Ruiz M, Torres A, Ewig S et al (2000) Noninvasive versus invasive microbial investigation in ventilator-associated pneumonia: evaluation of outcome. Am J Respir Crit Care Med 162:119–125

    CAS  PubMed  Google Scholar 

  64. Sole Violan J, Fernandez JA, Benitez AB et al (2000) Impact of quantitative invasive diagnostic techniques in the management and outcome of mechanically ventilated patients with suspected pneumonia. Crit Care Med 28:2737–2741

    Google Scholar 

  65. Fagon JY, Chastre J, Wolff M et al (2000) Invasive and non-invasive strategies for management of suspected ventilator-associated pneumonia. A randomized trial. Ann Intern Med 132:621–630

    Article  CAS  Google Scholar 

  66. Heyland DK, Cook DJ, Marshall J et al (1999) The clinical utility of invasive diagnostic techniques in the setting of ventilator-associated pneumonia. Canadian Critical Care Trials Group. Chest 115:1076–1084

    CAS  Google Scholar 

  67. Niederman MS (1998) Bronchoscopy for ventilator-associated pneumonia: show me the money (outcome benefit)! Crit Care Med 26:198–199

    CAS  PubMed  Google Scholar 

  68. Alvarez-Lerma F (1996) Modification of empirical antibiotic treatment in patients with pneumonia acquired in the intensive care unit. ICU-Acquired Pneumonia Study Group. Intensive Care Med 22:387–394

    CAS  Google Scholar 

  69. Luna CM, Vujacich P, Niederman MS et al (1997) Impact of BAL data on the therapy and outcome of ventilator-associated pneumonia. Chest 111:676–685

    Article  CAS  PubMed  Google Scholar 

  70. Rello J, Gallego M, Mariscal D et al (1997) The value of routine microbial investigation in ventilator-associated pneumonia. Am J Respir Crit Care Med 156:196–200

    CAS  PubMed  Google Scholar 

  71. Heyland DK, Cook DJ, Griffith L et al (1999) The attributable morbidity and mortality of ventilator-associated pneumonia in the critically ill patients. The Canadian Critical Care Trials Group. Am J Respir Crit Care Med 159:1249–1256

    CAS  Google Scholar 

  72. Kollef MH, Sherman G, Ward S, Fraser VJ (1999) Inadequate antimicrobial treatment of infections: a risk factor for hospital mortality among critically ill patients. Chest 115:462–474

    Article  CAS  PubMed  Google Scholar 

  73. Rello J, Torres A, Ricart M et al (1994) Ventilator-associated pneumonia by Staphylococcus aureus. Comparison of methicillin-resistant and methicillin-sensitive episodes. Am J Respir Crit Care Med 150:1545–1549

    CAS  Google Scholar 

  74. Palmer DL (1984) Microbiology of pneumonia in the patient at risk. Am J Med 76:53–60

    Article  CAS  PubMed  Google Scholar 

  75. Menon LR, Divate S, Achaya VN et al (2002) Utility of BAL in the diagnosis of pulmonary infections in immunosuppressed patient. J Assoc Physicians India 50:1110–1114

    CAS  PubMed  Google Scholar 

  76. Kollef MH, Vlasnik J, Sharpless L et al (1997) Scheduled change of antibiotic classes: a strategy to decrease the incidence of ventilator-associated pneumonia. Am J Respir Crit Care Med 156:1040–1048

    CAS  PubMed  Google Scholar 

  77. Raymond DP, Pelletier SJ, Crabtree TD et al (2001) Impact of a rotating empiric antibiotic schedule on infectious mortality in an intensive care unit. Crit Care Med 29:1101–1108

    CAS  PubMed  Google Scholar 

  78. Ibrahim EH, Ward S, Sherman G et al (2001) Experience with a clinical guideline for the treatment of ventilator-associated pneumonia. Crit Care Med 29:1109–1115

    CAS  PubMed  Google Scholar 

  79. Kollef MH (2003) Treatment of ventilator-associated pneumonia: get it right from the start. Crit Care Med 31:969–970

    PubMed  Google Scholar 

Download references

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2004 Springer-Verlag Italia

About this chapter

Cite this chapter

Luzzani, A., Polati, E., Bassanini, S. (2004). Pulmonary Infections in the Intensive Care Unit. In: Gullo, A., Berlot, G., Lucangelo, U., Pellis, T. (eds) Perioperative and Critical Care Medicine. Springer, Milano. https://doi.org/10.1007/978-88-470-2135-8_17

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-2135-8_17

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-0278-4

  • Online ISBN: 978-88-470-2135-8

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics