HAP and VAP Patho/Treatment Flashcards
Most Common Pathogens
- Staph aureus (+)
- Pseudomonas aeruginosa (+)
- Klebsiella sp (-)
Diagnostic Methods
- Clinical observation
- Chest Xrays
- Cultures
- BAL
Risk factors for MDR VAP
- Prior IV abx use in last 90 days
- Septic shock
- Greater than 5 day hospital stay (prior to occurrence of VAP)
- Acute renal replacement prior to VAP
When to empirically cover MRSA
- Pts with risk of MDR
- MRSA risk unknown or greater than 10%
If MRSA expected what do you treat with
-VANCOMYCIN
Pseudomonas double coverage if…
- Pt with MDR risk
- Resistance unknown or > 10%
Empiric treatment for patient with MDR risk
1) Cefepime/ceftazidime or imipenem/meropenem or Zosyn
2) Cipro/levo or amikacin/gent/tobramycin
3) Vancomycin/Linezolid
Gram Negative abx with antipseudomonal effects
- Zosyn
- Cefepime/certazidime
- imipenem/meropenem
- Cipro/Levo
- Aminoglycosides
Empiric therapy of HAP- not high risk of mortality and no MRSA risk factors
Choose one
- Zosyn
- Cefepime
- Levo
- Imipenem/meropenem
Empiric therapy of HAP- not high risk of mortality and risk factors for MRSA
Choose one
- Zosyn
- Cefepime/ceftazidime
- Levo/Cipro
- Imipenem/meropenem
Plus
Vanco or linezolid
Empiric HAP therapy with high risk of mortality and MRSA risk
Choose two
- Zosyn
- Levo/Cipro
- Cefepime/ceftazidime
- imipenem/meropenem
Plus
-Vanco/Linezolid
Mortality Risk factors
- Need for ventilation
- Septic shock
Risk for MRSA
- IV abx use in last 90 days
- Unknown MRSA resistance or resistance >20% (for HAP)
When to implement double pseudomonas coverage
- IV abx use in last 90 days
- High risk mortality
- Structural lung disease
How to adjust therapy if MRSA is known
- Vanco/ Linezolid alone
- D/C all other abx
