Hospital Acquired Pneumonia

Question 1

HAP Definition

Answer 1

Pneumonia that occurs at least 48 hr after admission

Question 2

HCAP Criteria

Answer 2

at least one: hospitalized, nursing or LTCF in last 90 d; IV abx, chemo, wound care or dialysisin last 30 d

Question 3

VAP Definition

Answer 3

Pneumonia that occurs 48-72 hr after endotracheal intubation

Question 4

Onset of HAP/VAP

Answer 4

early: 2-5 d after admission, late: 5+ d after admission

Question 5

HAP Dx

Answer 5

CXR w/ infiltrates and plus at least 2 (temp 38+, leukocytosis/penia, purulent secretions)

Question 6

Early-Onset HAP Bugs

Answer 6

S. pneumon, H flu, S aureus, Enterobacter

Question 7

Late-Onset HAP Bugs

Answer 7

Pseudomonas, Acinetobacter, ESBL Kleb, MRSA

Question 8

MDR Risk Factors

Answer 8

ABX in prev. 90 d, high frequency of abs resistance, immunosuppressed, late onset

Question 9

HAP w/o MDR RFs Tx

Answer 9

Ceftrixone, Resp FQ, Amp/sulbactam, or Ertapenem

Question 10

HAP w/ MDR RFs TX

Answer 10

Antipseudo B-Lactam (Zosyn, cefepime, ceftazidime, doripenem, imipenem, meropenem) plus (AG or levofloxaxin) plus (vanco or linezolid)

Question 11

Duration of HAP Tx

Answer 11

At least 7 days; MRSA; 10 d, Acinetobacter/Pseudomona: 14 d

Question 12

De-escalation of HAP Tx

Answer 12

If clinical improvement by 48-72 hr