Nosocomial Pneumonia: Strategies for Management

In the United States, recent legislation regarding mandatory public reporting of hospital-associated infections and the potential financial impact of Centers for Medicare & Medicaid Services rule changes related to hospital reimbursement have focused greater scrutiny on health care-associated infections. Occurring with a frequency of 5 to 15 cases per 1000 admissions, hospital-acquired pneumonia is one of the most serious nosocomial infections encountered in hospitalized patients. Although the attributable mortality associated with hospital-acquired pneumonia is debated, impact in terms of increased length of stay and hospital costs is significant. Most studies on the subject note an increased length of stay of 10 to 14 days at a cost of $10 000 to $15 000. However, the results of recent studies suggest that with careful attention to a variety of clinical care issues, many cases of nosocomial pneumonia can be prevented. Hence, it is quite appropriate for Rello and colleagues to review the current understanding of nosocomial pneumonia.