HAP - LRTI

Question 1

additional risk factors (to CAP) for HAP

Answer 1

hospitalization >2 days
hospitalization within previous 3 months
resident of long term care
patients on dialysis or other home based programs
aspiration due to immobility, ventilation, supine position, and nasogastric tube
antacids or gastric acid suppression

Question 2

most likely pathogens in hap

Answer 2

s pneumoniae particularly if within 3 days of admission
saureus including MRSA
enteric and non enteric GNB
acinetobacter - not commone
stenotrophomonas maltophilia - common in intubated

Question 3

HAP compared to CAP has higher rates of what

Answer 3

AM resistance including multi drug resistance
dalyed or inappropriate AM therapy
higher mortality

Question 4

empiric iv treatment early onset within 3 days of admission

Answer 4

ceftriaxone

Question 5

empiric iv treatment HAP > 3 days of admission or risk factors for resistant pathogens

Answer 5

ceftazidime + vanco 
pip tazo with or without vanco for MRSA 
mero with or without vanco 
severe allerg: cipro/levo + vanco 
FQ allergy: aminoglycoside and vanco

Question 6

issues regarding AM activity in the lungs

Answer 6

blood bronchus barrier penetration
site of infection
optimal dosing to optimize efficacy and minimize adverse effects

Question 7

MSSA iv therapy

Answer 7

clox or cafazolin

allergy - vanco or linez but not dapto

Question 8

MRSA iv therapy

Answer 8

vanco

alternative: linez

Question 9

enterobacteriacae (k.pneumoniae, ecoli, enterobacter) iv therapy

Answer 9

ceftriazone
cipro/levo/moxi
depending on susceptibility pip tazo or mero

Question 10

paeruginose iv therapy

Answer 10

ceftazidime or piptazo or mero +/- gent/tobra or cipro/levo

Question 11

typical duration

Answer 11

7 days but depends