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Oxford Textbook of Medicine$
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Oxford Textbook of Medicine (5 ed.)

Edited by David A. Warrell, Timothy M. Cox, John D. Firth

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Latest update

The November 2012 update sees updates to over 70 chapters, focusing on Neurology and Gastroenterology. This update also incorporates a selection of 29 Case Histories taken from related titles in the Oxford Case Histories series, linked to from related chapters. Each case includes several questions followed by detailed answers and discussion to enhance diagnostic and clinical understanding.

Neurology updates include substantial updates to key chapters and new material on a wide range of topics including spinal cord injury, autonomic nervous system disorders, and inherited neurodegenerative diseases. 

Gastroenterology updates include extensive revisions of key chapters on liver failure and acute pancreatitis and new material on a wide range of matters, ranging from the common to the rare: including surgical treatments for colonic diverticular disease, antibody tests for immune disorders, and a revised treatment algorithm for small bowel bacterial overgrowth.

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Publisher:
Oxford University Press
Print Publication Date:
May 2010
Print ISBN-13:
9780199204854
Published to Oxford Medicine:
May 2012
DOI:
10.1093/med/9780199204854.001.1

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Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up to date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breastfeeding.

Contents

Nosocomial pneumonia

Chapter:
Nosocomial pneumonia
Author(s):

John G. Bartlett

DOI:
10.1093/med/9780199204854.003.180403

Nosocomial pneumonia is generally defined as a new pulmonary infiltrate on chest radiography, combined with evidence of infection expressed as fever, purulent respiratory secretions and/or leucocytosis, with onset at least 72 h after admission. It is the most frequent lethal nosocomial infection (overall mortality 8 to 20%).

Aetiology—most cases are caused by Gram-negative bacteria (50–70%) or Staphylococcus aureus (20–30%). Gram-negative bacteria reach the lung by aspiration of gastric contents or by microaspiration of upper airway secretions, throat cultures revealing that 60 to 70% of patients on intensive care units are colonized by these organisms (compared to 2–3% of healthy people).

Prevention—the best proven methods of prevention are by nursing the patient in the semi-upright position to reduce the risk of aspiration, and hand washing between patients to prevent transmission of nosocomial pathogens.

Diagnosis—this is often straightforward: due to easy access to cultures from tracheal aspirates and the ease of growing likely pathogens.

Management—when empirical decisions are necessary in seriously ill patients, the favoured drugs directed against Gram-negative bacteria are ceftazidime, cefepime, imipenem/meropenem, doripenem, piperacillin/piperacillin–tazobactam, ticarcillin/ticarcillin–sulbactam, or ciprofloxacin. For S. aureus, vancomycin or linezolid is added.

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