Day 6- Hospital Acquired Pneumonia Flashcards
What is the cut off for HAP and VAP?
What is the higher quality sampling method?
What sampling methods are recommended?
48 hours after admission for HAP and intubation for VAP.
Invasive respiratory sampling and noninvasive is lower quality.
Non-invasive and Semi-quantitative.
Why is MRSA nasal screening good?
Which antibiotic can you not use in the lungs?
What are risk factors for MDR pathogens in VAP?
99% negative predictive value, MRSA nasal swab might be used to RULE OUT an infection due to MRSA.
Daptomycin.
Prior use of IV antibiotics in the past 90 days, >5 days of hospitlization prior to the occurence of VAP, septic shock at the time of VAP, ARDS prior to VAP, Renal replacement therapy prior to VAP.
What is the risk factor for MDR pathogens in HAP?
Do we always empirically cover for MSSA and Pseudomonas in VAP?
What are the 1st drugs we use to cover MSSA and Pseudomonas? (CLIMP)
Prior use of IV antibiotics in the past 90 days.
YES!!
CLIMP–> Cefepime, Levofloxacin, Imipenem/cilastin, Meropenem, Pip/tazo.
When do you add on MRSA coverage for VAP and what 2 can you add?
When do you add on second pseudomonas coverage for VAP?
When do you do 3 drug therapy?
When 20% of S.aureus is MRSA. Vanco/Linezolid.
Patients treated in units where >10% of GNR isolated are resistant to an agent being considered for monotherapy and where susceptible rates of GNR are unknown.
If patient has ANY MDR VAP risk factors. Do original CLIMP coverage + one of your Anti-MRSA agents + Levo/Cipro(if first agent was not a FQ) or aminoglycoside(tobra, genta, etc.).
When do you add second pseudomonas coverage for HAP?
When do you do 3 antibiotics in HAP?
What are your vanco trough goals?
Structural lung disease.
High risk mortality factor(mechanical ventilation or septic shock), MDR HAP high risk factor, meets prevalence requirements.
10-15 for skin or urinary tract, 15-20 for worse.
What are your vanco dosing?
What is minimum treatment length for HAP/VAP?
25 mg/kg loading. 15 mg/kg maintenance.
7 day antibiotic.
