JAC Advance Access originally published online on June 10, 2008
Journal of Antimicrobial Chemotherapy 2008 62(3):641; doi:10.1093/jac/dkn226
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Letter to the Editor |
Comment on: Guidelines for the management of hospital-acquired pneumonia in the UK: Report of the Working Party on Hospital-Acquired Pneumonia of the British Society for Antimicrobial Chemotherapy
Internal Medicine, Norwegian American Hospital (Chicago), 1328 Greenwood, Wilmette, IL 60091, USA
* Tel: +1-847-256-3562; E-mail: luketcurtis{at}aol.com
Keywords: nutrition , infection , respiratory tract
Sir,
I appreciated the recent and very comprehensive guidelines for managing hospital-acquired pneumonia by Masterton et al.1
Malnutrition can greatly increase pneumonia morbidity and mortality rates in both children and adults. Malnutrition is responsible for an estimated 52% of the 2 million impoverished children who die annually worldwide due to pneumonia.2 However, the relationship between malnutrition and pneumonia in adults in the developed world is often overlooked.
Various studies have reported malnutrition for hospitalized elderly to range from 42% to 91% in the developed world.3 Several studies have reported that rates of both hospital-acquired pneumonia and nosocomial infections, in general, are significantly higher in malnourished versus well-nourished patients.4,5 A study of 578 nursing home elderly reported that rates of both pneumonia infection and antibiotic consumption were significantly higher in residents with low serum zinc levels.6
Many acutely ill patients require enteral tube feeding, which may present some aspiration risk. A study of 4049 mechanically ventilated patients reported that enteral feeding within 48 h of intubation was associated with a significant reduction in hospital mortality (27.8% versus 34.2%, P = 0.0005), even though rates of aspiration pneumonia were increased (12.6% versus 9.5%, P = 0.007) when compared with patients who received later enteral feeding.7
Use of ‘immunonutrition’ enteral formulas containing omega 3 fatty acids and extra levels of glutamine, zinc, copper, selenium and vitamins may reduce the risk of pneumonia among the acutely ill. Meta-analysis of 11 studies reported that the use of such ‘immunonutrition’ formulas was associated with a 46% reduced risk of hospital-acquired pneumonia when compared with standard formulas (P = 0.007).8 A study of 165 mechanically ventilated patients with severe sepsis reported that use of an enteral formula with omega 3 fatty acids and extra vitamins was associated with significantly lower mortality and significantly fewer days on mechanical ventilation when compared with patients on standard formula.9
Good nutrition can play a major role in preventing and treating hospital-acquired pneumonia. Much more research on the relationship between nutrition and pneumonia should be published and the results incorporated into future pneumonia guidelines.
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1 Masterton RG, Galloway A, French G, et al. Guidelines for the management of hospital-acquired pneumonia in the UK: Report of the Working Party on Hospital-Acquired Pneumonia of the British Society for Antimicrobial Chemotherapy. J Antimicrob Chemother (2008) 62:5–34.
2
Caulfield LE, De Onis M, Blossner M, et al. Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria and measles. Am J Clin Nutr (2004) 80:193–8.
3 Kubrak C, Jensen L. Malnutrition in acute care patients: a narrative review. Int J Nurs Stud (2007) 44:1036–54.[CrossRef][Web of Science][Medline]
4 Schneider SM, Veyres P, Pivot X, et al. Malnutrition is an independent risk factor associated with nosocomial infections. Br J Nutr (2004) 92:105–11.[CrossRef][Web of Science][Medline]
5 Rothan-Tondeur M, Meaume S, Girard L, et al. Risk factors for nosocomial pneumonia in a geriatric hospital: a case–control, one-center study. J Am Geriatr Soc (2003) 51:997–1001.[CrossRef][Web of Science][Medline]
6
Meydani SN, Barnett JB, Dallal GE, et al. Serum zinc and pneumonia in nursing home elderly. Am J Clin Nutr (2007) 86:1167–73.
7 Artinian V, Krayem H, DiGiovine B. Effects of early enteral feeding on the outcome of critically ill mechanically ventilated medical patients. Chest (2006) 129:960–7.[CrossRef][Web of Science][Medline]
8 Montejo JC, Zarazaga A, Lopez-Martinez J, et al. Immunonutrition in the intensive care unit. A systemic review and consensus statement. Clin Nutr (2003) 22:221–33.[CrossRef][Web of Science][Medline]
9 Pontes-Arruda A, Argao AMA, Albuquerque JD. Effects of enteral feeding with eicosapantaenoic acid, gamma-linolenic acid, and antioxidants in mechanically ventilated patients with severe sepsis and septic shock. Crit Care Med (2006) 34:2325–33.[CrossRef][Web of Science][Medline]
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