Pneumonia complicating abdominal sepsis: an independent risk factor for mortality

Pneumonia acquired during hospitalization (nosocomial) is the leading cause of death from hospital-acquired infection. This condition is usually caused by aspiration of gram-negative bacilli, often in patients with decreased immune defenses. A prospective study was undertaken of 300 patients with intra-abdominal abscess to compare the outcomes of patients with nosocomial pneumonia with the outcomes of patients without pneumonia but with recurrence of intra-abdominal abscess. There were 34 patients who were admitted to the hospital with pneumonia; these had a mortality of 44 percent and were excluded from the study. The mortality of 171 patients with no nosocomial pneumonia and no recurrent intra-abdominal abscess was 20 percent (34 patients). The 36 patients with recurrent abdominal abscess had a 17 percent mortality; 47 patients with nosocomial pneumonia had a 53 percent mortality. There were and additional 12 patients who had both nosocomial pneumonia and recurrent intra-abdominal abscess; mortality in this group was 75 percent. Several risk factors were identified: APACHE II score (Acute Physiology and Chronic Health Evaluation), the need for assistance with respiration, steroids, generalized peritonitis, and need for surgery. It is concluded that nosocomial pneumonia is an independent risk factor associated with significant mortality, compared with recurrence of intra-abdominal abscess. (Consumer Summary produced by Reliance Medical Information, Inc.)