[Risk factors and prognostic factors in nosocomial pneumonia outside the intensive care units setting]. / Factores de riesgo y pronósticos de la neumonía nosocomial en los pacientes no ingresados en unidades de cuidados intensivos.

INTRODUCTION: Nosocomial pneumonia (NP) is the second most frequent cause of hospital-acquired infection and is associated with elevated morbidity and mortality rates, particularly in intensive care units (ICU). The objectives of this study were to determine the incidence, risk factors and prognostic factors of NP acquired outside the ICU. METHODS: A prospective case-control study was performed. All NP cases were acquired outside the ICU, and each case was paired with a control subject matched for gender, age, date of admission and hospitalization area. Epidemiological, clinical and microbiological data were obtained from cases and controls, and the risk factors and prognostic factors for NP were established. RESULTS: During the study period a total of 67 cases of NP outside the ICU were diagnosed. Estimated incidence was 3.35 cases/1,000 admissions. Mean age of the patients was 70 +/- 13 years and 48 of them were men. On multivariate analysis adjusted for confounding factors, bronchoaspiration, previous surgery and steroids were significantly associated with the development of NP. Mortality attributable to NP was 27%. The existence of an ultimately or rapidly fatal underlying condition and the presence of leukocytosis or leukopenia were associated with poor prognosis. CONCLUSION: The incidence of NP outside the ICU setting is low. Measures to reduce bronchoaspiration and judicial steroid use are necessary to decrease the risk of acquiring NP and to improve the prognosis.

Factores de riesgo y pronósticos de la neumonía nosocomial en los pacientes no ingresados en unidades de cuidados intensivos / Risk factors and prognostic factors in nosocomial pneumonia outside the intensive care units setting

Introducción. La neumonía nosocomial (NN) es la segunda causa de infección hospitalaria, presenta una elevada morbimortalidad y es más frecuente en las unidades de cuidados intensivos (UCI). Los objetivos del presente estudio fueron conocer la incidencia, los factores de riesgo y los factores pronósticos de la NN en pacientes no ingresados en la UCI. Métodos. Se realizó un estudio prospectivo de caso-control, donde los casos eran pacientes con NN adquirida fuera de la UCI. Cada caso fue emparejado con un control por edad, sexo, fecha de ingreso y unidad de hospitalización. En todos los casos se analizaron datos epidemiológicos, clínicos y microbiológicos, estableciéndose los factores de riesgo y pronósticos de la NN. Resultados. Durante el período de estudio se diagnosticaron 67 casos de NN con una incidencia de 3,35 casos/1.000 ingresos. La edad media fue de 70 6 13 años, y 48 de ellos eran varones. Tras un análisis multivariante ajustado por factores de confusión, la broncoaspiración, la cirugía previa y el uso de esteroides se asociaron significativamente al desarrollo de NN. La mortalidad atribuible a la NN fue del 27%. La existencia de leucopenia, leucocitosis y enfermedad de base fatal o inmediatamente fatal se asociaron a un peor pronóstico. Conclusión. La incidencia de NN adquirida fuera de la UCI es baja. La utilización racional de esteroides y el uso de medidas para disminuir la broncoaspiración podrían disminuir el riesgo de NN y mejorar el pronóstico (AU)

Introduction. Nosocomial pneumonia (NP) is the second most frequent cause of hospital-acquired infection and is associated with elevated morbidity and mortality rates, particularly in intensive care units (ICU). The objectives of this study were to determine the incidence, risk factors and prognostic factors of NP acquired outside the ICU. Methods. A prospective case-control study was performed. All NP cases were acquired outside the ICU, and each case was paired with a control subject matched for gender, age, date of admission and hospitalization area. Epidemiological, clinical and microbiological data were obtained from cases and controls, and the risk factors and prognostic factors for NP were established. Results. During the study period a total of 67 cases of NP outside the ICU were diagnosed. Estimated incidence was 3.35 cases/1,000 admissions. Mean age of the patients was 70 6 13 years and 48 of them were men. On multivariate analysis adjusted for confounding factors, bronchoaspiration, previous surgery and steroids were significantly associated with the development of NP. Mortality attributable to NP was 27%. The existence of an ultimately or rapidly fatal underlying condition and the presence of leukocytosis or leukopenia were associated with poor prognosis. Conclusion. The incidence of NP outside the ICU setting is low. Measures to reduce bronchoaspiration and judicial steroid use are necessary to decrease the risk of acquiring NP and to improve the prognosis (AU)