HAP and VAP EXAM II Flashcards
Definition of HAP
Pneumonia developed after being at least 48 hours in the hospital
Definition of VAP
Pneumonia developed after at least 48 hours of intubation
What are the common pathogens for HAP and VAP?
-Strep pneumo (+)
-H. flu
-Ecoli and Klebsiella (enteric (-))
-Pseudomonas, Acinetobacter (non-enteric (-))
-Staph aureus (MRSA and MSSA)
-Legionella (atypical)
Which pathogens are not common in HAP and VAP?
Atypicals except for Legionella
-Mycoplasma
-Chlamydophila (atypical)
What helps to determine an empiric treatment for HAP and VAP?
-Antibiogram
-shows the #of isolates and the percentage of successful treatment with an antibiotic drug
-helps to predict successful treatment or resistance of drugs and relative drugs
When is treatment against MRSA recommended?
-Unit prevalence more than 20% -> so any hospital (HAP)
-IV Abx within 90 days
-Increased risk for mortality (ventilatory support needed and septic shock)
Drugs for MRSA, MSSA
MSSA: beta-lactams
MRSA: Vancomycin or linezolid
Duration: 7 days
Drugs for Anarobes
-Pip/Tazo
-2nd GEN Cephalosporins: Cephamycins, Cefmetazole, Cefotoxin, Cefotetan
-Metronidazole
-Clindamycin (Lincosamide)
When is treatment for Pseudomonas recommended?
-all HAP patients should have an agent against Pseudomonas
When is a double coverage for pseudomonas appropriate?
-Resistance to the agent being considered for monotherapy > 10% -> resulting in 3 dose regimen (2 for Pseudomonas and 1 for MRSA)
-IV Abx within 90 days
-Increased risk for mortality (ventilatory support needed and septic shock)
-Structural lung disease underlying
Drugs for Pseudomonas
- it has to be a ß-lactam: antipseudomonal
Pip/Tazo
Ceftazidime IV (3rd)
Cefepime IV (4th)
Meropenem (Imipenem)
Imipenem/Cilastin
Aztreonam - if 2nd needed: Aminoglycoside (gentamicin, amikacin) or Quinolone
Duration: 7 days
