The gastropulmonary route of infection - fact or fiction?

Article Abstract:

Infection of the respiratory tract is a significant cause of illness and death among hospitalized patients. Many researchers believe that one of the risk factors for pneumonia is the increase in stomach pH. An increase in stomach pH, indicating a decrease in stomach acidity, occurs in many serious illnesses. The decreased acidity provides a more favorable environment for the growth of bacteria. These bacteria may be washed back up the esophagus, and only a tiny amount need to be aspirated into the airway to seed a respiratory infection. Other researchers are skeptical. They suggest that the patients with the decreased stomach acid tend to be the sickest, and it is hardly surprising that the sickest patients also have the highest rates of infection. However, numerous studies that shed light on this problem have now been completed. Patients treated with certain drugs develop decreased stomach acid, and this clearly results in increased growth of bacteria. Detailed examinations of the bacteria in the stomachs of patients on mechanical ventilation have revealed that the bacteria causing a respiratory tract infection have most likely come from the stomach in from 30 to 40 percent of the cases. Further evidence is based on the findings that patients receiving medication with effects on reducing stomach pH have, on average, one-third more bacteria in their windpipes than do similar patients taking medication that does not affect stomach acidity. Hospitalized patients sometimes require treatment to prevent the development of stress ulcers. In light of the accumulating data on bacteria spreading from the digestive tract into the respiratory tract, it would seem most appropriate to administer an anti-ulcer drug that does not decrease the stomach acidity. Some studies have indicated that this is, indeed, the case. These studies have shown that the rate of pneumonia among hospitalized patients receiving prophylactic treatment for ulcers is higher for treatments such as antacids, ranitidine, and cimetidine, which decrease stomach acidity, than for treatments such as sucralfate, which protect the stomach without significantly changing its acidity. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Peptic ulcer, Sucralfate

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Preventing nosocomial pneumonia: state of the art and perspectives for the 1990s

Article Abstract:

Pneumonia is the second most common infection that is acquired during hospitalization (nosocomial pneumonia). It can be caused by several different types of bacteria, including Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, and Legionella pneumophila. Nosocomial pneumonia is estimated to occur in 1 out of every 100 to 200 patients that become hospitalized and in 18 percent of all patients who undergo surgery. It can prolong hospitalization for eight or nine additional days. This can mean an additional cost for the patient of up to $2,863 (in 1985 dollars). It is estimated that nosocomial pneumonia results in death in 20 to 50 percent of the infected patients. Risk factors for acquiring pneumonia include age greater than 70 years, reduced consciousness, chronic lung disease, chest surgery, mechanical ventilation, and fall or winter season. Patients who cannot breathe on their own and require an endotracheal tube or mechanical ventilation have a 7- to 21-fold greater risk of contracting pneumonia than patients who do not require breathing devices. The microorganisms that cause pneumonia can be found on and inside of instruments and diagnostic devices. Nasogastric tubes, endotracheal tubes, mechanical ventilators, resuscitation bags, spirometers, and catheters are possible sources of contamination. These devices should be thoroughly disinfected after each use. Since bacteria can grow on the skin, hand washing before and after contact with infected patients is a good idea. Vaccines and antibiotics have been used for preventing and treating nosocomial pneumonia. More effective methods of controlling nosocomial pneumonia are needed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Artificial respiration, Mechanical ventilation

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