Hospital Acquired Pneumonia Flashcards
Nosocomial pneumonia Types
Hospital-acquired pneumonia (HAP)
Ventilator associated pneumonia (VAP)
Health care associated pneumonia (HCAP)
HCAP
Development of pneumonia in an outpatient setting in an individual with extensive health care contact
CAP
Develops more than 48 hours after admission to the hospital
VAP
Development of pneumonia in a mechanically ventilated patient 48 hours after endotracheal intubation
What is different from CAP
Change in normal flora
Different pathogens
High frequency of drug resistance
Patient’s have worse underlying health status
HAP bugs
Staphlococcus aureus
Pseudomonas aeruginosa
Gram negative rods (Enterobacter, Klebsiell pneumoniae, Escherichia coli)
VAP bugs
MRSA
P. aeruginosa
MSSA
Stenotrophomonas maltophilia
HCAP bugs
Common organisms that are more likely to be drug resistant
Diagnostic clues
Streptococcus pneumoniae: Rust-colored sputum
Pseudomonas, Haemophilus, and pneumococcal species: green sputum
Klebsiella species pneumonia: Red currant-jelly sputum
Anaerobic infections: Often produce foul-smelling or bad-tasting sputum
Klebsiella radiographic clues
Extensive lobar consolidation
Air bronchograms
Cavitary lesions (gas filled space in an area of consolidation)
Staphlococcus aureus pneumonia
Often seen post influenza
MRSA associated with high mortality and necrotizing pneumonia
Pseudomonas
2nd most common cause of nosocomial pneumonia
Gram negative
Cough productive of purulent sputum, dyspnea, fever, chills, confusion, and severe systemic toxicity
Characteristic sweet, grape-like odor
common with Cystic Fibrosis!
General Treatment for Nosocomial Pneumonia
Imipenem or meropenem!!
If suspect Legionella add on Levofloxacin
If suspect MRSA + Vancomycin
If suspect Pseudomonas add on Cipro or Tobramycin
