Hospital acquired pneumonia

Question 1

Define HAP

Answer 1

Acute lower respiratory tract infection acquired after at least 48 of admission (and not incubating at the time of admission)

Question 2

Define ventilator associated pneumonia (VAP)

Answer 2

• Pneumonia occurring more than 48 hours after endotracheal intubation

Question 3

HCAP?

Answer 3

no longer a subtype of pneumonia

Question 4

HAP and CAP epidemiology

Answer 4

• Most common nosocomial infection (22%)

Question 5

HAP extends hospital admission by ……

Answer 5

7-11 days

Question 6

HAP mortality

Answer 6

approx. 10% (increased mortality if progresses to bacteraemia - esp. acinetibacter and pseudomonas)

Question 7

Who is at a higher risk of HAP

Answer 7

• Burn patients

Question 8

Common HAP aetiology

Answer 8

• Gram negative bacilli

- Gram positive cocci

Question 9

Gram negative bacilli causing HAP

Answer 9

• Escherichia coli
• Klebsiella penumoniae
• Enterobacter spp.
• Pseudomonas aeruginosa
• Acinetobacter spp.

Question 10

Gram positive cocci causing HAP

Answer 10

• Staphylcoccus aureus - inc. MRSA

- Streptococcus spp.

Question 11

Rare causes of HAP

Answer 11

Oropharyngeal commensals

• Viridans group streptococci
• Coagulase negative staphylococcus
• Neisseria spp.
• Corynebacterium spp.

Anaerobes

Viral and fungal

Question 12

Patients exposed to antimicrobials may be colonised with ……

Answer 12

MDR - multidrug resistant pathogens

Question 13

How can bacteria be introduced into the alveoli?

Answer 13

• Micro and macro aspiration
• Leakage of secretions
• Inhalation
• Haematogenous spread (eg. catheter)

Question 14

Sources of HAP in the hospital

Answer 14

• Healthcare devices
• Environment
• Patient-to-patient transfer

Question 15

Diagnosis of HAP

Answer 15

• Abnormal imaging

+

• 2/3 clinical features
  = fever 38+
  = Leukocytosis/leukopaenia
  = Purulent secretions

Question 16

Symptoms of HAP

Answer 16

• Cough
• Chest pain
• Malaise
• Asymmetrical chest expansion
• Diminished resonance
• Abnormal auscultation - crackles, rhonchi
• Tachycardia

Question 17

Empiric monotherapy - no MDR risk factors

Answer 17

• Piperacillin/tazobactam
  OR
• Cefepime

Question 18

Empiric therapy - risk of MDR - need to add 2 drugs (3 total)

Answer 18

NEED ONE TO COVER MRSA

Add
- Ciprofloxacin
OR
- Levofloxacin
OR
- Gentamicin

AND
- Vancomycin
OR
- Telavancin

Question 19

Cultures - gram negative HAP - treatment

Answer 19

• Cefepime or meropenam

Question 20

Cultures - gram positive HAP - treatment

Answer 20

• MSSA = nafcillin or cefazolin

- MRSA = vancomycin