HAP

Question 1

What is hospital acquired pneumonia?

Answer 1

Pneumonia that is not incubating at the time of admission to hospital and develops in a patient hospitalized longer than 48 hours.

Question 2

Explain low vs. high risk of multi-drug resistant organisms (MDR).

Answer 2

Low risk of MDR organisms:

• patients in low risk ward (any duration)
• high risk area (ICU, high dependency unit) for less than 5 days
• streptococcus pneumoniae and non-MDR gram negative bacilli

High risk of MDR organisms:

• patients hospitalized in a high risk area for longer than 5 days
• broader spectrum initial regimen used

Question 3

What is the treatment of mild HAP with low risk of MDR organism?

Answer 3

Amoxycillin + clavulanate
OR (if nil orally)
Benzylpenicillin plus gentamicin

Question 4

What is the treatment of moderate/severe HAP with low risk of MDR organism?

Answer 4

1) Ceftriaxione
2) Benzylpenicillin plus gentamicin
2) Cefotaxime
2) Piperacillin + tazobactam (Tazocin)
2) Ticarcillin + clavulanate (Timentin)

Question 5

What is the treament of high risk of MDR organisms?

Answer 5

1) Piperacillin + tazobactam (Tazocin)
1) Ticarcillin + clavulanate (Timentin)
2) Cefepime (4th gen, broad soa with anti-psuedomonal activity)

Add vancomycin if MRSA is suspected or proven.

Question 6

What are the common pathogens causing HAP?

Answer 6

• gram -ive bacilli
• MRSA
• pseudomonas aeruginosa
• drug resistant enterobacteriaceae
• acinetobacter spp.