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Spotlight On Pneumonia

Pneumonia, a major health issue in both hospitals and the community, is actually an inflammation of the lungs which causes the alveoli (air sacs) to fill up with fluid. The resulting congestion causes a dramatic decrease in lung function and makes it hard for the patient to breathe correctly. Around one person in 100 will develop pneumonia every year in the UK and the condition proves fatal in 14 of every 100 cases (in intensive care, and in severe pneumonia, the mortality rate can be as high as 33 per cent). There are four million cases of pneumonia every year in the United States and Europe combined. Pneumonia remains the fifth leading cause of death. Mortality rates were very high before the advent of antibiotics - and the spread of antibiotic resistance means that pneumonia is, once more, a cause for concern in our hospitals.

Most cases of pneumonia are caused by infection of the lower respiratory tract, occurring when the patient breathes in infected droplets from the air. It is a complicated problem for the clinician, because there are many types of pneumonia caused by many different infective agents (bacteria, viruses, fungi).

The American Thoracic Society points out four major types of pneumonia:

Community-acquired pneumonia (CAP), which occurs in the community in previously healthy people. Usually it is caused by bacteria or viruses, rather than fungi. Around 25 per cent of those with CAP will need hospital treatment -; otherwise the condition is mild.

Hospital-acquired (or nosocomial) pneumonia (HAP), which tends to occur 48 hours or more after admission and was not evident at the time of admission.

Ventilator-associated pneumonia (VAP) is a type of HAP which is associated with endotracheal intubation for assisted breathing in the intensive care unit.

Healthcare-associated pneumonia (HCAP) occurs in patients who are not actually in hospital but are having treatment. This form of pneumonia is usually linked to:

- Intravenous therapy, wound care or chemotherapy within the previous 30 days
- Living in a nursing home or some other type of long term care facility
- Hospitalisation in an acute care hospital for two or more days within the previous 90 days
- Attendance at hospital or kidney dialysis unit within the previous 30 days

Pneumonia can be caused by a wide range of pathogens and sometimes more than one pathogen is involved. The following bacterial species have been associated with pneumonia:

Escherichia coli
Klebsiella pneumoniae
Enterobacter species
Pseudomonas aeruginosa
Acinetobacter species
Staphylococcus aureus (including MRSA - methicillin-resistant Staphylococcus aureus)
Streptococcus species

Pneumonia caused by viruses and fungi is less common, unless the patient has impaired immunity when normally harmless organisms can take hold.

Hospitalised patients are exposed to more dangerous bacteria, which are often drug resistant. This is the real, and growing, problem. Pneumonia can be difficult and time-consuming to diagnose with accuracy. The patient must be started on antibiotics (if the cause is thought to be bacterial, which it most often – but not always – is) as soon as possible but they receive the wrong antibiotic in up to 40 per cent of cases. This means antibiotics are being used inappropriately, which only increases the spread of antibiotic resistance. Matching the antibiotic therapy to the microbe that is involved in the particular case of pneumonia also improves the outcome for the patient.

More rapid and accurate methods of diagnosis of pneumonia, based upon genetic analysis, are in the pipeline and are being discussed with interest at current medical conferences. But prevention of the transmission of pneumonia is also vitally important. An air purifier like the IQAir HealthPro range can be part of the infection control strategy because its high efficiency particulate air (HEPA) filter captures bacteria (size 0.25 to 25 microns) and viruses (0.0025 to 0.025 microns), thereby reducing the number of airborne infectious particles inhaled.