HAP, VAP and non-resolving PNAs Flashcards
Which PNA?
48+ hours after admission and did not appear to be incubating at the time of admission
Hospital Acquired Pneumonia (HAP)
(Nosocomial)
Which PNA?
a type of HAP that develops more than 48 – 72 hours after endotracheal intubation
Ventialator associated pneumonia (VAP)
Pathophys of what?
•Pharyngeal colonization
- Upper airway instrumentation (NG or ET tubes)
- Contamination by dirty hands, equipment and contaminated aerosols
- Tx with broad spectrum antibiotics
- Malnutrition, advanced age, altered LOC, swallowing disorders, underlying pulmonary and systemic disease
VAP
What are common Aerobic gram-neg bacilli that cause HAP/VAP
- E-coli
- Klebsiella pneumonia
- Enterobacter spp
- Pseudomonas aeruginosa
- Acinetobacter
“EEK PA”- don’t be negative!
What are common gram positive cocci that cause HAP/VAP
Staph aureus (including MRSA)
Stretococcus spp
What 6 things are needed to dx HAP/VAP
- New lung infiltrate plus evidence that the infiltrate is of infectious origin (F, purulen sputum, leukocytosis, decline in oxygenation)
- Sputum gram stain and culture are indicated
- blood cultures
- CBC/CMP
- pulse oximety and or ABGs
- consider thoracentesis
General guidelines for tx of which PNAs?
- Consider local microbiology and antimicrobial susceptibility patterns
- Consider risk factors for multidrug-resistant pathogens
- Inappropriate therapy is major risk of excess mortality
- Initial antibiotic therapy should be given promptly
- Use different antibiotic class for patients with recent antibiotic use
- Prevention!
Tx of HAP/VAP
HAP/VAP- What are 6 risk factors for multi-drug resistent pathogens?
- Antimicrobial therapy in previous 90 days
- Current hospitalization ≥ 5 days
- Admission from healthcare-related facility
- High frequency of antibiotic resistance in community or specific hospital unit
- Immunosuppressive disease and/or therapy
- Risk factors for healthcare-associated pneumonia
THe following are risk factors for what?
- hospitalization ≥ 2 days in previous 90 days
- home infusion therapy (including antibiotics) or home wound care
- chronic dialysis within 30 days
- family member with MDR infection
- residence in nursing home or extended care facility
HAP/VAP:
Risk factors for multi-drug resistent pathogens
What is the duration of tx of HAP, VAP?
- Traditional length of treatment: 14-21 days
- Patients who respond to initial treatment may limit treatment to 7 days
•Exception: Pseudomonas aeruginosa (have to tx for 14 days)
Best tx of VAP is prevention… What 6 things can be done to prevent this?
- Avoidance of acid-blocking meds
- Decontamination of oropharynx
- Selective decontamination of the gut
- Probiotics
- Positioning (to decrease risk of aspiration)
- Subglottic drainage
What other 5 diagnoses should you consider in non-resolving pneumonias?
- Atypical Infection
- Viral
- Fungal
- Aspiration
- CHF
- Cancer
- Fibrosis
What 4 diagnostic tests could be done to further evaluate a non-resolving pneumonia?
–Chest CT
–Fiberoptic bronchoscopy
–Thoracoscopy
–Open lung biopsy
What is a common cause of CAP and something that you should consider in a non-resolving pneumonia?
Influenza (A, B, C subtypes)
Check flu A, B antibodies
***Secondary bacterial pneumonia COMMON (STAPH)