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PDAT6 ID > 15 - HAP > Flashcards

15 - HAP Flashcards

1
Q
  • *Dose / ADR**
  • *AntiPseudomoal Carbapenem**

HAP - 2 Drug treatment for Pseudomonas or Resistant Gram -NEG-
Risk Factor for MDR
ABx <90 days / >5day hospitalization
VAP - Septic Shock / ARDS / Acute renal replacement therapy

Unit where patient is residing has a:
>10% incidence of RESISTANCE to the ANTBIOTIC
that is being considered for monotherapy

Prevelance is NOT KNOWN & INTUBATED
Or
patient has structural lung disease –> ↑risk of G- infxns​
CYSTIC FIBROSIS or BRONCHIECTASIS

A

1st drug in 2 drug HAP treatment

Imipenem
500mgIVPBq6h

  • *Meropenem**
  • *1gm** IVPB q8h

renal adjustment

RASH / DIARRHEA

SEIZURES** for **IMIPENEM

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2
Q

When to COVER MRSA?

HAP

A

Risk factor for MDR
ABx <90 days / >5day hospitalization
VAP - Septic Shock / ARDS / Acute renal replacement therapy

Unit where patient is residing has:
>10% incidence of MRSA

Prevelence of MRSA NOT KNOWN
and/or
patient is INTUBATED
and/or
SEPTIC SHOCK

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3
Q

HAP Treatment if

MSSA ISOLATED

A

2-N-O-C

Nafcillin
2gm IVPB q4h

Oxacillin
2gm IVPB q4h

Cefazolin
2gm q8h

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4
Q
  • *Dose / ADR**
  • *MonoBactam**

HAP - 2 Drug treatment for Pseudomonas or Resistant Gram -NEG-
Risk Factor for MDR

Unit where patient is residing has a:
>10% incidence of RESISTANCE to the ANTBIOTIC
that is being considered for monotherapy

Prevelance is NOT KNOWN & INTUBATED
Or
patient has structural lung disease –> ↑risk of G- infxns​
CYSTIC FIBROSIS or BRONCHIECTASIS

A

1st drug in 2 drug HAP treatment

  • *AZTREONAM**
  • *2gm** IVPB q8h
  • *NEUTROPENIA**
  • ↑*Liver Enzymes
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5
Q

HAP TREATMENT if

Increased risk for ANAEROBES

A

METRONIDAZOLE** or **CLINDAMYCIN

can be added to regimens except for:
imipenem / meropenem
piperacillin+tazobactam

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6
Q

HAP TREATMENT if

VAP ORGANISM** sensitive only to **AG’s or COLISTIN

A

INHALATION ADMINISTRATION

in ADDITION TO SYSTEMMICALLY

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7
Q
  • *Dose / ADR**
  • *B-Lactam / B-lactamase Inhibitor**

HAP - 2 Drug treatment for Pseudomonas or Resistant Gram -NEG-
Risk Factor for MDR

Unit where patient is residing has a:
>10% incidence of RESISTANCE to the ANTBIOTIC
that is being considered for monotherapy

Prevelance is NOT KNOWN & INTUBATED
Or
patient has structural lung disease –> ↑risk of G- infxns​
CYSTIC FIBROSIS or BRONCHIECTASIS

A

1st drug in 2 drug HAP treatment

  • *Piperacillin / Tazobactam**
  • *4.5gm** IVPB q6h

Rash / Diarrhea

THROMBOCYTOPENIA

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8
Q

Diagnosis for HAP

A

CXR

Sputum Culture

Endotracheal Tube Culture

Worsening Respiratory Status

NEW S/Sx
Fever / ↑WBC / ↑Sputum

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9
Q
  • *Dose / ADR**
  • *AntiPseudomonal Fluroquinolone**

HAP - 2 Drug treatment for Pseudomonas or Resistant Gram -NEG-
Risk Factor for MDR

Unit where patient is residing has a:
>10% incidence of RESISTANCE to the ANTBIOTIC
that is being considered for monotherapy

Prevelance is NOT KNOWN & INTUBATED
Or
patient has structural lung disease –> ↑risk of G- infxns​
CYSTIC FIBROSIS or BRONCHIECTASIS

A
  • 2nd drug* in 2 drug HAP treatment
  • *FIRST CHOICE >**
  • *Levofloxacin**
  • *750mg** IVPB QD
  • *Ciprofloxacin**
  • *400mg** IVPB q8h

DI’s
Antacids / Iron / Mag / Alum / Calcium

Caution with KIDS / Tendon Rupture
QTC Prolongation / Hypoglycemia

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10
Q

Which HAP drugs

  • DO NOT REQUIRE*
  • *RENAL ADJUSTMENT**
A

LINEZOLID
many drug interactions

Nafcillin** / **Oxacillin
MSSA resistant treatment

  • *Moxifloxacin**
  • not used for hospitals*
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11
Q

What HAP drug has DRUG INTERACTIONS?

& What drugs?

A

LINEZOLID
600mg q12h for MRSA Coverage

SSRI’s - Fluoxetine

TCA’s / Venlafaxine

Mirtazapine

TRAZADONE

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12
Q

HAP TREATMENT if

FUNGUS
is isolated or suspected

A
  • *LYMPHOSOMAL AMPHOTERICIN B**
  • *100-150mg QD**

less nephrotoxic / infusion rxns vs
amphoTERRIBLE B

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13
Q

HAP TREATMENT if

ESBL Organism
Extended Spectrum Beta-Lactamases

A

Carbapenem

B-Lactamase Inhibitor
Tazobactam

Fluorquinolone
Levo/Cipro

and/or

AminoGlycoside

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14
Q

HAP TREATMENT if

CARBAPENEM RESISTANT

A

COLISTIN

POLYMIXIN B

and/or

Aztreonam

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15
Q

Microbio Etiology of
HAP

A

Gram Negative Bacteria - 60%

Pseudomonas Aeruginosa

Enterobacter Sp

Klebsiella Pneumoniae

Gram Positive Bacteria - 18%

Staphylococcus Aureus

Streptococcus Pneumoniae

Fungi / Virus / Atypicals - 22%

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16
Q

Dose / ADR

Linezolid

HAP Need MRSA Coverage if 1 of:

Risk factor for MDR

Unit where patient is residing has:
>10% incidence of MRSA

Prevelence of MRSA NOT KNOWN
and/or patient is INTUBATED
and/or SEPTIC SHOCK

A

Linezolid
600mg IVPB q12h

NO RENAL ADJUSTMENT

Myelosuppression / Serotonin Syndrome

DI’s:
SSRI’s / TCA’s / VENLAFAXINE
Trazadone
Mirtazapine

17
Q
  • *Dose / ADR**
  • *AminoGlycosides**

HAP - 2 Drug treatment for Pseudomonas or Resistant Gram -NEG-
Risk Factor for MDR

Unit where patient is residing has a:
>10% incidence of RESISTANCE to the ANTBIOTIC
that is being considered for monotherapy

Prevelance is NOT KNOWN & INTUBATED
Or
patient has structural lung disease –> ↑risk of G- infxns​
CYSTIC FIBROSIS or BRONCHIECTASIS

A

2nd drug in HAP 2 drug treatment
*AVOID AG’s & Colistin if* alternative agents
available to cover Gram-NEG- organisms

GAT

Gentamicin / Tobramycin / Amikacin

NEPHROTOXICITY / OTOTOXICITY

18
Q
  • *Dose / ADR**
  • *POLYMIXIN**

HAP - 2 Drug treatment for Pseudomonas or Resistant Gram -NEG-
Risk Factor for MDR

Unit where patient is residing has a:
>10% incidence of RESISTANCE to the ANTBIOTIC
that is being considered for monotherapy

Prevelance is NOT KNOWN & INTUBATED
Or
patient has structural lung disease –> ↑risk of G- infxns​
CYSTIC FIBROSIS or BRONCHIECTASIS

A

2nd drug in HAP 2 drug treatment
AVOID AG’s & Colistin if alternative agents
available to cover Gram-NEG- organisms

  • *COLISTIN**
  • *5mg/kg** x1 dose –> 2.5mg/kg IVPB q12h
  • *POLYMIXIN B**
  • *2.5-3mg/kg/day** IVPB –> 2 Daily Doses
  • LAST RESORT -> toxic*

NEPHROTOXICITY / NEUROTOXICITY

POLY

19
Q

HAP TREATMENT

2 DRUGS
for
Pseudomonas or Resistant Gram-NEG-

SECOND DRUG

A

“CCBM + FAP”

Antipseudomonal Fluoroquinolone

  • *Levofloxacin** - 750mg IVPB qd
  • *Ciprofloxacin** - 400mg IVPB q8h
  • *AminoGlycoside**
  • *Gentamicin / Tobramycin / Amikacin**
  • *Polymixin**
  • *Colistin** - 5mg/kg x1dose -> 2.5mg/kg IVPB q12h
  • *Polymixin B -** 2.5-3mg/kg/day IVPB in TDD
20
Q

HAP TREATMENT if

NO MRSA RISK FACTORS / No factors for Resistance

A

Empirically Cover with MONOTHERAPY“CLIP-M”

Cefepime

Levofloxacin

Imipenem

Piperacillin-Tazobactam

Meropenem

21
Q
  • *Dose / ADR**
  • *AntiPseudomoal Cephalosprins**

HAP - 2 Drug treatment for Pseudomonas or Resistant Gram -NEG-
Risk Factor for MDR

Unit where patient is residing has a:
>10% incidence of RESISTANCE to the ANTBIOTIC
that is being considered for monotherapy

Prevelance is NOT KNOWN & INTUBATED
Or
patient has structural lung disease –> ↑risk of G- infxns​
CYSTIC FIBROSIS or BRONCHIECTASIS

A

1st drug in 2 drug HAP treatment

  • *Ceftazadime**
  • *2gm IVPB q8h**
  • *Cefipime**
  • *2gm IVPB q8h**

RASH / DIARRHEA

22
Q

HAP TREATMENT
LENGTH OF THERAPY

A

7 DAYS

De-escalate when SENSITIVITIES come back

23
Q

HAP Treatment for

MRSA COVERAGE

A

VANCOMYCIN
dosed to achieve troughs of 15-20mcg/mL

or

  • *LINEZOLID**
  • *600mg IVPB q12h**
24
Q

When to use
2 DRUGS
for
Pseudomonas or Resistant Gram-NEG-

A

Risk Factor for MDR
ABx <90 days / >5day hospitalization
VAP - Septic Shock / ARDS / Acute renal replacement therapy

Unit where patient is residing has a:
>10% incidence of RESISTANCE to the ANTBIOTIC
that is being considered for monotherapy

Prevelance is NOT KNOWN & INTUBATED
Or
patient has structural lung disease –> ↑risk of G- infxns​
CYSTIC FIBROSIS**or**BRONCHIECTASIS

25
Q

S/Sx of HAP

A

Same as CAP

PLUS

Increased O2 Needs

Increased Secretions

26
Q

Risk Factors for
MULTI DRUG RESISTANT PATHOGENS
HAP

A

<90 day Antimicrobial Therapy

> 5 days of Hospitalization

Septic Shock @ time of VAP

ARDS preceding VAP

Acute Renal Replacement Therapy prior to VAP

27
Q

Dose / ADR

Vancomycin

HAP Need MRSA Coverage if 1 of:

Risk factor for MDR

Unit where patient is residing has:
>10% incidence of MRSA

Prevelence of MRSA NOT KNOWN
and/or patient is INTUBATED
and/or SEPTIC SHOCK

A

Vancomycin
15-20 mcg/mL
dosed to achieve throughs

Nephrotoxicity / Ototoxicity / Infusion RXN

dose adjusted

28
Q

HAP Treatment / Dose / ADR

NOC
Nafcillin/ Oxacillin /Cefazolin

A

MSSA ISOLATED HAP
2-NOC

Nafcillin - 2gm IVPB q4h

Oxacillin - 2gm IVPB q4h

Cefazolin - 2gm q8h

NO RENAL ADJUSTMENT

Rash

29
Q

HAP TREATMENT

2 DRUGS
for
Pseudomonas or Resistant Gram-NEG-

FIRST DRUG

A

“CCBM + FAP”

Antipseudomonal Cephalosporin

  • *CEFtazadime** - 2gm IVPB q8h
  • *CEFipime** - 2gm IVPB q8h

Antipseudomonal Carbapenem

  • *Imipenem** - 500mg IVPB q6h
  • *Meropenem** - 1gm IVPB q8h
  • *B-Lactam_/_B-lactamase inhibitor**
  • *Piperacillin / Tazobactam** - 4.5gm IVPB q6h
  • *Monobactam**
  • *Aztreonam** - 2gm IVPB q8h

PDAT6 ID (31 decks)

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