Clinical and epidemiological features of nosocomial pneumoniae in the hospitals of the Amur Region

Aim. To study the epidemiology of nosocomial pneumoniae (NP) in the Amur Region and according to the Amur Regional Clinical Hospital to study the characteristics of their course in a multidisciplinary hospital.

Materials and methods. On the basis of the Amur Regional Clinical Hospital, a prospective study was conducted to study the clinical features of the NP (118 patients); In addition to case histories, 456 samples of material (sputum, bronchial wash) were selected for the purpose of bacteriological research to study the characteristics of the microbiological landscape of the hospital (retrospective analysis). 70 case histories of patients diagnosed with NP who were treated in the City Clinical Hospital of Blagoveshchensk and 15 case histories of patients from the Central Regional Hospital of the Amur Region, where the regional vascular center functions, were studied in retrospect.

Results. The conclusion was made that in the Amur Region with a low population density in large areas, assistance to patients with severe somatic pathology is carried out mainly in the hospitals of the regional center, which explains the greater incidence of NP in the hospitals of the regional center hospitals. NPs are more likely to develop in elderly patients with a polymorbidic background (72%) who have risk factors for nosocomial infection (97.4%). In most cases, NPs were registered in those departments of the surgical and therapeutic profile where there were patients with severe somatic pathology who underwent serious invasive treatment methods or immunosuppressive therapy, were on bed rest or mechanical ventilation due to the underlying disease, or in patients with various options of consciousness disturbance. The main etiological factors for the development of NP were gram-negative bacteria (59.8%) with a predominance of microbial associations (58.5%). In specialized departments, causative microbial agents in early NP were: Streptococcus pneumoniae (36.4%), Klebsiella pneumoniae (11.8%), Staphylococcus aureus (2.5%), Pseudomonas aeruginosa (0.8%); with late NP - Klebsiella pneumoniae (28.3%), Pseudomonas aeruginosa (8.4%), Streptococcus pneumoniae (5.1%), Staphylococcus aureus (4.2%), Acinetobacter (2.5%). In the intensive care unit, causal microbial agents for early NP were diagnosed with: Streptococcus pneumoniae (7.8%), Pseudomonas aeruginosa (6.4%), Klebsiella pneumoniae (6.4%), Staphylococcus aureus (3.5%), Acinetobacter (0.7%); with late NP - Klebsiella pneumoniae (40%), Pseudomonas aeruginosa (20%), Staphylococcus aureus (3.5%), Streptococcus pneumoniae (2.5%), Acinetobacter (1.7%). Clinical and laboratory characteristics of NP in large hospitals of the region are given.

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