Chulalongkorn Medical Journal


Background : Nosocomial pneumonia (NP) is ranked high among all health careassociated infections. The incidence and causative bacteria may bedifferent from studied hospital to the others.Objective : To investigate incidence of NP and its causative bacteria amongchronically ill patients who were admitted at a general hospital inthe central region of Thailand.Methods : A prospective study, which was carried out in department of medicine ofa general hospital in the central region of Thailand from April to September2016. A total of 330 chronically ill patients who were admitted tothe department of Medicine. NP is defined as pneumonia with onset noless than 48 hours after hospital admission and NP diagnosed by doctors.The causative bacteria were cultured from sputum of NP patients.Identification was carried out by standard biochemical profile and to testthe multi-drug resistance of the bacteria from the microbiological laboratoryof the study hospital. The descriptive statistics were used to analyze data.Results : Among 330 chronically ill patients, 50% were female, and 58.2% wereover 60 years of age. The incidence of NP was 16.4% (54/330) or 17.0per 1,000 patient-days. The incidence of ventilator associated pneumonia(VAP) was 43.5% (40/92) or 32.7 per 1,000 ventilator days and theincidence of hospital-acquired pneumonia (HAP) was 5.9% (14/238) or 8.0per 1,000 patient-days. Female patients, with age > 60 years, withunderlying diseases such as cardiovascular and metabolic syndrome,patients with subconscious and unconscious, those with totaldependence, those with long admission days, and those with medicalinstrument uses had relatively higher incidence of NP. The mostpredominant causative bacteria was A. baumannii (34.3%). Amongsputum with A. baumannii, 79.2% were multiple-drug resistance A.baumannii (MDR - A. baumannii).Conclusion : Chronically ill patients admitted at the hospital, especially, those withlong duration of admission and/or receiving medical instrument hadrelatively higher incidence of NP. Among them, the predominant causativebacteria was A. baumannii with multiple-drug resistance.


Faculty of Medicine, Chulalongkorn University

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